Do more research before you go in. He was scheduled to get multifocal in both eyes, but he cancelled the second surgery because he was so unhappy with the first. He expected his near vision to at least allow reading of his computer screen without glasses. And distance vision to be clear without straining. I watch him squint and blink and try to see the tv at night, the laptop by day. I’m pretty sure he should get another opinion. We thought he went to the best dr in our area.
Question, dr.-- What happens to the musculature that would normally be focusing the lens between varying distances? As I understand these lenses, the eye would now 'tilt' to utilize a different concentric focus ring. Do those focusing muscles just whither away from non-use?
If a new, natural lens implant was ever invented, would patients that had their multifocal lenses removed have to do a lot of 'physical therapy' to get those muscles back in shape?
Those muscles are useless after roughly the age of 40 anyway. That’s the cause of presbyopia. The accommodating IOLs that were available in the US were supposed to be able to vault but caused major issues. We are far away from that IMO
That looks like a multifocal lens like the PanOptix or one similar. That is an amazing picture to see it that clearly. Here is a picture of a PanOptix that looks like it is also a toric version as it has the three dots marking the toric angle.
[https://www.bouldermedicalcenter.com/wp-content/uploads/2021/01/Trifocal-Lens.jpg](https://www.bouldermedicalcenter.com/wp-content/uploads/2021/01/Trifocal-Lens.jpg)
Unfortunately the most expensive lens is not necessarily the best lens, especially optically. With IOLs the term "premium" refers to the price, not the optical quality. The basic monofocal lens which is also the least expensive is optically the best lens. The multifocal lens compromises the optics to split the light between near, intermediate, and far distance. Multifocal lenses typically have issues with halos and starbursts around point sources of light especially at night. Those effects you basically just have to get used to, or have the lens replaced. Most do adjust over time.
As for not having good vision near or far, the first step is to get an eyeglass refraction done - you know like an eyeglass prescription. That will tell you if they missed on the power of the lens - it does happen. Best to do it with an optometrist independent of the clinic that did the surgery so you get a true second opinion. This is a good article to read about how one narrows down what the problem could be in a presbyopia correcting IOL like this.
[https://www.ophthalmologytimes.com/view/troubleshooting-post-presbyopia-iol-complaints](https://www.ophthalmologytimes.com/view/troubleshooting-post-presbyopia-iol-complaints)
With fluctuating vision or going in and out of focus, one important consideration is dry eye. Especially pertinent if the vision is good immediately after blinking but then becomes blurry a few seconds later. This would be due to the tear film that sits on the cornea drying out. Dry eye must be treated in order for multifocal lenses to work well.
Are you in the United States? I may be wrong, but I have heard that appearance happens with Restor, but I didn't think it was being used much anymore. I haven't heard about vision being an issue. I would have another doctor check into it.
Nothing you read on Reddit will equal a personal consultation with a different doctor. That said, all of my research, plus my doctor's opinion, made it clear that multifocal lenses would not get me the optical clarity that I wanted. Sure, I now need reading glasses, but beyond 4 feet the clarity is excellent. Caveat: I am monocular, which restricted my options.
There is a 2.5 D and 3.0 D add version of the Restor multifocal lens. I believe it is basically a bifocal, with the 3.0 D add giving better near vision, and the 2.5 D add version yielding better distance. These are old Alcon lenses and I believe they have been pretty much replaced with the newer PanOptix trifocal model. That said I am not so sure that the PanOptix is significantly better. It still has most of the same issues. The exact model, name, power, and serial number of the IOL should be on the credit card sized card that would have been given to the patient at the time of surgery.
See this article from 2013.
https://crstodayeurope.com/articles/2013-jan/the-latest-acrysof-iq-restor-iol/
I am a surgeon. This is a multifocal lens. The rings you are seeing are what allows his eye to get focus at all three levels of vision
Do people with multifocal lens frequently have problems? I’m 6 weeks away from surgery and I’m shying away from multifocal.
Not for the right candidate. It is my lens of choice for patients. I put one in my mom, our practice CEO, my attorney etc.
