Lens replacement a 2nd time? Or yag?

Eye care
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I had multifocal lens 3 months ago. My distance vision is not that great. I have been given glasses which does improve a lot. I'm told with a laser enhancement op this is the vision they hope to achieve for me. On going for an appointment today i was told I have protein cell build up on both eyes. This HAS to be removed via yag laser op before any laser enhancement can be done. Well after reading about yag I became aware that once yag has been performed you can not easily ever replace your lens should u need too. I asked my optical advisor why would anyone wish to do this. I thought the lens were for life. She said occasionally some people may not adapt to the multifocal lens 4 example night vision could be blighted by glare halis starbursts. Well this is what I get badly. It's affecting my life where by I avoid darkness driving at all cost.

Iv been advised to consider doin lens replacement again and having monofocal lens as risk of glare halo etc much less.

I'm Terrify ed to even consider having to put my precious eyes through that again and all the what ifs? ? My job involves night driving. So this is in jeopardy. I'm 45 years old. The thoughts of rest of my life being so restricted by the difficult night driving is awful. It's zapped my confidence. Is there anyone who's done lens replacement and then also done it again?? Is it worth doing or just too risky. My recovery in vision took 3 months this time. Hav app mon discuss with surgeon my options. Any advice welcomed. So scared again.

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Hi Wendy,

If you are having problems with the lens and find it difficult to drive at night, you might consider a lens replacement.  As you say, it does carry risks (as with any surgery) but also has the potential to resolve the problems you are experiencing.

A monofocal lens is the time-tested workhorse of cataract surgery.  It has the lowest incidence of unpleasant problems such as low contrast sensitivity (problems driving at night), glare, halos, etc.  However, you will only have good vision at one distance and will need glasses (or contacts) or everything else.  You might also consider a lens such a the Symfony, which is an extended depth of field lens that provides much better intermediate and usually reasonable near vision with the same risk as a monofocus lens of low contrast sensitivity, glare, halos, etc.

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Wendy , check with your doctor to see if you are a candidate for monovision where one eye is set for distance and the other is set for reading and mud ground . No glare or halos . You might need a pair of driving glasses which sets your reading for distance like your distance eye . Your vision will then be very crisp and nice for either nighttime or daytime driving . No glares . No halos . Btw the lenses used to create monovision are monofocal lenses, just set at different strengths . Multifocal lenses are bad because they break the light spectrum into thirds for the three different focal lengths they offer . This is why they need a lot of light to work .

I am 60 and had monovision installed about 6 months and although it's not perfect I never wear glasses for anything unless I'm driving at night

Good luck to you and go monofocal , you'll be much happier and even happier if you try the monovision.

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Sorry , I meant to say mid ground

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So sorry to read about your cartaract surgery results. 

Many of us go in with the expectations that our surgeons tell us. Not always the results however. I understand how you would be a bit relunctant to try surger again. 

I had a similar issue and have astigmatism lens a then laser. Nothing really improved  my vision before cataract surgery. 

After another opinion on my vision becoming worse it's been recommended to just leave the eye to rest in my case and try another lense later.

hope you decide to do what's best for you. It's always a challenge.

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Wendy, I have an 80 year old friend who sustained an eye injury which required cataract lens replacement quite a lo g time after his initial cataract surgery. So it is possible and he's doing great.

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re: "given glasses which does improve a lot"

The first question would be whether it improved your distance vision *enough*. If not,  then a laser enhancement wouldn't improve your vision any more than glasses did. It wouldn't impact glare/halo/starburst issues (unless I guess there is reflection from glasses that didn't help).  That would suggest considering a lens exchange to a monofocal or the Symfony which has fairly low risk of night vision issues.  I do find it odd that someone whose job involves night driving wasn't given enough warning about potential night vision issues with multifocals (though most poeple don't have problems, enough do that its important to think the risks through).

