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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I had a Restor multifocal IOL implanted 2 1/2 months ago. I

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I had a Restor multifocal IOL implanted 2 1/2 months ago. I like the improvement in my reading. Most things I can now read without glasses, however the sharpness of vision I had is gone. The glare is so significant that I need to wear light sunglasses when shopping under fluorescent lights. I was prepared by my surgeon for halos at night but was not expecting loss of sharpness and troubling glare in the daytime.
My doctor "is afraid" to implant my right eye with any IOL because of my complaint.
Will implanting a second multifocal lens possibly clear up the glare and lack of sharpness? Should I have a Monofocal IOL implanted in my right eye to improve sharpness? Will my eyes learn to work together with one multifocal and one monofocal? What is my time frame for making this decision?

Doctor DanB : Hello and thanks for your question. Are you available to chat?
Doctor DanB : Multifocal IOLs such as Alcon's AcrySof IQ ReSTOR rely on multiple optical zones to provide clear vision at multiple focal planes.  They tend to more reliably provide clear near and intermediate vision, but can produce bothersome glare and halos for more than a minority of patients; these symptoms are most markedly pronounced at night or in low-lighting conditions.  While some have a resolution of these symptoms in just a few weeks, it is not uncommon to see these persist for several weeks to even months.  Most with these bothersome symptoms have resolution by one year post-operatively, but even still there are some who never gain relief and require explantation of the lens in favor of a monofocal implant.  In addition, because the brain requires an adaptation period to learn how to function with a new visual apparatus which is different from the native crystalline lens, patients can be frustrated with their visual dysfunction during these few weeks to months, especially when compared to heightened expectations of spectacle-free vision. In addition, most premium IOLs including the Restor cause a degradation of contrast sensitivity in the vision.  This means that images seen through these lenses are somewhat less sharp and vibrant than those seen through a monofocal IOL.  This becomes especially apparent in someone who has a pre-existing eye condition which inherently reduces contrast sensitivity.  This can include, but is not limited to, people with glaucoma, macular degeneration, chronic inflammation/infections, dry eye syndrome, and corneal or retinal dystrophies or degenerations.  For this reason, it is vitally important to have a discussion with your surgeon regarding any risk factors you currently have that may make a successful implantation of one of these premium IOLs less likely to happen.  If you do have one of these eye problems already, your chances of being happy with any of these premium IOLs are markedly less and the probability of significant side effects rise dramatically. 
Doctor DanB : Do you have any of these eye problems (glaucoma, macular degeneration, chronic inflammation/infections, dry eye syndrome, and corneal or retinal dystrophies or degenerations)?
Customer: I have had dry eyes for years since I had ptygeria removed 40 yrs ago. It has never been diagnosed as a syndrome
Doctor DanB : Unfortunately, because of your dry eyes, there's a considerable chance that your symptoms may not resolve on their own. Though, even if you didn't have dry eyes, there's still a chance they wouldnt resolve, just more of a chance because if the dry eyes.
Customer: If this wont resolve on its own., what is the next step?
Customer: should I have the other implant? If not what do I do next?
Doctor DanB : It depends on how long you want to give it before you take the next step (some are willing to wait 4-6 months), but if they don't resolve then you might consider having he lens explained (removed) and have a mono focal IOL implanted.
Customer: Is it more difficult to have two different lenses, what are the drawbacks?
Doctor DanB : Unfortunately there isn't really a consensus on whether it's more difficult to have two different lenses or whether it's more difficult to have both of the same lenses (that may not work so well). Everyone is different and so it is difficult to know how you would respond best, XXXXX XXXXX opinion is if the lens is not working well in one eye, having both eyes with that same lens is not going to make the symptoms better, it just may be more of the same.
Customer: im using Refresh 4 times daily with Refresh PM at night. Is there a better treatment for dry eyes?
Customer: im thinking of having the monofocal lens implanted in 2 weeks. It that to soon?
Doctor DanB : Those are both very good treatments. You may benefit from Restasis prescription drops, but that would depend on the exam your ophthalmologist does concerning your dry eyes. And no, having the mono focal IOL implanted in two weeks is not too soon.
Customer: this is a difficult question I know. I choose a well known surgeon with many credentials who is very busy. He scheduled the surgery after my first appointment with no preop check. Is this normal?