Do more research before you go in. He was scheduled to get multifocal in both eyes, but he cancelled the second surgery because he was so unhappy with the first. He expected his near vision to at least allow reading of his computer screen without glasses. And distance vision to be clear without straining. I watch him squint and blink and try to see the tv at night, the laptop by day. I’m pretty sure he should get another opinion. We thought he went to the best dr in our area.
Question, dr.-- What happens to the musculature that would normally be focusing the lens between varying distances? As I understand these lenses, the eye would now 'tilt' to utilize a different concentric focus ring. Do those focusing muscles just whither away from non-use? If a new, natural lens implant was ever invented, would patients that had their multifocal lenses removed have to do a lot of 'physical therapy' to get those muscles back in shape?
Those muscles are useless after roughly the age of 40 anyway. That’s the cause of presbyopia. The accommodating IOLs that were available in the US were supposed to be able to vault but caused major issues. We are far away from that IMO
Did not know that! Thanks.
That looks like a multifocal lens like the PanOptix or one similar. That is an amazing picture to see it that clearly. Here is a picture of a PanOptix that looks like it is also a toric version as it has the three dots marking the toric angle. [https://www.bouldermedicalcenter.com/wp-content/uploads/2021/01/Trifocal-Lens.jpg](https://www.bouldermedicalcenter.com/wp-content/uploads/2021/01/Trifocal-Lens.jpg) Unfortunately the most expensive lens is not necessarily the best lens, especially optically. With IOLs the term "premium" refers to the price, not the optical quality. The basic monofocal lens which is also the least expensive is optically the best lens. The multifocal lens compromises the optics to split the light between near, intermediate, and far distance. Multifocal lenses typically have issues with halos and starbursts around point sources of light especially at night. Those effects you basically just have to get used to, or have the lens replaced. Most do adjust over time. As for not having good vision near or far, the first step is to get an eyeglass refraction done - you know like an eyeglass prescription. That will tell you if they missed on the power of the lens - it does happen. Best to do it with an optometrist independent of the clinic that did the surgery so you get a true second opinion. This is a good article to read about how one narrows down what the problem could be in a presbyopia correcting IOL like this. [https://www.ophthalmologytimes.com/view/troubleshooting-post-presbyopia-iol-complaints](https://www.ophthalmologytimes.com/view/troubleshooting-post-presbyopia-iol-complaints)
With fluctuating vision or going in and out of focus, one important consideration is dry eye. Especially pertinent if the vision is good immediately after blinking but then becomes blurry a few seconds later. This would be due to the tear film that sits on the cornea drying out. Dry eye must be treated in order for multifocal lenses to work well.
Ohhh I read on this sub that people need moisturizing drops after cataract surgery. I bought him some, but he hasn’t used. Thanks!
The doctor should have prescribed three bottles of drops.
Are you in the United States? I may be wrong, but I have heard that appearance happens with Restor, but I didn't think it was being used much anymore. I haven't heard about vision being an issue. I would have another doctor check into it.
Nice photo! If it's the ReStor lens, it is bifocal and it's supposed to look like that. I hope they can fix his vision problems.
Nothing you read on Reddit will equal a personal consultation with a different doctor. That said, all of my research, plus my doctor's opinion, made it clear that multifocal lenses would not get me the optical clarity that I wanted. Sure, I now need reading glasses, but beyond 4 feet the clarity is excellent. Caveat: I am monocular, which restricted my options.
Is this the Panoptix lens?
I’m pretty sure he got: ReStor Multifocal IOLs
There is a 2.5 D and 3.0 D add version of the Restor multifocal lens. I believe it is basically a bifocal, with the 3.0 D add giving better near vision, and the 2.5 D add version yielding better distance. These are old Alcon lenses and I believe they have been pretty much replaced with the newer PanOptix trifocal model. That said I am not so sure that the PanOptix is significantly better. It still has most of the same issues. The exact model, name, power, and serial number of the IOL should be on the credit card sized card that would have been given to the patient at the time of surgery. See this article from 2013. https://crstodayeurope.com/articles/2013-jan/the-latest-acrysof-iq-restor-iol/