Hi Jim, I'm sorry to hear of your difficulties.

Refractive Lens Exchange (RLE) is the removal of the natural lens
inside the eye and replacement with an artificial intraocular lens
(IOL). RLE is commonly recommended for patients who are fully
presbyopic (cannot focus on items near when wearing distance
correction) and/or have high refractive error that is more difficult
to correct with laser assisted surgery such as LASIK, PRK, LASEK, or
Epi-LASIK.

The ReSTOR IOL manufactured by Alcon is designed to improve vision at
all distances when compared to a conventional single-focus IOL. ReSTOR
uses multiple concentric circles of different image power that defract
light to cause focus at different points within the eye. The
theoretical system of ReSTOR is that the rings of different focus
properties will allow you to see items near and items far without the
need for reading glasses. A convention single-focus IOL will provide
focus only at near or only at far.

Multifocal IOLs have been around for years and have, in my opinion,
never lived up to the promise. The biggest problem is that the
multi-focus defracted or refracted light is scattered light, and this
light scatter can cause halos around light sources and blur,
especially at night.

ReSTOR attempts to minimize night halos by making the IOL apodized.
Simply put; narrow multi-focal rings are in the center portion of the
IOL and a wide single focus ring is at the periphery. The theory is
that during the day or in bright light, the central concentric rings
will provide vision at all distances, and in low light environments
when the pupil is large, the single focus periphery will reduce halos.

Well, that is the theory, anyway. You are living with the reality.

Because the ReSTOR lens relies upon the pupil to help provide the
right kind of focus energy in different lighting environments, ReSTOR
is very pupil size dependant. If your pupils don't get large enough,
then you will only be looking through the multi-focal center of the
lens and will get the full night time halo effect. If your pupils are
too large, light is able to hit the edge of the IOL, causing an arc or
glare effect. My bet is that your pupil sizes in bright light, normal
light, and low light is not consistent with the mechanics of the
ReSTOR lens and this is contributing to your problems.

Another problem with the theory behind ReSTOR is that no matter how
large your pupil becomes, light passing through the center of the IOL
will be defracted. It will be defracted in daylight, at night, and at
every light level in between. Adding single focus at the edge of the
IOL is not going to stop the multi-focus in the center just because
the pupil gets big.

The science of the ReSTOR is really quite remarkable and it is
manufactured with exacting precision. Unfortunately, surgery of any
kind is rarely as exact as the manufacturing of a plastic product. If
the IOL is slightly decentered or settles at an angle, the defractive
effects can be negatively affected, and dramatically so. Even
excellent surgeons who do a good job can end up with IOLs slightly
off.

The physics of any diffractive device has limits. To accommodate those
limits, the ReSTOR lens has less focus at mid-distance than near and
far. For somebody who uses a computer screen about 18-22 inches away,
glasses may be a requirement. Laser refractive surgery can move that
range closer (say 12-17 inches) or farther (25-30 inches) but this
will be shifting all focal points closer or farther so to gain
something, you are going to be lose something else.

The first thing you need to do is…nothing. I'm serious. If you can
deal with the vision limitations, don't do anything until several
months have passed and your brain has been able to adjust to the new
images coming in from the eyes. It is really quite amazing how the
brain will "look around" some problems and vision will improve. If
after an appropriate time you find that your vision is intolerable,
your only real option is to have the ReSTOR lenses removed and a
single focus IOL put in its place.

If you do decide to have your ReSTOR IOLs explanted and a single focus
IOL implanted, I very highly recommend that you do this on your
dominant eye first with at least a month in between eyes. The ReSTOR
IOL in your nondominant eye and a conventional single focus IOL in
your dominant eye may provide you with a multifocal monovision effect
that is not only satisfactory, but superior to having both eyes with a
single focus IOL.

I am curious; did your doctor require you to wear multifocal contact
lenses before surgery so you could get an idea of the type of effects
you would encounter? Multifocal contacts use very different physics
than the ReSTOR lens, but a trial may indicate intolerance or
acceptance of multifocal vision.

Glenn Hagele
http://www.USAEyes.org

I am not a doctor.

Glenn Hagele
Executive Director
USAEyes.org

"Consider and Choose With Confidence"

Email to glenn dot hagele at usaeyes dot org

http://www.USAEyes.org
http://www.ComplicatedEyes.org

I am not a doctor.

Do you see it all the way around, or just a crescent?  Is the edge
lighter or darker than the rest of your vision?

Hopefull that will go away completely, but I wouldn't guarantee it.

Is this overlapping, ghosting images, or completely separate images? Is
it the same for each eye (do you get the same effect if you cover one
eye, then the other?) Are they vertically separated, horizontally, or
obliquely?

I don't like the sunglass  idea.  You need all the light you can get at
night.

Sounds like you were over sold.

I don't even much like the idea for cataract patients.  I mean we like
good, clear single vision without halos and rings too, you know.  I got
Technis single vision lenses implanted in Jan and am very happy with the
quality of my vision. I do not recommend any of the multifocal or
focusing IOLs for my patients, period. They have a long way to go before
I'd ever suggest them.

Other than waiting, there is only explantation and reimplanting a better
lens.  Not much of an option, I know, but if I were in your shoes, I'd
be exploring that possibility...

w.stacy, o.d.

Jim, Seems that refractive surgeons don't tell you everything you need to
know
to make an informed decision until it's too late. It is my very strong
feeling that
any patient fully informed about refractive surgery would decline. One
exception
is cataract surgery after the cataracts are bad enough to obscure vision.
There is
an eye surgery that may offer a reasonable trade-off.

Fixing myopia, hyperopia and presbyopia... well that's a joke. The surgeons
know
that they reduce visual quality and in the process do permanent damage to
the eye
but they keep doing it for CASH.

Jim, pay close attention to your eye health from this point forward. Turns
out IOL
implants have been associated with loss of endothelial cells. Nobody knows
what
this does long term. I'm sure your surgeon didn't mention it to you although
he must
know. This is a breach of informed consent, and constitutes malpractice.

Hi All,

I promised to follow up on my ReSTOR IOL implants now five months later. My
surgeon has now laser "tweaked" my right eye and I no longer need glasses. Close
vision in bright light is good but double vision if low light. I need a small
light over my keyboard at night to stop double vision. To see my computer screen
clearly I must sit close or use reading glasses. Distance vision is good. I am
learning to live with side "crescents" and the halos. My optometrist says my
vision is 20 to 25 / 30. All things considered I would give this lens a 7 out of
10 overall.

I've been reading about  accommodating IOL like Crystalens from eyeonics, inc.
Unlike the multifocal ReStore lens I understand it has one focal point that
moves like the natural lens does. Is this the next generation of IOL and does it
work better in practice?

Jim K.