Doctor DanB : No, not having a pre-op is not normal, at least not for me. I always have a pre-op with my patients including an in depth discussion, especially when a premium IOL is being considered.
Customer: I saw another surgeon a few days ago who gave me a very throrough exam. He has done only 15 explants of lenses but several thousand implants. I like him very much and would like to use him. Since my 1st surgeon is so well know, should I stick with him..
Customer: in researching explant of lens, it seems very dangerous
Doctor DanB : I think just because a surgeon is well known is not a good enough reason to stick with him, especially if you feel like someone else is good enough and has your best interests aspt heart more than the first surgeon. And no, explaining the lens is not dangerous, no more dangerous than doing the original surgery, just different and not nearly as common as putting in the lenses. I think the botXXXXX XXXXXne should be, if you trust the second surgeon more than the original (your gut feeling), I would go with the second. If the second surgeon has done 15 explains, I think that's plenty to know what they are doing.
Doctor DanB : Do you have any other questions about this? 
Customer: Yes
Customer: I saw another surgeon a few days ago who gave me a very throrough exam. He has done only 15 explants of lenses but several thousand implants. I like him very much and would like to use him. Since my 1st surgeon is so well know, should I stick with him..11:36 PMin researching explant of lens, it seems very dangerousDoctor DanB says:
Customer: My original surgeon does one explant each week according to his staff
Customer: isstaff is it possible to loose my eye site from an explant procedure?
Doctor DanB : It sounds like he should be technically quite proficient at it then. I think it's hard to miss going with the first surgeon, but there's a lot to be said for going with someone you trust. It's possible to lose your sight wi any eye surgery, though the odds are very small that this happens.
Customer: do you agree that I should go ahead with the monofocal in the right eye and wait to see how I adapt for several months before I consider removing the multifocal?
Doctor DanB : I think that is a very reasonable step to take and probably the choice I oukd make for myself.
Customer: if I have more questions, how do I contact you?
Doctor DanB : You can come back to this same thread. Also, if you like I can send you a follow-up message later to see how you're doing and you can communicate again with me through that route. If you'd like to do it that route when would you like me to check in on you to see how you're doing?
Customer: I have an appointment Feb 25. So please contact me after that appt. how do I return to the thread?
Doctor DanB : Just sign back into Just Answer and you should be able to access this same question. But after you provide feedback, I'll be sure to send you a follow-up question after Feb 25th.
Customer: Should I ask my 1st surgeon at Feb 25 appt why I didn't have a preop appt and request one for the other eye?
Doctor DanB : Yes, I would. That gives you the chance to have a detailed conversation with your surgeon to ask about these details that may not have been addressed prior to your first surgery.
Customer: so I gather you feel I should continue with the 1st surgeon and solve this with him?
Doctor DanB : Not necessarily. If I were in your place, I would be inclined to try the second. Name recognition on,y carries so much weight with me. If he didn't have a detailed conversation with you about the Restor lens in the first place, especially your risks of having problems because of your dry eye, then it maynm
Doctor DanB : It may make me think twice about having another surgery with him.
Customer: thanks for your help. I'm very anxious over this situation. Are you ok with the fact that the 2nd surgeon has only done 15 explants?
Doctor DanB : Yes, explains are not very common so as long as he's done more than a dozen, and most im
Doctor DanB : Most importantly you trust him after seeing him, imwoukd be okay with the second surgeon doing the explanation.
Customer: thank you. What should I say to the 1st surgeon about switching?
Customer: i hope I will be able to sleep tonight. This has been weighing heavily on my mind
Doctor DanB : I think you don't need to say anything more than I wanted a second opinion and feel comfortable with the second surgeon doing the surgery. And thank you for your care thus far. Try and breathe deeply and relax. I think you are going todo just fine.
Customer: again many thanks. I will keep my appointment with the 2nd doctor on Feb 11th. Please contact me again after that
Doctor DanB : I will do so. Good luck to you. I look forward to talking with you then. Your feedback is important to me and will help me improve my encounter with future customers.  Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any positive feedback and/or bonus you may feel prompted to provide would be welcomed and is appreciated.  If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied.  My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry! 
Customer: thanksthat thanks you are great!
Doctor DanB : Tanks!
Doctor DanB : I saw you joined the chat again. Did you have any other questions?
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