Lens replacement a 2nd time? Or yag?

After 2 weeks he tld that he implanted wrong power iol so he replace with a new Abbot Toris Tecnis Multifocal lense with stiches. But now after several months I have shadows,blurry,hazy vision,

circular rings,and stardust , even with new glassess, for near and far vision.I requested Eye surgeon to implant similar monofocal(like in my right eye,which is fine) in my left eye but he refused to replce for third time.He said it will have complications.Kindly advise me what to do and did any body have similar situation.

Wow, I'm so sorry to hear that.  Are the symptoms easing at all?  While most people heal completely and neuroadapt within a few months, it can take longer, especially after a more difficult second surgery.

It sounds like it would be worth consulting with different (perhaps more experienced) ophthalmologists.

Bottom line if you have catarcats ,  Get the basic MONOFOCAL len's , perhaps try monovision with monofocals , but stay away from multifocal lens no matter what your doctor might say . Monofocal is covered with your insurance, The multifocal option is not because it presumably offers perfect vision at all distances. It  simply does not !  In theory , it sounds great , but results are not so good . Doctors want you to choose this option because they make more money . You, the patient want to trust your doctor but beware . Stay MONOFOCAL and use glasses for up close work . You will be SOOOO happy if you do !!! it will be like your vision when you were 40 but needed reading glasses to see well up close. The evil Multifocal option is all about doctors and lens makers getting rich , but they dont work well for most because they are awful in low light and create halos and glare. DO NOT BUY THE HYPE . Stay strong . Stay MONOFOCAL, stay happy !! 

The vast majority of people who get premium lenses are happy with them. Its mostly the minority of unhappy patients who post online so people get a skewed opinion of the results.  It is true though that no lens provides perfect vision at all distances at the moment, though premium lenses can do a much better job of that than a monofocal. A minority do have problematic issues like halos so people do have to consider the risks before going that route. I went for the Symfony (extended depth of focus) rather than a multifocal due to the lower risk of things like halos, but I would have risked a multifocal if that hadn't become available since I'd had good luck with multifocal contacts and preferred those to monovision with contacts.  I figured that it was worth the very tiny risk of needing a lens exchange if I had problematic halos in order to get the benefit of a wider range of vision for the rest of my life. 

In terms of "vision when you were 40 but needed reading glasses to see well up close", I'd say that might be true of monofocals using monovision to get added near. Otherwise monofocals set for distance are more like someone's vision at 60 when they've lost all accommodation. A typical description I see is that on average people can expect things from 6 feet inward to be getting blurry with a monfocal set at distance. Full monovision has tradeoffs, like reduced stereopsis (3D perception) since you are using 1 eye for much of the visual range rather than 2. A small amount of monovision, micro-monovision, like might be used with the Symfony or Crystalens doesn't have much impact on stereopsis. 

When I went to see my opthamologist about cataract suregery , I had done my research and was set for the multifocal lense. It was my doctor himself here in Los Angeles that talked me into monovision for a multitude of reasons. First and foremost, many of his patients are not happy with the final result of the multifocal lense. It's not just the unhappies on this forum. He doesn't believe MF manufacturers  are here to stay or there would be a lot more compainies investing in the technology. That is not happening. He is a renowned and highly sought after opthamalogist . And remember , he could have made more money by putting me in what I wanted and that was the multifocal lense. I'm glad I listened to him.

If you talk to multiple refractive surgeons, you will get multiple opinions.  To me, this means there isn't overwhelming evidence for any one view, or else virtually all ophthalmologists would share it.  (By analogy, consider the suture-vs-staple debate among other types of surgeons: many have a strong opinion, but there is no overwhelming evidence for either approach.)  It's true that monofocal IOLs are the workhorse, with lower risk of side effects, and many years of experience, not to mention being covered by insurance and Medicare.  However, they do come with the need for glasses or contacts.  Multifocals have a higher risk, and not everyone is happy with the resulting vision, but many describe their vision as terrific and are delighted at not needing glasses or contacts.  The Symfony seems (based on clinical results) to offer the best of both, especially when used in a micro-monovision approach (perhaps 0.5 D of myopia in one eye).

