Lens Exchange After Cataract Surgery - Has anyone had one?

According to an article on the subject by Daniel H. Chang, MD:

"...glare and starbursts generally result from posterior capsular opacification (PCO), refractive error (eg, astigmatism), optical aberrations, and/or problems with the tear film or ocular surface. Halos are typically related to multifocal IOLs." or the Extended Focus Lens, Symfony.

All toric lenses can rotate from the installed position. My Symfony toric lens also had rotated about 20 deg from the installed position, which resulted in astigmatism. It was easy for the surgeon to check for that during the eye examination. He gave me a choice of getting the lens rotated back in position or getting LASIK enhancement done to correct the problem. Both of those were free for me (may not be true for everyone) and I opted for LASIK enhancement to correct the astigmatism and any spherical prescription error.

While my eye has improved to 20/15 after the LASIK enhancement, there was a period when the vision was not clear as I like. The solution to that turned out to be making sure that my eyes are not dried, even if I don't feel any irritation due to the eye dryness.

The main message is that leaving aside the night vision issues for the moment, you should have a good check-up to see how good your day vision with that eye is. Knowing those results will help your doctor and you understand better the best way to improve your night vision.

However, that makes it harder to figure out the reason for the night vision issues of glare and starbursts.

What does the doctor say about the reason?

One other thought. Even though your toric lens has not rotated, that does not necessarily mean that you may not have some leftover astigmatism  or  spherical prescription error. Correcting that for night driving with glasses may improve the night vision enough to be a little less bothersome.

Even though, your vision was not crystal clear even after dialing the various lens power, do you know:

1. What lens power gave you the best vision? Since the doctor said that the astigmatism is zero, this is probably just the spherical correction.

2. Even though it was not crystal clear even with the best correction, what were you able to read with it? 20/25, 20/30?

3. Did the doctor suggest at all the reason for your not getting a clear vision with the best lens prescription?

As I said before, it is important to know the reason for the unclear vision before you take the next step, specially if the next step is to get the lens replaced.

If I had to guess, my feeling is that:

1. A wrong power lens was installed in your eye. The easiest way to correct the power is not to do the lens exchange, but to have LASIK (or PRK) to correct the power. I have had LASIK enhancement in both of my eyes and have been very pleased with the results. LASIK and PRK should give similar results, but the eye recovery from LASIK is much faster. PRK is better for persons who are engaged in contact sports or similar activities, which may jar the cornea flap.

2. You probably have dry eyes without any discomfort symptoms. No one's cornea is perfect. It is a good tear film on the cornea, which smooths out the cornea surface to provide the best vision. For me, if my eyes are dry, the best-corrected vision can change from 20/15 to 20/25..

Dr is being very vague about what the cause is. I have my second opinion tomorrow and hopefully will get more information .

Eye drops have been recommended but I’m not sure dry eye is the problem as I do not see a difference in vision with or without after a few days use. 

Am I understanding you right that you are using readers of 1.75D in left and 2.0D in right for seeing well in the distance?

In any case, I think that you need to see a good LASIK surgeon to evaluate your eye to see if that is a good solution for you. Many of the good LASIK surgeons provide free consultation.

While everyone is different, here is a general statement from one of the web sites,which indicates that the +2D correction needed for your eye does not rule out the LASIK (or other similar procedures) for you :

For "Mild and Moderate Cases of Farsightedness (+2 Diopters to +5 Diopters).

Laser vision surgery procedures like LASIK, PRK, LASEK, and EpiLasik are capable of correcting only up to about + 5 Diopters of farsightedness (Hyperopia)."

Distance vision was corrected with lasik 20 years ago. With the aging process, even that wonderful clear vision gradually blurred. 

I received multifocal toric Lens in right eye. Multifocal Lens in left eye. Restor 2.5 I wanted to be able to see clearly at all distances and right now my vision is worse than before having cataract surgery. 

Then, why are you saying that your lens power is way off

I think what 201a was asking is what is the prescription you need now to get clear distance vision (as you say your distance vision is currently blurry).   If it is just a matter of the lens power being off (IOL) then that can be corrected with either glasses or lasik surgery.  But you will want to know if it can be corrected with glasses.  An optometrist should be able to tell you what your current prescription is.

If your eyes cannot be corrected with glasses there is another underlying issue with your vision.

The whole point of installing multifocal iol was to avoid wearing glasses 

In the past 18 months I’ve been to two optometrists and one opthomologist. No one has said anything about any eye problems other than aging/cataracts and lens replacements have been suggested. 

This post was about exchanging current iol. I plan on doing just that for clearer vision. 

How many others have had exchanges and it’s been a problem? Any other further steps needed after an exchange? 

My own surgeon made it clear prior to my surgeries he does not do exchanges.

Also a surgeon should never promise you are glasses free with a premium multifocal lens. I think you can reasonably expect less dependence on them.  

You still should find out what you actual prescription is andvreadons for power being off.

Each weekly visit to the surgeon/opthomologist we have done many tests. Dialing in to find which power would provide clearer vision. Lasik enchancement was suggested before cataract surgery. But obviously getting the correct power is the first step. I don’t think the dr/surgeon has made a major mistake. I believe my measurements were off. He did the best he could.