Renewed vision: An eye surgeon’s personal experience

Cataract surgeon William Martin, MD, FACS, relates his story of worsening cataracts, surgery and implantation with the AcrySof^® IQ ReSTOR^® IOL +3.0 D.

By 2006, I was in trouble.

William Martin

Probably the most significant problem I had was driving at night and depth perception. I had a great deal of difficulty judging how close I was to the side of the road or to the center line. Street signs were problematic. I had an overall decrease in the quality of the vision. Glare at night also was a huge problem.

The second problem was reading. I was a successful mono-corrective contact lens wearer, but I knew that as my cataracts were getting worse that I did not want monofocal surgery. My feeling was that if I could have bilateral vision again, that is what I wanted.

By 2009, the AcrySof^® IQ ReSTOR^® IOL +3.0 D (Alcon Laboratories, Inc.) was available. I have performed almost 3,000 multifocal and pseudo-accommodating procedures. All of the multifocal lenses and pseudo-accommodating lenses are excellent lenses, but when it came to making a decision for my own eyes, the lens that I had the most extensive experience with and the lens that I felt the most comfortable with in terms of what I wanted out of my experience was the IQ ReSTOR^® IOL + 3.0 D (SN6AD1).

For me, going from monovision to multifocality has been a blessing.

Background

I had moderate to high myopia starting in my teens and my twenties. I stabilized at about a -5.50. I experienced a significant myopic shift with both eyes, although my left eye was much worse than my right.

For the last 20 years, during my mono-correction experience, I lived in a two-dimensional world. Now my world is three-dimensional again. The increase in stereopsis and depth is really hard to explain. Things pop up. Things jump up. I see depth now with clarity. I used to focus one eye for distance and one eye for near. I did well, and it was a good compromise, but what I wanted was exactly what I got, which was stereopsis and depth. If I try to recall what my vision was like prior to developing significant cataracts, I think that my current vision is better, primarily because I have binocularity.

Expectations, results

In my surgical experience, my lens of choice is the AcrySof^® IQ ReSTOR^® IOL +3.0 D. In terms of what I was seeking, in terms of my experience with my own patients and from what I understood theoretically from these lenses, this was the lens that I wanted.

I expected the surgical experience and the postoperative experience to be what we tell our patients: “You may have some discomfort during the procedure.” “There’s going to be a period of blurriness afterward.” “You’re going to have some trade-offs; there are going to be some compromises.” I expected all that. What I did not expect was how quickly everything improved. I had essentially no discomfort. I received minimal sedation during the procedure. How quickly my vision rehabilitated was remarkable to me, and this is something that I did not really think was going to happen. Within 2 hours after the procedure, I was walking around downtown Charleston, and I could see better out of my still-dilated operative eye than I could out of my nondilated 20/20 minus unoperated eye. The side effects that I expected, halos and glare, are not present. I have an appreciation for the incredible vision that I have gotten in return.

I was an ideal candidate because I have spherical cornea. I have a good ocular surface. I have a healthy macula. I was informed, and even more important I was motivated. As a result, my vision has been repaired.

Expert Q&A – Elective IOLs   Robert J. Cionni Kerry D. Solomon What are the barriers to using more elective IOLs in practice? Robert J. Cionni, MD: When a patient is scheduled to come in for a cataract evaluation or consult, we send them information about cataracts and their lens options in advance. Typically patients come into my office saying, “Hey, I want that IQ ReSTOR® lens or I want that IQ Toric lens because I’ve had astigmatism all my life.” Then, instead of being a salesman, your role is to let the patient know whether he is a candidate for the lens that he wants. Kerry D. Solomon, MD: You are more of an educator helping to answer questions, which is key. So send them information on the front end. We give them DVDs and animations to watch when they come in. It is all helpful. The more tools we can give patients so that they can ask good questions and make good decisions, the better we are all going to be. How do you mark patients for AcrySof® IQ ReSTOR® IOL (Alcon Laboratories, Inc.) implantation? Robert J. Cionni, MD: My favorite method of marking the visual axis and gauging the capsulorhexis size is to use the Mastel 5.75 Optical Zone Marker. I begin the case under the microscope with the pupil undilated so that it is in its normal physiologic position. I ask the patient to look directly into the light of the microscope. I center the cross hairs of the optical zone marker in the center of the Purkinje image of the light filaments and depress it onto the corneal surface. The optical zone marker puts a circular dent on the cornea. The pupil is then dilated with 1% MPF lidocaine combined with 1:25,000 epinephrine. I trace the capsulorhexis directly beneath the visible circular mark. Due to corneal magnification the CCC ends up being about 5 mm in diameter. At the end of the case, I center the IOL in the capsulorhexis. The visual axis is usually nasal of center, so I typically orient the haptics vertically and nudge the IOL into the center of the capsulorhexis. The “sticky” nature of the hydrophobic acrylic helps the IOL to remain centered postoperatively. Eric D. Donnenfeld Does the IOL stay in the middle of the capsular bag or does it stay in the middle of the capsulotomy? Eric D. Donnenfeld, MD: One of the nice things about the AcrySof® IQ ReSTOR® IOL is that it really sticks where you put it, and you can alter the position of the lens to the patient’s benefit. Robert J. Cionni, MD: Especially if you remove all the viscoelastic out of the bag, this lens tends to have a sticky nature and tends to stay where you put it. I am amazed at how beautifully centered the implant is in an undilated pupil. When the surgeon marks a patient in the undilated state and injects intracameral lidocaine with epinephrine to dilate the pupil, the surgeon might look at that and say “I don’t want to make my capsulorhexis there. That’s not centered.” It actually is centered. The pupil dilates asymmetrically.