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Refractive Lens Exchange - Oh no it isn't! 22 Jan 2017 12:44 #71

  • Carl G
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I wanted to put up a few notes on RLE for anybody a) contemplating it, or b) who has had it and wonders why their eyesight is not good.

I had what I thought was cataract surgery in 2013 and I'm currently in litigation with OE and my surgeon, for lying, medical negligence, and in general them being money-grabbing cowboys, so I freely admit you're not going to get an impartial opinion for me on that score. However, all that to one side I'm considering explantation (the one where they cut yours eyes open, whip the lenses out and stick another one in) because my vision is bad and getting worse. Most likely prognosis is I need a YAG Capsulotomy, which in itself is no big deal but which then precludes the possibility of explantation. And I do not think I can live with these goddamned lenses for much longer.

The thing is, I contacted a surgeon who is both trusted and considered to be one of the best in the country to discuss this. He raised the prospect of exchanging my Lentis M-Plus multifocal lenses for trifocals. And in doing so opened up a fairly large can of worms for me.

So, having made the mistake of not doing enough research first time around I dived into PubMed and other literature sites to find out whatever I could about these lenses. This is some of what I found, and it goes a long way to explaining why my vision is poor, why your vision may be poor, and why despite whatever Optical Express say it is never going to get any better (advice: sue them now, do not wait).

The fact is the very term ‘Refractive Lens Exchange’ is a misnomer, as it tends to suggest (in the context of multifocal/trifocal lenses) that you’re swapping one refractive lens for another. This is not the case. Multifocal RLE replaces the normal refractive lens in the eye with a diffractive lens.

Consider this for a second. How else would you stick a bifocal lens inside your eye? You can't have the top bit being for distance and the bottom bit being for close-up, this is right inside your eye after all - so lens designers have to do something a) clever, and b) frighteningly unnatural.

The optical properties of this diffractive lens are defined by its ‘kinoform.’ To imagine this, think about the serrated edge of a saw as being like the profile of the lens. The size and orientation the ‘teeth’ produce the overlapping components that make up the various images, which are then composited on the retina in order to make the two (or three) pictures the brain needs to differentiate between in order to obtain visual acuity at varying distances. The calculation of this kinoform is immensely complicated. It is not surprising that an optics designer would feel pretty pleased with themselves at coming up with a viable solution, I have to concede that they are impressive pieces of engineering.

If your eye were a camera the story would probably end there. It isn't, it's part of a massively complicated system with your brain stuck at the back end of it. So diffractive lenses (front on they might look a bit like ripples on a pond, radiating outwards) are very clever and have nothing at all to do with the millions of years of evolution that went in to developing your optical system, Don't take my world for that, there are plenty of surgeons who agree with this and I'll list some examples below.

Diffractive (monodical and trifocal) lenses introduce two problems.

The first is loss of light due to scattering. In the papers and presentations available on the following link by Dr Damien Gatinel you can see that in multifocal lenses as much as 20% of the available light is lost <before> you consider the ~ 60-40 split of the remaining light into near-far usage. No wonder it’s so much harder to drive at night! Trifocals do better but there is still a loss.

The second, and perhaps even more serious problem, is reduction in contrast sensitivity.

This link is to an article in the Journal of Cataract and Refractive Surgery referring to the XXV Congress of the European Society of Cataract and Refractive Surgeons. The title, 'Monofocal vs. multifocal for refractive lens exchange: should contrast or accommodation be emphasised in pursuit of best visual performance?'

Believe it or not this is a really interesting article in which Dr James McDonald argues the case for monofocals.

"Monovision is much more compatible with the human visual system,” he said.

Dr McDonald cited research into binocular fusion and rivalry that illuminates the basic physiology and neuropsychology of vision, much of it conducted by Randolph Blake, PhD, Centennial Professor of Neurocognitive Science,Vanderbilt University, Nashville,Tennessee, US, and colleagues.

This research indicates that the entire human visual system “is very much structured to respond to contrast orientation,” Dr McDonald said. He argued in essence that monovision is preferable because its ability to preserve contrast complements the visual system’s built-in reliance on image contrast.

This systemic contrast orientation begins in the retina, where three sets of receptors respond to low, middle and high contrast frequencies, Dr McDonald said. Using animations he demonstrated how low frequency contrast shows basic outlines of objects, middle frequencies provide information about space and motion used when driving or moving rapidly, while high frequency contrast receptors fill in the fine detail and sharp edges we perceive in objects all around us.

