Near Vision difficulties after ReStor implant one month ago

I don't have the technical measurement information about my current/
pre surgery vision which may render my questions impossible to answer
but I'm hoping to find others who may share their experiences with me.

Pre-surgery I was very near-sighted with apparenly mild astigmatism
and steep corneas. I have worn glasses for about 45 years and use my
eyes intensively/extensively at all distances, including alot of PC
work and reading on the job as well as for close work hobbies. My work
requires that I view alot of different distances minute by minute
through-out the day.

One month after cataract surgery on my dominant eye I now drive
without my glasses for the first time in my life. I go to lectures and
no longer have to sit in the front seat to view. I am able to see the
alarm clock without my glasses. In fact, I've not used my glasses for
the last 3 weeks at all.

Although I'm EXTREMELY pleased with this distant vision, I am
distressed that my "second sight" cataract-caused vision in my non-
operated-on second eye with cataract is so superior to my near vision
in my dominant, newly implanted ReStor eye. I had considerable
swelling (edema) with my surgery and my recovery seemed to be at least
one week behind most other people's recovery. I really couldn't see
well enough to drive to my job for about 5-6 days. (I still have to
get on my hands and knees to get my eyes close enough to my work to do
my work.)

I realize that my "good" "second sight" in my non-dominant eye will
eventually cease due to increasing cataract growth and then I will be
forced to implant some lens in my second eye.
I hate to let my cataract become more dense as I let the dominant eye
cataract get too dense before surgery BUT I can't see giving up my
presently good near vision in my non-dominant eye yet.

I am assured that with the second ReStor implant my near vision will
be much better and that my vision won't really improve until I do get
the second implant.

I wonder how my near vision can improve with a second ReStor implant
when the near vision in the first eye is so much poorer than my
"second sight" in my non-operated eye. It doesn't make sense that if I
can't see up close now that I would see so much better up close with a
second ReStor implant. How can two negatives make up a positive in my
layman's way of thinking?

When I was researching recovery from cataract surgery, I mainly found
articles referring to a very speedy return to work. Acquaintances who
I polled said they were playing cards that evening after cataract
surgery.

Now I understand that neuroadaptation takes as long as up to a year
before one's new lens and brain learn to see as well as they are going
to. One month isn't very far into that process.

It is difficult for me to just "trust" that my near vision will be
better with a second ReStor. I have no desire to have alot of follow-
surgery to get my near vision back. I have no desire to start wearing
readers/glasses for my nearly constant up-close reading needs when
I've not had to wear glasses for up-close reading for the last 2-3
years.

I have difficulty reading my piano music now through the blur. I can't
read the blurry page of a book 8-10 inches from my eyes without the
aid of my non-implanted/original cataracted eye. If I cover my "bad"
eye, this computer text is blurry. With both eyes in use, the blur is
much less.

I feel like I have traded near-sightedness for far-sightedness now and
I'm not sure I'm happy with the exchange. I realize that no implanted
vision is as good as one's healthy original vision (providing that one
did have original good vision!)

With the relatively early onset of my cataracts, the decisions I make
now on my second implant will likely be what I'll have to live with
the rest of my life (hopefully 30-40 years) as I'm not interested in
any more surgery. I know that surgery outcomes can't be predicted and
that each recovery is different.

Thank you for any insights to my near vision concerns.

Felix wrote:

BUT I can't see giving up my
> presently good near vision in my non-dominant eye yet.

How close in (in inches from your face) do you have to get to see
clearly with that eye?

>
> I am assured that with the second ReStor implant my near vision will
> be much better and that my vision won't really improve until I do get
> the second implant.

I doubt it will be unless your surgeon "over plusses" you, which will
improve your near vision at the expense of distance vision in that eye.

>
> I wonder how my near vision can improve with a second ReStor implant
> when the near vision in the first eye is so much poorer than my
> "second sight" in my non-operated eye.

There are two possibilities that come to mind: 1. You may be "over
minused" so that you are actually using the near focus of the ReStor for
seeing distance. 2. You may only be able to use the distance part of the
Restor lens due, e.g. to pupil size. If 1. is true, adjusting the
power may help. If 2, probably not.


It doesn't make sense that if I
> can't see up close now that I would see so much better up close with a
> second ReStor implant. How can two negatives make up a positive in my
> layman's way of thinking?
>
They don't, and you are on exactly the right track.

One thing you might try. Pick up a cheap pair of + 2.00 OTC readers and
remove the lens from the side that your non-IOL (cataractous) eye will
see through.

Now put those on and compare R & L vision at far and near.

If the vision is now much better on the IOL eye than the other, you
might want to go for surgery sooner than later. If not as good or about
the same, forget surgery for now. You might like using this "custom Rx"
for some functions.