Unfortunately a complicating factor is that often halo&glare issues can go away over time as people adapt to the lens, and such issues are much more common soon after surgery, even among those with monofocals. They usually only talk about statistics about halos and other artifacts only at the 3 month or 6 month postop point after most initial adaptation has occured.. but some people can take serveral months or even a year or more for the artifacts to go away, and of course some never see them go away. I'm not sure if the PCO might be contributing to the night vision issues, if so a YAG might  help them, but there is no guarantee. 

Although a lens exchange isn't as easy after a YAG, it can still be done and good results should still be expected. The issue is that after a YAG, when the lens is removed it is likely that the capsular bag the lens was in will tear and the replacement lens can't be placed in the bag. Although they prefer to places IOLs in the bag, if the bag is damaged they place the IOL outside the bag and suture it to other parts fo the eye. Most lenses now that go in the bag are 1 piece lenses, but outside the bag they need to use a less common 3 piece lens. That is the biggest difference since  most premium lenses can't be used outside the bag, so after a YAG you wouldn't be able to use the Symfony for instance, and I don't think the Crystalens can be placed outside the bag either, so you'd presumably be using  a monofocal lens. 

re: "My recovery in vision took 3 months this time"

That sounds atypical. I don't know if that means it would take that long next time, or if you just had one time bad luck. Usually people's distance vision is good within a couple of days of surgery, with only issues like night vision artifacts taking longer to recover or with premium lenses their near vision may take some time to improve.  

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sorry to hear, i would be very careful .. my left is a mess had it done July 27 2016 I have everything going on in there eye from floasters, flicking, things like weds in corners of eye brinking, also bad case of ND. I was told all this would go awau well it has not. plus vision lose  .. use to have 20/25 on that I now 20/40 . Docxtor told me come in and he would fix it!!! hum well after hearing all the horror stories .. I am not ready to take a change of going blind.

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Wendy, I'm sorry for all of your problems, I can relate to them.  I too have had extreme halos on headlights, street lights, porch lights, any lights.  I even have it in the day.  When I go into large stores with a lot of fluorescent lighting I wear sun glasses.  In the night they are a 15 on a scale of 1 to 10, really bad.  I've discussed this with my surgeon and he is saying it is from the lens and an option is to have it removed and replaced.  I also have Negative Dysphotopsia (a black arch shaped or moon shaped rim around the outer side of my eye in my peripheral vision).

My surgeon said that he wants me to wait at least six months to see if anything changes.  I still have about three months to go to get there.  I will say that I have had changes in my site and with flickers and floaters etc. since my surgery.  As time passed things got better (it's been two months).  I've thought a lot about this and at this time I don't think I will have it removed and changed because I've read up a lot about it and people have done that and things end up worse.  I guess each of us have to decide what we think is best for ourselves. 

As far as my vision, I paid extra for the better lens so that I could see far/intermediate and close.  My vision is okay in all of those areas except for small print, I have to use a magnifying glass.  At this point, I feel that I'm probably not going to get another surgery because then my sight may be worse and I won't be able to see as well.  I'm figuring I'll just get used to things and keep the lens I have.  I haven't driven in the night for over a year (before I got my Cataract surgery) so I'm figuring that I just won't ever drive in the night again.  However, I am retired and 64 years old so I can do that unlike you since you said you drive in the evening for your work.

I just thought I'd share my story with you so you know that you're not alone.  This forum is very helpful, I've read many stories and cases.  I  had extreme problems after my surgery and finding this forum  really helped me understand that I wasn't alone and crazy.  I thought Cataract surgery was a piece of cake and then I'd be able to see so well.  That was not the case, it was a real nightmare.  I had 12 appointments in less than two months.  I hope things get better for you.  All the people in this forum are in my prayers....we sure need it.

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Hi. Thank your nice advice.An eye surgeon did experiment on my left eye 10 months ago by implanting Abbot Toris Tecnis Multifocal lense.