Visual sensations generated by contrast at the retina continue through a series of neural processes that winnow information before passing it to the higher areas of the visual cortex where data are assembled into visual perception. Dr McDonald pointed out that very little neural processing power is applied to the data until it reaches the higher centres of the visual cortex, suggesting that the raw data of perception are directly related to initial contrast on the retina. Indeed, Dr Blake’s research using functional MRI scans and other tests demonstrates that incoming image contrast is highly correlated with the magnitude of neural response in the primary visual cortex, and primary cortex response is almost directly related to the level of activity in the higher neural processing areas associated with visual and cognitive perception

I have to say the terms Dr McDonald uses in the article, in particular ‘waxy’ vision, align exactly with my experience.

Here is the punchline:
We are really overtaxing our visual system when we use a multifocal lens. Between the retina and visual cortex there are three places where the information is thrown away. By the time it gets to the visual cortex there is not enough information to clean up the image.”

So what's the answer? A number of patients do in fact report a good outcome with multi and tri focal lenses. In a lot of instances though, these patients vision was exceptionally bad prior to having surgery, so the baseline they were starting from was not especially high. These patients had surgery for the most part because they really needed it, not because they wanted to be 'glasses free' (which is one of the stupidest marketing slogans I've ever heard in my entire life). Presumably there are also those who are able to make the leap as far as contrast sensitivity is concerned. I've never met one, but there have to be some out there.

But the real killer is this: it is almost impossible to see any significant advantage in multifocal and trifocal lenses over monofocal. In my experience If you need cataract surgery, get monofocals. The chances are you will need reading glasses for some closeup work, but a good surgeon should be able to give you close to J2 reading distance and full distance with monofocal. The incremental acuity improvements with multi and trifocal lenses is marginal, whereas the failings in contrast sensitivity can be acute.

If you don't need cataract surgery, don't have RLE. Do not do it, you will end up worse off.

And do not believe a single word the likes of Optical Express tell you.
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Refractive Lens Exchange (RLE) 14 Jan 2017 15:19 #72

  • Lorraine B
  • Lorraine B's Avatar
My post echoes so many others on here in that I had multi-focal lenses implanted in February of 2016. I had approximately 5 weeks of 'acceptable' vision but whilst working at my computer on week 6 (I am a medical secretary) I suddenly realised that the words on the screen were not clear and they appeared to be blurry and doubled. I panicked and immediately called OE to report this sudden deterioration in my eyes. I was asked to make my way to my local OE ASAP so someone could check out the problem. The optometrist I saw on this occasion was very concerned that I may have developed swelling of the Macular and I was instructed to go to St Vincent Street for a special scan to rule this out. It was st this early stage the words 'posterior lens capsulisation' were mentioned. Seems I had developed this complication very early. They were not keen to treat this due to the relatively new scarring post op and told me I needed to wait till 12 weeks at least. I was told I needed a YAG laser procedure and that as soon as I'd had the YAG my eyesight would be back to the previous level prior to the capsulisation.

After 3 months I had this procedure done by Joanna McGraw in St. Vincent Street but afterwards there was little or no difference that I was aware of. I was told to be patient. I thereafter had about 18 further appointments, each time seeing a different optometrist who suggested different solutions to my by now terrible standard of vision. I had one lens, two lenses, glasses etc, nothing apart from one pair of prescription glasses helped.

I now had astigmatism which required a further laser 'top up' This, I was told, was a quick 30 second fix. 'No big deal' 'A simple op’. Arrangements were made for me to attend Glasgow for an initial consult with Joanna McGraw. At this consultation she informed me that the 'simple' laser fix would in fact render my distance vision poor and I would ultimately need glasses for my distance but would improve my reading.

My heart sank as nobody had told me about this compromise at any time. Then, after examining my eyes, she declared that I wasn't in fact suitable for the simple surgery and I would need a different type of laser involving removal of the epithelial cells on my cornea, using a strong alcohol solution after which a laser procedure would be done on my eye . Those were her words.
She told me this was a painful surgery, that I should bring painkillers as the anaesthetic only lasted 10 minutes and also if I could get my hands on Diazepam that too would be advisable if I felt anxious. She also told me that I needed to book time off work , approximately 5 days as this was the time it took for the cells to regrow. I told her there was no way I was subjecting my eyes to any more surgery of this type and left.

I wrote to OE clinical services team and asked for a) a refund b) contact lenses c) a pair of glasses as I now needed them to be able to work/read and I received a ten page response from Stephen Hannan saying they would be giving none of this. I was again offered the surgery with a deadline of February after which time they claim they have zero responsibility to me.

Sadly my eyes are worse now than before I started. I am unable to drive at night and I am unable to even watch TV from the comfort of my bed at night as I suffer doubling of the images. I have to close one eye. To say I am devastated is an understatement.

