My ReStored Eyes – American Ophthalmologist talks about Multi-Focal IOLs in his eyes (10 October 2009)

What I’ve Learned  

Even though I’ve been involved with multifocal intraocular lenses for over 20 years, it is amazing what I’ve been able to learn in the past three weeks from my own experience with having multifocal lenses in my eyes.

20/20 isn’t 20/20

One of the remarkable things about my experience has been that prior to the surgery my vision with both eyes was 20/20- when measuring both eyes together.  The vision in my left eye was 20/40- and the right eye was 20/20-.  However, my experience has been that the quality of my vision since the surgery has improved enormously, far better than I can remember it for many years.  Colors simply “pop”.  The definition or contrast is truly remarkable.  Road Signs, which before were visible, now simply jump out.  My depth perception has increased enormously.  The term high definition is passed around carelessly these days.  But, that’s the term that keeps coming to my mind when I think about the increased quality of vision that I have.  One way of thinking about this is the difference in vision with polarizing sunglasses.  Depth increases and quality improves.

Lifestyle Complaints

All of us have had the experience of speaking with patients who have not realized how much their lifestyles have been compromised by their decreased vision.  The improvement in my vision has been remarkable.  Along with that improvement, has been an increase in my comfort level with certain activities.  Night vision is the area that I notice this the most.  I used to enjoy driving at night.  However, over the years, I had not realized how much I had cut back on my night time driving.  This was not a conscious decision, but simply an adaptation I made in response to the decreased quality of vision that I was experiencing.  Now night time driving is again a delight.  Road signs are crisp, depth is improved and rainy weather is no longer an issue.  I am now more diligent in exploring with my patients what kind of compromises they have created in their own lives to adjust to the changes caused by cataracts.

Side Effects

                  Halos
                     
Initially, halos were very noticeable, but resolved quickly (within 24 hours).  Now halos are only noticeable under specific lighting conditions :  halogen headlights, some street lights and certain traffic lights.  The halos, however, are not intrusive.  Frankly, if it weren’t for the fact that I know some patients find them bothersome, I probably wouldn’t even notice them.

 

                      Glare
Glare is rare and usually only occurs when the sun is low in the sky and oblique to my vision.  Waxy vision occurred early on, but resolved quickly.  I think, in my own experience, this is related to the size of the pupil.  It may be that patients with larger pupils are more susceptible to this phenomenon.

 

                       Yellowing Vision
I have no perception of yellow vision at all, even when only one eye was done.  In fact, colors appear truer than they did previously, and I find that I can differentiate subtle things, like the color of my socks.  One of the issues that I had when the cataracts were developing was differentiating dark blues from blacks and dark browns.  That is no longer a problem.

 

                   Side Shadows or Light
Many of us who do a lot of these lenses have heard patients describe side shadows associated with the lenses.  I have not had that experience.  However, I have noticed that when overhead lights are in a certain location with respect to my eye, I can see some “rays” in the periphery of my vision.  This has become less noticeable and, again, is not intrusive.

 

One of the important lessons about side effects is to inform patients in advance about the possibility of these side effects and the fact that these side effects will significantly improve with time.  One of the things that I tell my patients is that just as patients initially notice the presence of a bifocal in their bifocal glasses, as they become presbyopic, in time they learn to neuro adapt to the bifocal and end up not noticing it at all.  Frankly, having worn bifocals and now having multifocal implants, the presence of the side effects from the multifocal implant are much less intrusive than what bifocals were. 

Mono Correction

Some surgeons who I greatly respect have strongly recommended mono correction to multifocal lenses.  As a very successful mono correction contact lens wearer for almost 20 years, I can tell you that the quality of vision with the multifocal lens compared to mono correction is far superior.  In fact, the vision with mono correction is not even in the same ball park.  My depth perception and stereopsis, the quality of my reading and my quality of my distance vision is far superior than it ever was with mono correction contacts.  I would be very reluctant to recommend mono correction to my patients.  In fact, while I used to do a lot of mono correction, I believe I will now move more and more toward multifocals.

Contacts

One of the remarkable things about my experience has been vision without contacts.  I have been a very successful contact lens wearer for over thirty years.  In fact, I firmly believe that I was totally unaware of the presence of contacts in my eyes.  However, the feeling of excellent vision without contacts is a remarkable experience.  The best simile that I can think of is the difference between swimming with a bathing suit and skinny dipping.  (Of course, these days it’s more likely for me to be “chunky dunking”.)  The quality of my vision is superior than it was with my contacts, and the feeling of freedom and nothing on the surface of the eye is truly a great feeling.

Surface Disease

The quality of my vision improves enormously when the surface of the eye is adequately lubricated.  The use of tears greatly improves the quality of my vision,

These are the major points that I’ve learned so far. 

Dr W. Martin
14/10/2009

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