Considering multifocal IOL exchange 12 years out & post YAG

Posted , 7 users are following.

Hi everyone,

I'm considering IOL exchange in my LE 12 years after the original implant (I have a ReZoom multifocal IOL) & also had YAG laser 6 years ago. I've been dealing with halos/dysphotopsias since the beginning and started noticing fog around text & diplopia symptopms after the YAG. I'm a self described perfectionist and probably should never have selected a multifocal IOL but I was only 17 yrs old at the time and didn't do any research beforehand...

The reason I've been able to get by all these years is because my RE is natural & can filter out the LE disturbances. I recently discovered I have a developing cataract in my RE and the vision is getting dimmer (so my theory is that the RE now has trouble filtering out the LE problems). Below is a short timeline that covers my eye history:

2007- original cataract surgery with ReZoom mIOL set for intermediate. Noticed halos & waxy vision from day one but it was tolerable (however I was never amazed with my vision - it was just OK).

2013- YAG treatment and vitrectomy in the same month. These surgeries cleared up some haziness I had prio but now I see fog around words & diplopia is more noticeable and disturbing.

2019- visited Dr. Steve Safran in New Jersey and he said he could exchange for 3 piece monofocal IOL with 2% chance of "something going wrong". He does IOL exchanges all the time so I trust he would be the best for my situation.

All in all, I can't decide if I should move forward with the exchange for a monofocal (the recommendation is to use a Softport AO aspheric lens). I currently refract to 20/15 in both eyes which is amazing so I would hate to attempt this surgery & somehow end up worse than I am now. At the same time I don't want to live the rest of my life dealing with these symptoms so I can't decide if it's really worth trying.

Any opinions are greatly appreciated since I'm starting to feel afraid of the future. I'm only 29 years old with hopefully 50+ years left to live so this decision isn't easy knowing the long term consequences it will have on my life

Thank you all for your support,

Grant

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11 Replies

  • Posted

    Dr. Safran did my exchange for the sofport last April. If you are going to do it, you are in good hands.

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    • Posted

      Really thats amazing!! What lens did you have before & how much did it help you? Are you glad you did it?

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    • Posted

      This is actually my third lens in this eye. The previous lens was a tecnis monofocal zcb00. I Had negative and positive dysphotopsia. Dr. Safran exchanged it and while its not always perfect, it is better than it was and I have learned to cope with it.

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  • Posted

    Hi Grant - yes can certainly understand your worry and concern. Did you develop a cataract young to have a lens exchange at 17?

    My understanding is exchanges are not possible after a YAG and even without having a YAG they ate usually performed within 9 months of initial surgery - after that tome the IOL had really adhered yo the surrounding tissue. However those that do these surgeries should be informed. A question to ask is how many he has performed on patients in similar circumstances.

    Been on the forums over a year. Cannot think offhand of anyone who has had an exchange after a YAG. If there is hopefully he or she will weigh in with their experience.

    Wish you all the best. It is a tough journey!

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    • Posted

      Apparently he does these types of post-yag IOL exchanges quite routinely (several times per week he said). One thing that does concern me is my young age & the many years I've already had the current lens (probably lots of fibrosis & scar tissue has developed). I know he has done many exchanges but I'd be surprised if any of the patients were in their 20s haha. This is one thing that scares me - my eye structure is likely different than a 50-70 year old typical patient

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    • Posted

      True enough. Do you know shy you developed a cataract 12 years ago?

      I am amazed you've coped with it so long. the other issue with younger eyes is how much more pupils dilate - often beyond the IOL. Many visual disturbances in those situations.

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    • Posted

      They discovered the cataract when I was just 7 years old. They said I was apparently born with it (congenital cataract) so it wasn't caused by any known injuries.

      This new cataract developing in my right eye (which was discovered about 5 years ago) is somewhat of a mystery since I also didn't experience any injuries in this eye. I've been checked for diabetes too and I luckily don't have that. Overall I'm just a regular healthy 29 year old guy with rare eye issues.

      One other option I'm considering instead of exchanging is to fix my right eye first (implanting a monofocal IOL) and then re evaluate my visual situation since maybe these problems with my left rezoom eye are because the dominate RE is having trouble filtering out the halos/glare/dysphotopsias

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    • Posted

      I also think another reason I've been able to get by so long with these issues is because I've always had a problematic left eye (had the cataract since age 7 and now the multifocal lens problems).

      Basically my right eye has been trained to be super dominant because the left eye has always had issue (the left eye is a lazy eye so i know it doesnt do much work compared to my other eye)

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    • Posted

      I originally thought I was LE dominant but it learned to be dominant because cataract in RE was worse - although both needed doing. My surgeon speculated after noticing my eczema that the steriod creams could have caused my early cataracts. I have used the nasal sprays too for allergies. Wish I had known cataracts could be a side affect.

      I think your plan to consider having cataract surgery on eye needing it done may be a better one - especially if it needs it. It may counter balance the other eye. Would be nice if you didn't have to go through the exchange.

      Would same surgeon do the cataract surgery? What are his thoughts on this strategy?

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  • Posted

    Hello gmag! I'm so sorry that you've had to deal with these eye issues at such a young age. If you truly trust your surgeon and you are healthy, a 98% success rate is favorable odds (same odds as having a successful vitrectomy). If you have not already done so, it can't hurt to get a second opinion before going forward. Cataracts don't grow back, so I'm not sure what you mean about having had cataract surgery and now one is developing again? Was it just one eye?

    In my case, I went with a near vision lens (AcrySof IQ) and I'm quite pleased with the results (although it's only been three weeks since my cataract surgery; on an eye that had a vitrectomy a year ago). But I've been near sighted most of my life and don't mind wearing glasses or contacts. I'm assuming you'll be given a distance lens in an attempt to get you 20/15 vision, just note that you will likely need reading glasses for close up work.

    Making major decisions like these when it comes to our eyesight is nerve wracking for sure. I can't imagine doing so at such a young age (I'm 64). I hope others in our forum can provide you with additional advice. I'm not a medical professional, so I'm just sharing my own story...

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    • Posted

      I appreciate your response! I had cataract surgery on my left eye back in 2007. I have a new cataract forming in the other eye which I think is making it harder for my brain to filter out the disturbances in my left eye.

      The original IOL was a multifocal set for intermediate but with distance glasses I can correct to 20/15.. Without the glasses my distance vision is like 20/40 or something

      Very nerve wracking for sure!!

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