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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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I am trying to see if I can find a way to live with the Tecnis

Resolved Question:

I am trying to see if I can find a way to live with the Tecnis multifocal lenses I have or if I have to have them exchanged. I just learned that the first doctor I saw did a yag laser treatment on my right eye but did not tell me he was going to do that so I know now that the right eye will be a little more difficult to exchange.

In a nut shell this is what I have - 20/20 vision near and far. Extremely large halos at night and moderate halos during the day. No intermediate focus indoors from about 2 ft to 8 ft. Near focus at about 14" but if I move just a couple of inches either direction it is blurry.

The problem - I was working on my portable AC unit and the screw I was trying to get at was about 3 feet away from my face and I could not see it clearly enough to get it in the hole and get a screw driver on it. The 1.25 readers I have did not work at that distance and I could not get my eyes close enough to make use of the 14" distance focus that I have because the AC structure was in my way. What can I do in order to see the screw? I tried 1.0 readers and they didn't work either.

I don't like the halos but if I can at least figure out a way to see intermediate distances indoors I can at least be more functional.

Thank you for your time.
Submitted: 9 months ago.
Category: Eye
Expert:  Dr. Rick replied 9 months ago.

Dr. Rick :

Hi. I'm Dr. Rick and I have two decades of ophthalmology experience. I'm online and happy to answer your question today.

Dr. Rick :

Well, you are -- as they say -- between a rock and a hard place......

Customer: Thank you.
Dr. Rick :

Exchanging your Tecnis lens for a monofocal lens will have a very good chance of clearing up your glare issues.....but it will not solve all of your near, intermediate and far focus problems.

Dr. Rick :

Also, you may end up with complications of the exchange surgery and loose the excellent, 20/20, distance vision you have now.

Dr. Rick :

So. What to do?

Customer: :)
Dr. Rick :

If you can live with the glare issues and really want more to improve the focus problems then I

Dr. Rick :

I'd get fitted for no line bifocals with plane glass on top (since you see 20/20 in the distance w/o glasses now).

Dr. Rick :

This (costly but risk free) option may give you the different focus points you need to fix the next A/C unit that fails on your watch...

Dr. Rick :

I would not have the lens exchange done until ALL other options are exhausted unless, of course, the halo/glare problem is just something you really can't live with

Dr. Rick :

Does this make sense to you?

Customer: I had thought of that but the doctors I've talked to so far said progressives won't work with the Tecnis multifocal. I am willing to try anything that might improve my intermediate vision indoors. What power would the bottom of the lens be?
Dr. Rick :

The doctors are correct....progressives are very hard to get to work with the intraocular lens you have but, in the last decade, I've got a number of patients good results with them

Dr. Rick :

The power depends on many factors and requires a painstaking trail of lens powers in the fitting room at various distances such as the computer screen, arm length, dashboard length.....

Dr. Rick :

It is a very individualized process to try and work around the (all too common) problem you find yourself in right now.....

Dr. Rick :

You need to find an optometrist who will spend the time and work with you on this.......

Dr. Rick :

Then, if it doesn't work, go ahead with a lens exchange. It can be done even after a yag laser capsulotomy although an anterior vitrectomy may needed at the time of surgery.

Dr. Rick :

In rare cases a retina specialist may have to remove all the vitreous......

Customer: The last doctor I talked to said he has done an exchange after YAG and he puts some type of barrier between the lens and the inside of the eye when he does the procedure. Have you heard of this?
Dr. Rick :

It is called healon......works most of the time....I've done it myself :)

Customer: Is it safe?
Dr. Rick :

yup

Customer: I don't like that you said " most of the time". What happens the other times?
Dr. Rick :

Vitreous oozes out all over :) But that is not the end of the world. Every ophthalmologist/cataract surgeon knows how to deal with vitreous....no big deal.

Dr. Rick :

Nothing in medicine -- or life -- is 100%

Customer: even if he used that procedure would you still recommend against doing an exchange ?
Customer: this is really hard...
Dr. Rick :

No. Don't get me wrong. Since you have 20/20 vision you have to accept that, of all the options available to you, lens exchange carries the most risk: Just like your initial surgery -- infection, bleeding, poor result, retinal detachment or swelling, loss of vision, loss of eye...

Dr. Rick :

Trying progressive reading glasses only have the risk of removing money from your bank account and, maybe, causing a small dent on the bridge of your nose...