All the studies I've ever found indicate most people are happy with premium lenses. Data collected in studies is a more reliable thing to look at than the anecdotal impression gotten by a doctor, even a good doctor. Unfortunately some doctors don't like dealing with any complaints, and therefore any issues may seem like "many" to them, they prefer the conservative "safe" approach.   Its actually a good marketing strategy since if they are the "safe" doctor then they get patients referred there, and don't have problem patients scaring people off. That doesn't mean that their conservative approach is the best one for everyone. 

 Those with monofocal lenses may not express unhappiness the way a minority of those with premium lenses do, however they may not be as happy with their vision as they might have been with premium lenses. Most people are happy with whatever option they receive. Many folks are willing to have some risk of problems in exchange for a better result for the rest of their lives, but some doctors don't like seeing any problems and talk patients out of it.  A problem patient scares off other prospective patients.

re: "doesn't believe MF manufacturers are here to stay or there would be a lot more companies investing in the technology"

That isn't a credible argument, I see a decent amount of activity in the sector and its not clear what sort of evidence and reasoning he could provide as to why it "should" or would be more.     Doctors don't necessarly know much about business or the world of tech investing (I've been an entrepreneur, and networking with other entrepreneurs, in the software&net tech and startup world for decades, though not the medical device world).   

There are many premium lenses available outside the US that aren't approved in the US, and the companies don't even bother trying to get them approved due to the high costs involved. Even the US company behind the Symfony didn't try for approval here until after it was approved elsewhere, and its likely if they didn't already have a big distribution network in the US they wouldn't have bothered. I haven't heard anything yet about US company Alcon trying for approval for the Panoptix trifocal it now has approved in Europe.  The US in general tends to do a  disproportionately large share of  medical R&D, in addition to having one of the larger potential markets for premium lenses, so  the problems with the US market  likely  reduces the R&D budget quite a bit.   The FDA's problems likely have far more to do with the level of investment in new IOLs than anything to do with the technology itself.

There isn't infinite funding available for all the potential R&D projects that might lead to something useful in every potential niche in the world.   Companies compete for R&D funding, including competing with other industries looking for investment. They need to factor in things like risk and the total budget required to get something to market. There is a huge cost to get a new medical device developed and approved, and risk that while all that is being spent a competitor might beat them to the punch, or some unforseen problem might arise. 

 Premium lenses currently have a fairly low market share, mostly due to not being covered by insurers or government payment programs, and partly since some doctors are cautious and there isn't yet a  lens without some risks. Some think the lower risk profile of the Symfony might  lead it to boost the market share of premium lenses, but its hard to say. Regardless the current  limited market size limits the amount of R&D funding, even though people realize that in theory a "perfect" (or at least "near-perfect" IOL might have a huge payday by expanding the share of premium IOLs greatly. That near- perfect IOL doesn't exist, and any investment in a candidate path to get there has technical risk that it might not achieve its goals (or might not be approved) or risk it might have a limited time on the market before a better competitor arises, etc. Its not a sure thing that investors will necessarily pour money into, depending on whatever competing investment options there are.

Appreciate all the interest in my initial comment and my opinion. A bit surprised actually.  In the end,  wouldn't  it be nice if we could try all these options before we buy. Bottom line is we can't. Glasses and contacts can mimick but are different from an implant. I believe each individual brain and it's communication with the eyes is beautifully unique. What works wonderfully for one person , might be a disaster for another . As it stands today, the outcome this surgical procedure, even with all of our science simply cannot be  predicted,  This is why I lean towards monovision.  If your brain can and does adjust to this new visual system, you're golden. If a patient 's brain can't adjust to it after several months and doesn't like it,  then with a little lasik,  the reading eye can be set to the same as the distance eye and now the patient has traditional crisp monofocal vision but will now require glasses for up close activities. The nice thing here is no invasive surgery or removal of a lens further tramatizing the  patient if the mono doesnt work.

I tried monovision using contacts and liked it, but then later I liked multifocal contact lenses even better despite reduced low light vision which I didn't really notice. I didn't notice the loss of stereopsis while using monovision (likely in part because the differene between the eyes started low and increased slowly over a few years), but when I swithed to multifocals the world seemed subtly more 3D in the near range and I preferred that.  In the unlikely event I ever have an accident or an eye health problem that impairs vision in one eye, I appreciate the fact that I'd still have a wider range of vision with the remaining eye. 