After 2 weeks he tld that he implanted wrong power iol so he replace with a new Abbot Toris Tecnis Multifocal lense with stiches. But now after several months I have shadows,blurry,hazy vision,

circular rings,and stardust , even with new glassess, for near and far vision.I requested Eye surgeon to implant similar monofocal(like in my right eye,which is fine) in my left eye but he refused to replce for third time.He said it will have complications.Kindly advise me what to do and did any body have similar situation.

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Go to FB type in Negative dysphotopsia, or lasik surgery

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Also go to FDA type in lens recall

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Wow, I'm so sorry to hear that.  Are the symptoms easing at all?  While most people heal completely and neuroadapt within a few months, it can take longer, especially after a more difficult second surgery.

It sounds like it would be worth consulting with different (perhaps more experienced) ophthalmologists.

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Bottom line if you have catarcats ,  Get the basic MONOFOCAL len's , perhaps try monovision with monofocals , but stay away from multifocal lens no matter what your doctor might say . Monofocal is covered with your insurance, The multifocal option is not because it presumably offers perfect vision at all distances. It  simply does not !  In theory , it sounds great , but results are not so good . Doctors want you to choose this option because they make more money . You, the patient want to trust your doctor but beware . Stay MONOFOCAL and use glasses for up close work . You will be SOOOO happy if you do !!! it will be like your vision when you were 40 but needed reading glasses to see well up close. The evil Multifocal option is all about doctors and lens makers getting rich , but they dont work well for most because they are awful in low light and create halos and glare. DO NOT BUY THE HYPE . Stay strong . Stay MONOFOCAL, stay happy !! 

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The vast majority of people who get premium lenses are happy with them. Its mostly the minority of unhappy patients who post online so people get a skewed opinion of the results.  It is true though that no lens provides perfect vision at all distances at the moment, though premium lenses can do a much better job of that than a monofocal. A minority do have problematic issues like halos so people do have to consider the risks before going that route. I went for the Symfony (extended depth of focus) rather than a multifocal due to the lower risk of things like halos, but I would have risked a multifocal if that hadn't become available since I'd had good luck with multifocal contacts and preferred those to monovision with contacts.  I figured that it was worth the very tiny risk of needing a lens exchange if I had problematic halos in order to get the benefit of a wider range of vision for the rest of my life. 

In terms of "vision when you were 40 but needed reading glasses to see well up close", I'd say that might be true of monofocals using monovision to get added near. Otherwise monofocals set for distance are more like someone's vision at 60 when they've lost all accommodation. A typical description I see is that on average people can expect things from 6 feet inward to be getting blurry with a monfocal set at distance. Full monovision has tradeoffs, like reduced stereopsis (3D perception) since you are using 1 eye for much of the visual range rather than 2. A small amount of monovision, micro-monovision, like might be used with the Symfony or Crystalens doesn't have much impact on stereopsis. 

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When I went to see my opthamologist about cataract suregery , I had done my research and was set for the multifocal lense. It was my doctor himself here in Los Angeles that talked me into monovision for a multitude of reasons. First and foremost, many of his patients are not happy with the final result of the multifocal lense. It's not just the unhappies on this forum. He doesn't believe MF manufacturers  are here to stay or there would be a lot more compainies investing in the technology. That is not happening. He is a renowned and highly sought after opthamalogist . And remember , he could have made more money by putting me in what I wanted and that was the multifocal lense. I'm glad I listened to him.

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If you talk to multiple refractive surgeons, you will get multiple opinions.  To me, this means there isn't overwhelming evidence for any one view, or else virtually all ophthalmologists would share it.  (By analogy, consider the suture-vs-staple debate among other types of surgeons: many have a strong opinion, but there is no overwhelming evidence for either approach.)  It's true that monofocal IOLs are the workhorse, with lower risk of side effects, and many years of experience, not to mention being covered by insurance and Medicare.  However, they do come with the need for glasses or contacts.  Multifocals have a higher risk, and not everyone is happy with the resulting vision, but many describe their vision as terrific and are delighted at not needing glasses or contacts.  The Symfony seems (based on clinical results) to offer the best of both, especially when used in a micro-monovision approach (perhaps 0.5 D of myopia in one eye).