Customer: It has been two years since the procedure was done. Any chance of my vision improving?
Dr. Rick :

There is a very, very good chance that an experienced surgeon can exchange your lens safely....but you never know when the lightning bolt will hit.

Dr. Rick :

At this point, the vision you have is the best you can expect for the rest of your life. These issues will not, in my opinion, go away at this point.

Customer: How I wish I could go back in time and get the monofocal instead
Dr. Rick :

Sadly, that is a phrase I hear all too often as a sub-specialist.....

Customer: Would I be able to wear the progressives all the time while I'm indoors or would I wear them only for intermediate vision.
Customer: and then ta
Customer: and than have to take them off?
Dr. Rick :

It will not make any difference if you wear them or not.....you can just use them when you need them.....it is not like a pill that you have to take everyday or it doesn't work. Glasses like this can be worn all the time or just when needed per your personal preference.

Customer: does it take a special doctor to figure out the right progressive lens? If he hasn't done it before will he know what to do?
Dr. Rick :

No. No special training needed. I would think that every optometrist could easily fit you for them.

Customer: when I drive at night I cannot see my climate or radio controls. When I use Pilocarpine I can see both. Is that an indicator of something?
Dr. Rick :

It means the pilocarpine is making your pupil small so you have pinhole effect and/or are being forced to look through the part of the tecnis focus rings that is set for about 2.5 feet.

Customer: So the clear image is there and my brain just can't pick it out?
Customer: I'm just trying to understand
Dr. Rick :

kinda....

Customer: Please bear with me. If had the exchange what are my chances of things going well or going wrong?
Customer: I just hate the halos too, but I don't want to make things worse.
Dr. Rick :

That is for the surgeon who examines your eye and plans to do the lens exchange to say.......not me; I just don't have enough data to give a quality answer to that question. I'm sure you understand where I am coming from...

Customer: Yes I do. I'm. Just frustrated and a little scared.
Dr. Rick :

I fully understand.

Customer: He said he want's to do some type of cell count before he would do the procedure. Do you know what he is talking about?
Dr. Rick :

Yes.

Dr. Rick :

Endothelial cell count of the front of your eye (cornea) to make sure your cornea can handle the stress of another eye surgery.

Dr. Rick :

Sounds like you are in the hands of a very ethical and well trained eye surgeon.

Customer: I wish I went to him the first time.
Dr. Rick :

:(

Dr. Rick :

We have covered a lot of ground here over the last hour. Is there anything else you would like to discuss at this point or have all your questions been answered to your satisfaction?

Dr. Rick :

I cannot see anything that you are typing. Our chat system may not be working well at the moment. I'll switch over to the Q&A system. This system works a lot like 'text messaging' but an email is sent to each of us anytime something is posted to this thread. We can continue to work on your question there..... :)

Customer: Also I've noticed that I can't see well in certain lighting conditions. When I go to Fry's it looks like I'm looking through a haze in the store. But other stores are much clearer. Also when dust gets on the inside of my sunglasses every spec of dust looks like a miniature Tecnis multifocal lens with the round disk in the center and rings going out. Is this a normal side effect?
Dr. Rick :

That is a problem with that lens.........

Dr. Rick :

From what you have posted, I do not feel you will be happy until that tecnis lens is out. It really seems to be bothering you.

Dr. Rick :

I'd talk to that surgeon and 'git 'er done ;)

Customer: It does - but I made a mistake the first time and I'm scared of making it worse.
Dr. Rick :

You seem pretty miserable now.......

Customer: I guess you've helped me as far as you can. I guess it all boils down to my choice
Dr. Rick :

The choice can only be made you .....

Dr. Rick :

That is correct.

Customer: I had such good vision in left eye before - Like they say, you have to live with the choices you make.
Dr. Rick :

But, that being said, you have done an excellent job of gathering information to make the best informed choice possible....I wish all my patients were as thoughtful are you ;)

Dr. Rick :

Like a "first" marriage lol!

Customer: thank you
Customer: That is right
Customer: :)
Dr. Rick :

My pleasure. I wish you the very best. Have a good weekend

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you can please give me a “10” rating in all areas. It has been a pleasure to assist you today.

Thanks in advance,

Dr. Rick MD FACS

Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7851
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and other Eye Specialists are ready to help you
Expert:  Dr. Rick replied 9 months ago.
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