Friday, December 16, 2011

Tecnis® Multifocal Lens Implant Glare & Halo

Question: On Aug. 26th I had a Tecnis® Multifocal lens implanted in my left eye. My cataract surgeon also did limbal relaxing incisions as both eyes have substantial astigmatism. The glares and halos are so bad that driving at night feels dangerous. My eye doctor assures me that most patients who experience that find that once the second eye is done, their brains adapt and it's no longer an issue. I'm afraid that if mine doesn't, I will not be able to drive AT ALL at night until I have both removed. We've already talked about going to monovision lens implants and have used contacts to mimic it as best as possible. However, my cataract surgeon says that because I already have the Tecnis® Multifocal in place, it's impossible to get a true monovision test. So, I would really appreciate your thoughts on:

A: The likelihood of the glares/halos becoming non-problematic once the second eye also has the Tecnis® in place;
B: The idea of using monovision IOLs instead, with the right eye having a toric lens implanted to correct the astigmatism.

Answer: Multifocal Lens Implants, including the Tecnis® Multifocal Lens Implant, use complex optical designs to achieve their vision correction properties. For that reason they do indeed require a varying degree of “neuroadaptation” in order for patients to get “used to the vision”. Depending on each individual patient’s “neuroplasticity” this adaptation process can take little time or even a few months. You are approaching 4 months and do not seem to report a notable improvement in sensitivity to the symptoms of glare and halo. Typically, for complete neuroadaptation to occur it does require implantation in both eyes. So, the information being provided to you by your Cataract Surgeon is quite consistent with the experience of others. So, while “conventional and experiential wisdom” would suggest proceeding with the right eye with a Tecnis® Multifocal, it does sound like in your case this would NOT be a prudent path based on the severity and persistence of your complaints. You do not state whether your left or right eye is your dominant eye and this could impact the relative success of monovision Lens Implants. The most conservative approach is to correct the right eye with an astigmatism correcting toric lens implant for full distance correction. Then depending on the residual symptoms of glare and halo, and the degree of satisfaction with your near vision at that time either leave the left alone or possibly have a lens exchange to replace the Tecnis® Multifocal with a single focus lens implant. Again, the conservative approach would be to avoid monovision as you have already demonstrated a less than optimal “neuroplasticity” and monovision does also require adaptation.

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