I'd say a bit beyond arm's length. I'm typing this on a laptop with a 13" screen and right-eye only I can't quite see well enough to write, but 1.5d reading glasses make that fine. With both eyes (without glasses) its sort of alright to type, but the thing about the right eye is it's now shown up just how bad the left eye is. It's not just about focus (as you'll know) the multifocal lenses have always been like having a greasy thumbprint on my eye. Over the past year or so though it's got to the point where nothing is sharp at any distance with that eye, and I still don't understand why. I'd assumed it was clouding of the posterior capsule requiring a YAG capsulotomy but apparently, this is not the case.
Why did they use two different multifocal lenses on you? That just seems crazy. Getting used to them when they're the same is hard enough, getting used to two different types/specifications just sounds downright impossible. Got to say, the guy who did my right eye was exceptional (Sasha will give you his name ) but perhaps, more importantly, he also has a lot of experience of removing these things.
I've been staring at my phone a lot over the past couple of days, not because there's anything interesting on it but because with reading glasses the screen is so damn sharp - to my right eye at least. The other thing about multifocal lenses is that sticking another lens in front of them really does not work - 1.5 over my right eye makes reading crisp and clear, but over my left eye it doesn't make any difference whatsoever. THEY DO NOT TELL YOU THAT IN THE SO-CALLED INFORMED CONSENT FORMS EITHER! (Apologies for shouting).
I'm back at Moorfields on Thursday for my three-week service. Hope we're also going to talk about getting the other of these damned things exchanged. Wishing you the very best of luck mate - Carl.
How far away is the focal point with your new monofocal lens?
I've got an awful multifocal in my left eye, and a different mulifocal in my right eye, which on its own feel fine (with the left eye shut). But the 'blended vision' thing is horrible. If I had known they were doing 'blended vision', I would have run a mile. But they withheld that information from me, omitting it it when I asked the surgeon to explain how the multifocal lenses worked.
I had a second opinion, who told me it was too risky to replace the bad multifocal lens in the left eye.
So I'm feeling quite sanguine about not being a case study in the Mail on Sunday today, despite Russell, their very nice photographer, turning up at my place of work and us having to fend off security guards from the adjacent company just to get a bit of greenery in-shot. I'm pretty sure the choice not to include my story was essentially down to my not actually owning a pink shirt to wear for the photo shoot. Sartorially challenged - shame on me
Anyway; the timing of the article (which seemed very watered down from the draft Thea Jourdan read over the phone; lawyers I guess) was from my perspective amazingly coincidental because just last week I went to Moorfields Eye Hospital (and I must be clear that it was the NHS side) to have a Lentis M-Plus multifocal IOL replaced with a monofocal lens. This was a somewhat risky exercise, as I'd had the multifocal lenses implanted by the dreaded Optical Express in 2013, so the risk of scarring/adhesion was not inconsiderable. I was actually quietly terrified by the prospect of the operation because there was the very real chance the lens would not come out. But last Wednesday I duly arrived at Moorfields at some ungodly hour of the morning ready to be sedated and to have Mr [admin edit] of External Diseases (I have no idea why the department is called this) make a couple of small incisions in my eye and attempt to cut up the old lens and replace it with a new one. Again, for the avoidance of doubt, this operation was about getting rid of the LENTIS M-PLUS (expensive) multifocal lens and replacing it with a 'cheap' NHS monofocal lens.
And again, to be pretty damned clear, this was the best decision I've ever made.
Within 36 hours the difference in the quality of vision between my left eye, which still has the multifocal lens, and the right eye was extraordinary. Improved contrast, tone, depth of colour (which I had not even realised was reduced) and a general sense of sharpness about my eyesight which I had thought lost six years ago. This is no longer simply an opinion; having a multifocal lens in one eye and a monofocal lens in the other now allows me to make a side-by-side comparison between the two technologies, and simply emphasises just how inferior visual quality from the multifocal lens is when compared to the monofocal. Hopefully, I will be able to have the left lens replaced in the next few months. I've said it before and I will say it here again; in my experience, the Lentis M-Plus lens is not fit to be implanted into a human being.