Most people adapt to low levels of monovision, but not everyone adapts to higher levels of it. There are studies showing an increased risk of injuries due to falls in elderly people with monovision. If people choose to use glassess to correct both eyes for distance for driving, and use progressive glasses, there are studies indicating slower reaction time when driving due to the need to look through different parts of the lens and a narrower visual width/height range for a particular distance.

Its true that a test with contacts isn't perfect since the characteristics of a multifocal IOL is going to be different than the multifocal contact lens, since none of them use the same optical design so the split of light for different distances and losss of light, etc, will be different. However it gives some sense of what its like to adapt to multifocal vision and the potential side effects.

Monovision with contact lenses in someone who hasn't yet lost all accommodation (e.g. when I tried it in mid-late forties) is likely better than with an IOL since you have more of a visual range for each eye. In contrast multifocal soft contacts (what I and most would try, rather than hard ones I hadn't researched) that   moves on the eye  since its on the surface and has contact with the eyelid during blinks, and is meant to last a few weeks are unlikely to   have the same optical quality that an IOL created to last decades is (although unfortunately I haven't seen data to confirm that assumption). 

The reason for the interest is that I went to the trouble of traveling abroad for a premium lens since I think it was a good choice for me, and may be for many others. I researched it well enough to know that my choice was a good one based on evidence and not "HYPE" as you implied people who got premium lenses were falling for. (granted I got an EDOF lens and not a multifocal, but I still would have chosen a trifocal if that weren't available).  Although it is very important to caution people about the risks of premium lenses, because people should only be taking risks they are fully informed about, its also not useful for people to be scared off from an option due to having an inflated view of the level of risks. 

To avoid putting in a URL (since they moderate those) do a search to find the source of this data point on how few people need to have a multifocal taken out: "These risks are low; the explantation rate for modern multifocal IOLs is reported to be between 0.2-0.5% (1/200 -1/500). ". Someone winds up being the "statistic" so the risks are important to be aware of, and not all are happy even if they don't go to the trouble of a lens exchange. In my case however when I had cataract surgery at age 52 I figured I may be living with the results for a few decades and I figured having a better visual range for all that time was worth the slight risk of a lens exchange (which I'd have done were the results not better than I'd expect from a monofocal, though granted another surgery adds risk, but the risks are low).   

Part of the interest was also reacting to the misguided comment by the doctor regarding the level of investment in new IOLs. There are myriad factors determining the level of investment in any particular technology in any field, and its difficult for anyone to make any credible claim as to what the "right" level would be or what that indicates in terms of the potential of the technology, especially since people have trouble evaluating risk and potential except for after the fact. Technologies that in hindsight appear to have been a waste of investment money often saw a suprising amount of investment, while good ideas that eventually appear were things people could have thrown money at even earlier but people didn't see their potential. 

I'm not as sanguine about "a little LASIK" as you are.  LASIK carries its own risk of unpleasant effects, including chronic dry eyes, glare, halos, etc.  (It seems the flap is responsible for at least some of this.)  And LASIK is permanent, so there's no possibility of undoing it.

Again, some respond better to Lasik than others, but I hear your concerns . Didn't mean to sound sanquine. As it stands with me , I have adjusted quite well (knock on wood!) to my monovision and have no intention of adjusting my reading to my distant eye . My only point was you have an option that for SOME might be more attractive than surgically removing one lense and replacing it with another. I don't profese to be a professional here I was simply offering another opinion to a person based on my own experience. 

Oh and btw , since one of my monofocals is set to the standard distance , I can speak from experience about the distance blur. The very slight Blur for me is 2 feet inward (everything else is very crisp) . I"m actually typing this with a bit of a struggle because Im doing so with my reading eye shut ! 

If your vision only starts to blur from 2 feet inward with a monofocal IOL, then you results are extremely atypical and no one should make decisions based on expecting a similar result. That would be like planning a budget expecting to win the lottery.  My comments was that I've seen surgeons suggest that the *typical* result to be expected by default is things getting blurry from 6 feet in. Its only a very tiny minority that are capable of doing some reading with a monofocal set for distance, due to having a larger natural depth of focus. 

I started playing around with my distance inward blur with my wife this morning and I was off by a little more than a foot . We figure it's more like 3 to 3 and half feet inward . Still not bad, but perhaps not the lottery.