If you elect surgery, I'd strongly oppose any multifocal IOL including
the ReStor, Crystalens, etc. I would recommend a prolate optics lens
like the Technis, and have them purposely over plus the eye by an amount
equivalent to your most common close work distance.

Good Luck.

w.stacy, o.d.

The archives of the Eye Care Forum (Optometry) at Med Help
International contain multiple postings from people who were in your
situation. For some, it just took more time for their near vision to
"come in," and they were eventually pleased with their ReStors. For
others, a second ReStor resulted in no improvement in near vision,
even after more than a year.

I only skimmed through the recent EyeQ Report of the 2007 ASCRS
meeting, but I do remember a few details. It is now believed that it
takes from 9-12 months for your brain to adapt to multifocals, and
reportedly a small percentage of people never adapt. (I guess they
become explant candidates.)

In your place, I'd postpone surgery on my second eye for as long as
possible. If there's been no change in near vision with the ReStor
when a second surgery becomes unavoidable, I'd go with Dr. Stacy's
suggestions. You might also consider consulting another doctor who is
very experienced with multifocals about your concerns.

"Felix" <(E-Mail Removed)> wrote in message
news:(E-Mail Removed) oups.com...
>I don't have the technical measurement information about my current/
> pre surgery vision which may render my questions impossible to answer
> but I'm hoping to find others who may share their experiences with me.
>
> Pre-surgery I was very near-sighted with apparenly mild astigmatism
> and steep corneas. I have worn glasses for about 45 years and use my
> eyes intensively/extensively at all distances, including alot of PC
> work and reading on the job as well as for close work hobbies. My work
> requires that I view alot of different distances minute by minute
> through-out the day.
>
> One month after cataract surgery on my dominant eye I now drive
> without my glasses for the first time in my life. I go to lectures and
> no longer have to sit in the front seat to view. I am able to see the
> alarm clock without my glasses. In fact, I've not used my glasses for
> the last 3 weeks at all.
>
> Although I'm EXTREMELY pleased with this distant vision, I am
> distressed that my "second sight" cataract-caused vision in my non-
> operated-on second eye with cataract is so superior to my near vision
> in my dominant, newly implanted ReStor eye. I had considerable
> swelling (edema) with my surgery and my recovery seemed to be at least
> one week behind most other people's recovery. I really couldn't see
> well enough to drive to my job for about 5-6 days. (I still have to
> get on my hands and knees to get my eyes close enough to my work to do
> my work.)
>
> I realize that my "good" "second sight" in my non-dominant eye will
> eventually cease due to increasing cataract growth and then I will be
> forced to implant some lens in my second eye.
> I hate to let my cataract become more dense as I let the dominant eye
> cataract get too dense before surgery BUT I can't see giving up my
> presently good near vision in my non-dominant eye yet.
>
> I am assured that with the second ReStor implant my near vision will
> be much better and that my vision won't really improve until I do get
> the second implant.
>
> I wonder how my near vision can improve with a second ReStor implant
> when the near vision in the first eye is so much poorer than my
> "second sight" in my non-operated eye. It doesn't make sense that if I
> can't see up close now that I would see so much better up close with a
> second ReStor implant. How can two negatives make up a positive in my
> layman's way of thinking?
>
> When I was researching recovery from cataract surgery, I mainly found
> articles referring to a very speedy return to work. Acquaintances who
> I polled said they were playing cards that evening after cataract
> surgery.
>
> Now I understand that neuroadaptation takes as long as up to a year
> before one's new lens and brain learn to see as well as they are going
> to. One month isn't very far into that process.
>
> It is difficult for me to just "trust" that my near vision will be
> better with a second ReStor. I have no desire to have alot of follow-
> surgery to get my near vision back. I have no desire to start wearing
> readers/glasses for my nearly constant up-close reading needs when
> I've not had to wear glasses for up-close reading for the last 2-3
> years.
>
> I have difficulty reading my piano music now through the blur. I can't
> read the blurry page of a book 8-10 inches from my eyes without the
> aid of my non-implanted/original cataracted eye. If I cover my "bad"
> eye, this computer text is blurry. With both eyes in use, the blur is
> much less.
>
> I feel like I have traded near-sightedness for far-sightedness now and
> I'm not sure I'm happy with the exchange. I realize that no implanted
> vision is as good as one's healthy original vision (providing that one
> did have original good vision!)
>
> With the relatively early onset of my cataracts, the decisions I make
> now on my second implant will likely be what I'll have to live with
> the rest of my life (hopefully 30-40 years) as I'm not interested in
> any more surgery. I know that surgery outcomes can't be predicted and
> that each recovery is different.
>
> Thank you for any insights to my near vision concerns.

Then, get a monofocal IOL set for near vision.