Sure, I need reading glasses. I stopped by Vision Express in Walton on Thames (I mention them just because I'm always slagging off optical companies, but this particular branch has been consistently excellent so credit where credit's due) yesterday and picked up a perfectly serviceable pair of ready-readers for fifteen quid, but even with a 1.5 dioptre prescription, the quality of vision at near-distance is much improved.
After six years of hell inflicted by Optical Express, thanks to the NHS the eyesight in my right eye is now freakin' delicious.
There's another thing; it's impressionistic and obviously subjective, but since the operation, I just feel better in myself. I'm starting to wonder if the reduced light levels and reduced contrast, as well as under-saturated colours, actually have a psychologically depressive effect - if you have mfIOLs and are reading this, do you find this to be the case?
If you are thinking about multifocal lenses, just be aware that having them implanted is a risk. Even the Mail on Sunday's research suggested that one in twenty recipients have problems, an absolutely scandalous statistic in surgical terms. Even if the operation goes smoothly you may not be able to adapt to them, and there is no way to tell in advance whether they will be good for you or not (but in my experience, probably not). You will be taking a leap in the dark; it's up to you, but be aware of the risk.
And to [admin edit] and the surgeons and staff of Mackellar Ward at Moorfields eye Hospital - thank you, you are all just completely amazing!
________________________ admin:Apologies Carl, but your surgeon sells laser and RLE in the private sector and I will not promote his services on my site, hence my edits. I am however happy to gve his name to anyone attending MEH for NHS treatment
I wonder whether you would be able to help me please, enclosed is a brief overview of my story!
I was lured in by Optical Express and their advertisements of laser treatment at £1500 per eye, however that turned out to be £6000, as I was not suitable for laser, and was advised that I would need lens replacement. I was given the hard sell and was called every couple of days by staff, and agreed to surgery. The original price was £6500, however as I work on the hospital wards, a £500 discount was offered, bringing the total to £6000.
I was advised that the “worst case scenario” would be that I might need +1 reading glasses in a dimly lit restaurant, which I accepted. I was told that I would not need glasses or contact lenses again, however this was only verbal.
I was informed that in less than 2% of patients, they might need a “simple” laser top up too “fine tune” the results.
Too cut a long story short, I had NLR at the Bristol clinic on 11th October 2018 and returned the following day to have the second eye done by Doctor Alex George. It was extremely busy and the surgeon was operating on 22 patients in the same day! I was very nervous and asked Doctor Alex George why he had not had surgery, and he had said that his prescription wasn't suitable!
I returned home and saw the Optician and I explained that it was like looking through cling film. I was told that there was a membrane covering my right eye, and to give it another week. I returned the following week, and the "membrane" had dissolved, however my eyesight still remained the same. As the weeks came and went my depression started to kick in. my vision blurred ,I could only see what was right in front of me, it was difficult for me to work, as working on the wards, I could not see patients faces, driving during the day was difficult as despite being told that I had reached the driving standard, I could not read the road signs, but was kept being told to remain patient, as they needed to heal, and it should all settle by day 90. In desperation I spoke to Colin Berry who tried to reassure me that he would help,and made an appointment for me to see my local optician. I was then advised that I had settled short sighted with an astigmatism, (this being a new condition) which resulted from surgery. I was informed that it would most likely settle on its own, and not to worry. However they would order me a pair of glasses and some contact lenses to help. After chasing them for 2 weeks, I was informed that they had not been ordered, but was given a pair of lenses from the shelf (although I was told that they were not my exact prescription, but they would help), they didn't, and I removed them the following day.
My vision has been blurred for the last 3 months and I have had nothing to help me with this, although I was told that I had reached the driving standard, I was shocked as I said that I couldn’t see properly, I couldn’t read the road signs; I was told everything was okay. One day when attempting to drive I damaged my car along the curb, as I couldn’t see it clearly. My work has been very difficult, as I cannot see people’s faces clearly, unless they are stood right in front of me.
The 90 days of waiting has now elapsed, and I have been informed that as I was in the unlucky 2% of patients, I am now suitable for "simple laser top up" on my right eye only, however the consent paperwork I have been given, is not what I was led to believe: it reads that there is a strong possibility that my eyesight could be made worse, they will be using an unlicensed product in my eye, complications may arise, and there is a strong possibility that I will need glasses! I have been lied to and misled, as this would not be a simple “top up” procedure. Obviously I have not signed to agree to accept all the very negative outcomes, however I am left with being short sighted, blurred vision, an astigmatism and I am still not able to drive at night, which I paid £6000 for. This is all the result of surgery, I now need glasses or contact lenses to try and rectify this, the whole reason for having the surgery was to not wear glasses!