Finally, yesterday I decided I need to at least have another pair of glasses as a spare. I called Optical Express to ask if they can send me a copy of my prescription so I can buy them locally. This request was met with excuses and I was told they needed to consult with a manager. I found this baffling. I was called back to be told I needed to submit my request in writing to the clinical services team. I couldn't believe it.

I called the Clinical Services team direct and was told they would email me a consent form. I received this and was even more disgusted to see that there was a fee! They were charging me for my own prescription.

I am beyond disgusted. £5000 of my hard earned money and they want me to pay for my own prescription. I am so so angry!

Thankfully this site is here. Please advise me, what's my next move???
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  • Gary
  • Gary's Avatar
Hi Alison,

I can sympathise with you very well here. I have the same problems unfortunately ever since I had my treatment in 2010, and endless promises from OE. I have astigmatism as well that they were treating me for, then the surgeon Jan Venter retired and since then they have done nothing. Now they want to charge me another £1000 for correcting what they had promised they would fix without cost to me. Along this journey, after Jan Venter retired, I also met this Dimitri Kazakos character and he is - as you say - a gobby rude and insulting individual, and he certainly does not fill you with any confidence.
I am having to look at other clinics to see if anything can be done to help me now they seem to have got away with it.


  • Allison
  • Allison's Avatar
Same person did mine in 2016 :(
It's beyond me how they can say Dimitri Kazakos is a top surgeon , this man is rude , talks utter drivel. I had lens replacement and my life will never be the same! I have blurred vision floater ,flashing lights, severe dry eyes - which wake me 3/4 of every night - and I will be on drops for the rest of my life. Dimitris Kazakos told me if any thing needed tweaking after operation it would be done, but this is total lies as now Optical Express don't wanna know . These people give you false information and when it all goes wrong they leave the the NHS to pick up the pieces


  • Paul Hogg
  • Paul Hogg's Avatar
I had lens replacement surgery in January 2016 at the Bristol clinic under the surgeon Alex George. I then entered the most horrifying year of my life!!!! It is like living a horror film. I have double vision, blurriness, dizziness, tremendous eye aches which develop in to pounding headaches. I now suffer palpitations and anxiety attacks and suffer from sleep deprivation as obtaining a good and full night's sleep is practically impossible. Basic family duties and events such as driving at night or visiting shops with bright lights have become almost impossible. It is just too difficult and painful for me - as well as dangerous!! I no longer ride my motorbike or take my son out on bicycle rides. I sometimes feel that I am on a different planet as now there are three moons in the sky at night!! These problems began almost immediately after the lens replacement surgery but Optical Express kept dismissing me and telling me that things would suddenly fall into place in six months time. This never happened and they insisted I underwent Yag Laser treatment.

Since then, the problems spiralled out of control and became tenfold. Alex George told me to ask my GP to fast track an appointment for me with a neurologist. Before this I had already been to the GP twice before when she ran tests (bloods etc) and said my general health was good. At my third visit after seeing Alex George my GP told me that there was no reason to refer me to a neurosurgeon as any problems I was then suffering started after my surgery with Optical Express and it should be them addressing the problems. She said ‘who the hell do they think they are?’ and told me to go back to OE and tell them this.

Now, Optical Express try to avoid my calls and do not answer emails. When I call to the shop in Queen Street, Cardiff, the staff always say there is no-one available to see me. Nobody at Optical Express is really interested in the fact that they have ruined my life!!!

I recently posted on Trustpilot and other Optical Express review sites and was immediately called by Allan Mcewan at the Head Office. He said they’d arrange for me to see Dimitri Kazakos, who he told me he is the most senior surgeon OE have and if anyone can solve the problem he can. But he also said his bedside manner is not the best! Then I was called by Colin Berry who gave me an appointment to see Dimitris Kazakos at Westfield in White City on the 24 January.

I am a Craftsman (carpenter) and I use CNC routers run by computers as well as traditional carpentry work. I produce one off bespoke pieces and have even been commissioned to produce the Urdd Eisteddfod Chair of the Bard in 2015. I can no longer see well enough to produce such pieces and Optical Express have taken away my ability to work and support my family. THEY HAVE RUINED MY LIFE.

They don't care about people at all they just want to take as much money from you as they can and leave you in pieces and in despair. I intend to start legal proceedings in the hope that something can be salvaged.

Do not trust these people - they are criminals - nothing more!

NHS for corrective surgery 07 Dec 2016 12:46 #76

  • Anonymous
  • Anonymous's Avatar
Following two years of hell after lens replacement surgery and a botched explant courtesy of David Teenan, the NHS are providing corrective surgery. They have offered another explant and a third lens which hopefully will sort out the many issues I have. I will always have to wear glasses and the risks of more surgery are ever present but I feel in much better hands and will be going ahead. Please consider the NHS if it is a choice for you, especially as a private explant will cost you £11,000!