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Agreed .

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All the studies I've ever found indicate most people are happy with premium lenses. Data collected in studies is a more reliable thing to look at than the anecdotal impression gotten by a doctor, even a good doctor. Unfortunately some doctors don't like dealing with any complaints, and therefore any issues may seem like "many" to them, they prefer the conservative "safe" approach.   Its actually a good marketing strategy since if they are the "safe" doctor then they get patients referred there, and don't have problem patients scaring people off. That doesn't mean that their conservative approach is the best one for everyone. 

 Those with monofocal lenses may not express unhappiness the way a minority of those with premium lenses do, however they may not be as happy with their vision as they might have been with premium lenses. Most people are happy with whatever option they receive. Many folks are willing to have some risk of problems in exchange for a better result for the rest of their lives, but some doctors don't like seeing any problems and talk patients out of it.  A problem patient scares off other prospective patients.

re: "doesn't believe MF manufacturers are here to stay or there would be a lot more companies investing in the technology"

That isn't a credible argument, I see a decent amount of activity in the sector and its not clear what sort of evidence and reasoning he could provide as to why it "should" or would be more.     Doctors don't necessarly know much about business or the world of tech investing (I've been an entrepreneur, and networking with other entrepreneurs, in the software&net tech and startup world for decades, though not the medical device world).   

There are many premium lenses available outside the US that aren't approved in the US, and the companies don't even bother trying to get them approved due to the high costs involved. Even the US company behind the Symfony didn't try for approval here until after it was approved elsewhere, and its likely if they didn't already have a big distribution network in the US they wouldn't have bothered. I haven't heard anything yet about US company Alcon trying for approval for the Panoptix trifocal it now has approved in Europe.  The US in general tends to do a  disproportionately large share of  medical R&D, in addition to having one of the larger potential markets for premium lenses, so  the problems with the US market  likely  reduces the R&D budget quite a bit.   The FDA's problems likely have far more to do with the level of investment in new IOLs than anything to do with the technology itself.

There isn't infinite funding available for all the potential R&D projects that might lead to something useful in every potential niche in the world.   Companies compete for R&D funding, including competing with other industries looking for investment. They need to factor in things like risk and the total budget required to get something to market. There is a huge cost to get a new medical device developed and approved, and risk that while all that is being spent a competitor might beat them to the punch, or some unforseen problem might arise. 

 Premium lenses currently have a fairly low market share, mostly due to not being covered by insurers or government payment programs, and partly since some doctors are cautious and there isn't yet a  lens without some risks. Some think the lower risk profile of the Symfony might  lead it to boost the market share of premium lenses, but its hard to say. Regardless the current  limited market size limits the amount of R&D funding, even though people realize that in theory a "perfect" (or at least "near-perfect"wink IOL might have a huge payday by expanding the share of premium IOLs greatly. That near- perfect IOL doesn't exist, and any investment in a candidate path to get there has technical risk that it might not achieve its goals (or might not be approved) or risk it might have a limited time on the market before a better competitor arises, etc. Its not a sure thing that investors will necessarily pour money into, depending on whatever competing investment options there are.

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Appreciate all the interest in my initial comment and my opinion. A bit surprised actually.  In the end,  wouldn't  it be nice if we could try all these options before we buy. Bottom line is we can't. Glasses and contacts can mimick but are different from an implant. I believe each individual brain and it's communication with the eyes is beautifully unique. What works wonderfully for one person , might be a disaster for another . As it stands today, the outcome this surgical procedure, even with all of our science simply cannot be  predicted,  This is why I lean towards monovision.  If your brain can and does adjust to this new visual system, you're golden. If a patient 's brain can't adjust to it after several months and doesn't like it,  then with a little lasik,  the reading eye can be set to the same as the distance eye and now the patient has traditional crisp monofocal vision but will now require glasses for up close activities. The nice thing here is no invasive surgery or removal of a lens further tramatizing the  patient if the mono doesnt work.