I am really not sure what to do, and wondered whether you have encountered something similar and your advice?
________________________ admin: Colin Berry should have referred you to the operating surgeon as soon as you reported your issues, and he is negligent for not having not done so. I advise that you take this matter up with the GOC.
Driving at night with Oculentis M Plus multifocal intraocular lenses. I mean, frankly it sucks but it's interesting how you develop strategies to cope with rubbish vision (which is still technically legal because car number plates are still recognisable).
So again, sorry that these posts are in reverse order but I wasn't aware of the image limit per post when I started typing. For anyone contemplating Refractive Lens Exchange with MF IOLs here's a piece of advice from someone who has had it done and lived with it for 6 years.
In a word, don't.
In February 2019 a very nice gentleman from Moorfields Eye Hospital is going to do his best to remove this piece of Oculentis crap from my eye and replace it with a refractive monofocal lens (don't get me started on the kinoforms of diffractive lenses, we could be here all night). The prospect of this op is of course completely bloody terrifying, but the surgeon has done it before and seems both hugely competent and completely ethical, so if he's up for giving it a try it would be remiss of me not to give it a shot too.
The idea that by March I might be able to see stars again is something I'm clinging to.
@IncyB Of course, it might even be worse than you think (it usually is). Whilst trawling the inter webs for information on light transmission in Oculentis M Plus MF IOLs I came across this, from Eye News website originally published (print I assume) in October / November 2014:
Injectable IOLs for macular pathologies
The Lentis Mplus High Add is an injectable IOL for patients with macular pathologies, first introduced by Oculentis in late 2013. It will now enter into a phase of controlled trials limited to three centres in Germany, designed to determine the inclusion criteria and the residual dependence on low vision aids for these patient groups. The early feasibility studies evaluating the Mplus High Add IOL carried out by the University of Heidelberg show considerable potential for improving quality of life for patients with age-related macular degeneration (AMD). This aspheric multifocal IOL has an 8.0D near addition, with 1.5 times magnifying power. According to Professor Auffarth, the Mplus High Add IOL is most suited to patients with stable macular disorders who have a minimum visual acuity of 1.0 logMAR and a maximum estimated visual acuity of 0.5 logMAR.
I read this in conjunction with a video Sasha sent me on another subject, but which contained one very pertinent slide, making a comparison between outcomes of MF IOL exchanges in patients with cataracts in their late seventies to mid eighties, with outcomes of people with the same lenses much earlier in life (and without significant cataracts). All that neuroadaptation stuff to one side, this particular slide was only complaining about light transmission values in the 85% range, whereas my understanding of M Plus is that distance vision has LTV of a truly atrocious 60%. And that's not faulty, that's how the damned thing was designed.
So my take on Oculentis is that even before you get to lens opacification - which is a major worry for the industry - these lenses were only ever designed to be implanted in people whose starting vision was sufficiently bad that ANY lens implant would represent an improvement in clarity. The trouble is that companies like Optical Express have been putting these lenses in to patients where lens replacement is an entirely inappropriate intervention. So the fact they have a great many profoundly unhappy patients currently suing them should hardly comes as a surprise. Anyway;
I had Lentis M Plus lenses implanted in Jan 2013, and from day one my vision has been atrocious. What's rather more troubling is that it seems to be getting worse quite rapidly. When I mentioned this in passing to the delightful Mr Stephen Hannan at Optical Express I received, by courier, a letter basically telling me to never darken their doorways again. In fairness I hadn't expected anything else, but it did emphasise quite how disingenuous OEs approach to patient care is. Anyway again;
It also struck me a while back that in all of the literature I have read concerning patient outcomes of MF IOL implants nobody had really tried to represent the patient experience in visual terms. I mean, in fairness it's tricky, right? Well, no. I've been using Photoshop since version 1 and if the police can use it for photofits then some multi-billion dollar turnover optics company like Zeiss or Oculentis should have damn well tried it. But they haven't, so I have.