Ruined my eyesight! 30 Nov 2016 19:10 #77

  • Gloria Sloanes
  • Gloria Sloanes's Avatar
Optical Express need closing down how can they get away with ruin people's eyesight. I am one of their victims. I was in the process of sueing them when the branch I was under went into liquidation in Edinburgh. I'm now left unable to drive at night and I cant go to the theatre as I can not see performers on the stage clearly, and no glasses improves my eyesight.
David Teenan did my lens replacement and he is still working for them. In a nutshell I paid all this money for them to ruin my eyesight. It's really is disgusting that they are allowed to get away with this!

Eye deterioration after lens replacement 27 Nov 2016 17:46 #78

  • Wayne dingwall
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My story similar to many OE customers.
I came into a little windfall and thought I'm sick of contact lenses. So I did a little bit of research and thought lens replacement was best for my age group and understand this would last longer than laser. Went to Optical Express and went away confident after listening to their very convincing spiel…
Had all the test done and told I was ideal candidate - MUG is what I understand they really meant.
After had surgery done in 2012 I felt ok, but eyes always felt dry and a little blurry in one eye. This blurriness in one eye continued so they did some laser on the weaker eye, didn't really make much difference...

Eyes started getting worse in 2015 and continue to deteriorate blurry, weeping, itchy and uncomfortable. This makes you feel tired and aggravated all time.
Went for eye test at different opticians recently to see what they said. They looked bemused as I only had these done 4 years ago but they didn't say much more, seemed they didn't want to criticise.
This worried me so I went to Optical Express and they made appointment for me.
Appointment day came and I was sat in reception then very sheepish looking employee approached me and said I need to pay £50 for special eye test. I only wanted a chat and some advice, but the advice I got was 'You had your eyes done 2012 and last check 2013 there fore you need to pay £50 for tests, HEAD OFFICE said so’
Why are they contacting head office when I only wanted a chat?
Getting very worried about my vision
Do not go optical express for these procedures you will regret it very much.. I paid £6600 for what?
Optical Express if you're reading this, I’m getting appointment at Moorfields Hospital to see how much damage you've done.
Will keep everyone updated!
This worried me so went to optical express they made appointment for me.
Appointment day came went down oe they booked me in done puffer test Sat back at reception then very sheepish looking employee approached me and said I need to pay £50 for special eye test, I only wanted a chat and some advice, the advice I got was... You had your eyes done 2012 and last check 2013 there fore you need to pay £50 for tests HEADOFFICE said so..... Why they contacting head office I only wanted chat..
Getting very worried about my vision
Do not go optical express for these procedures you will regret it very much.. I paid £6600 for what..
Optical express if your reading this, getting appointment for Moorfields hospital to see how much damage you've done

Refractive Lens Exchange (RLE) 08 Sep 2016 19:53 #79

  • Colin M
  • Colin M's Avatar
i had RLE procedure carried out in June 2013 by Dimitris Kazakos, I was assured all along that at any time after surgery, should my eyes need “tweaking" it would be carried out f.o.c for life, I had several follow up appointments and after one check up I was informed I would require YAG treatment on my left eye asap and that my right eye would need doing by the time the appointment for the left eye came through. I heard nothing for a year, so after contacting OE to find out what had happened to my appointment I was told I needed to have another check up at my local branch before they could do any more for me. It was at this appointment I was told I needed YAG on both eyes but at a cost of 790, when I said i had lifetime guarantee they told me OK, if I took in my copy of t&cs showing that information they would honour it. As numerous customers have commented hee nobody can seem to find their copy of t&cs as none were probably ever issued. My eyesight has deteriorated rapidly in the last 6 months, I can no longer read the epg guide on the tv from a few feet and spectacles have no effect. I have developed a major increase of floaters and I need bright lighting to be able to read and to carry out simple tasks in the kitchen, needing halogen lights on indoors during the day.

Post surgery with op ex 31 Aug 2016 18:36 #80

  • Anonymous
  • Anonymous's Avatar
Hi all

I had lens replacement surgery Nov 2014 . Extreme light sensitive etc so after OE running me around Sheffield Nottingham and Manchester for a year it was recommended I have an explant with David Teenan in Glasgow. Big mistake - more problems!
It is now almost September and they totally ignore me.
Forget Optical Express as their surgeons are not fit to practise …
I have spoken to Sasha today and she gave me excellent advice which I followed this afternoon.
Go ahead with any legal claim you may have been sitting on and go to your GP asap and ask to be referred to a NHS Consultant ophthalmic surgeon. The NHS may be able to help.
Mine agreed to refer me today ! Give it a go .
Best of luck xxx