The following seven images are based on photos taken on an iPad pro and then retouched in-situ to match as closely as I can the viewing experience of a patient with Oculentis M Plus multifocal intraocular lenses six years after surgery. The originals are around 3500 pixels in the long axis, but I've scaled these down so that they don't take too long to download (hopefully). The one exception was the night shot, where I used and iPhone and a colour look-up table in Photoshop to represent day as night (the night shots I got from my iPhone already had unrealistic artefacts in them). Also, I was in the passenger seat at the time
So this is an indoor shot in bright, ambient light of a bunch of plants at about 3 metres. Note that I'm trying to represent binocular vision.
Note how focus and blurring is inconsistent across the scene. Also, contrast reduction; this is probably my biggest single complaint about these lenses, they make the whole damn world a grey blur. Thanks, Oculentis. Next is an outdoor shot in similar light with similar artefacts, at distances of about 10 - 50 metres:
One of the biggest problems I have is with seeing faces at work. I can be walking down the corridor and see someone only 3 or 4 metres ahead, but not be able to recognise them. And if I can, it's still impossible to see if they're making eye contact. It's a bit like this:
Reading is a problem. I'm not down to wearing reading glasses yet, just stuffing my face in to magazines. This is an example at normal reading distance:
(Damn; can't add any more files on this post. I'll upload it and reply - back in a sec).
Here is a link to an article from 2017, with direct quotes. (Highlights and bold mine.)
"Another important aspect of MIOL (multifocal intraocular lens) or EDOF(extended depth of focus e.g Tecnif Symfony ZXR00) IOL implantation is the perception of postoperative photic phenomena that can potentially compromise patient satisfaction. Generally, when light enters the pseudophakic eye, several mechanisms can disturb the ideal light distribution on the retina. This ultimately leads to a perception of a flawed or imperfect picture or even ghost images and shadows.
Positive dysphotopsia symptoms are described as bright flashes, arcs, halos, or sprinkles of light and are usually strongest in scotopic (dim) light conditions under which the iris dilates
Thus, halos, from a physics standpoint, are INEVITABLE with MIOL and EDOF lenses. This fact is highly relevant, as in a survey Mamalis et al showed that halos and aberrations are a potentially adverse effect whose occurrence represents the main reason for MIOL explantation.
CONCLUSION It is important that the surgeon asks patients about their work and recreational activities to get as complete a picture as possible of each patient’s predominant visual needs. If, for example, manual or computer work is an integral part of the patient’s lifestyle, good intermediate vision should be supported by the chosen MIOL. If spectacle-free reading ability is strongly desired, an MIOL with a corresponding near addition might be the lens of choice. If both distances should be supported, a trifocal IOL would be suitable. Multifocal IOL defocus curves and capacities (Fig. 2) provide the surgeon and the patient with helpful information for this decision process.
As multifocality is usually linked with increased perception of halo and glare, the patient’s tolerance toward such photopsia also plays an important role. During preoperative consultation, the patient must be informed about the possibility of halo and glare
and the expected intensity for each specific lens type. A more relaxed personality with a readiness to compromise often indicates
higher compatibility with MIOLs, especially trifocal lenses, than a hypercritical and obsessive patient"
Interesting article which makes me wonder -
Were YOU asked in detail BY THE SURGEON (or indeed the office tea-lady) about your work and recreational activities with a view to establishing whether you could tolerate these side-effects and their impact?
Were you told halos were "inevitable", as they are according to the quote above from this scientific article?
The above article states that Posterior Capsular Opacification (which causes vision to become cloudy) is a COMMON long-term complication of cataract surgery (which includes IOLs in this article)
"The rates of PCO following surgery are estimated to be 12% at 1 year, 21" a year 3 and 28% at 5 years after surgery".
I don't know about you, but 28% is an unacceptably high risk to me. It is glossed over in the "OE consent" documentation. How many people would say "No Thanks" if they were told the statistics?
The article goes on to say that treatment with YAG laser capsulotomy is effective, HOWEVER, complications, including retinal detachment, macular oedema, and increases in intraocular pressure, may also occur. The risk of retinal detachment is well known to be higher in myoptics i.e short sighted people.
If a retina detaches and cannot be repaired, you go blind in the affected eye.