TOPIC:

Hi Al,

Al Faretta wrote: I am sceptical of some of the hype and it's best to have lower expectations to avoid disappointment. That’s what everyone tells me.

I suspect unfortunately that you may not be sceptical enough. Lowering your expectations is one thing; yes, these lenses are simply not very good. They try to shoe-horn an inferior optical technology - multiple overlapping images - into a system that has evolved to work with a single, varying focus image. Even that is not the problem though.

You can take all of your research, all of your due-diligence, and chuck it, because at the end of the day there is simply no way of knowing whether your brain has the necessary neuro-plasticity to adapt to multi-focal lenses. You cannot know in advance of surgery, and neither can your surgeon. That is why I say this technique is still experimental.

It is experimental because the underlying science of neuro-adaptation is not fully understood, but far more important than that, it is experimental because that science cannot be quantified. What is the mechanism that predicts a positive outcome? There isn't one. Who can predict whether patient X will be able to adapt and patient Y will not? No-one.

I do wonder if, with a less pressurised environment (i.e. a properly managed surgical practise, not a meat market) some greater degree of assessment might be given to the patient (other than a forty minute session with someone who isn't a surgeon). Perhaps prospective multi-focal lens patients should be required to wear multifocal contact lenses for three months prior to surgery. Maybe then they would find out if they are capable of adapting.

Perhaps also they should be shown visual representations of the potential outcomes of MFIOLs (halo's, fringing, double vision etc.) Or better still, perhaps they should be given tinted glasses with diffraction gratings to simulate the effects of driving at night.

But most importantly, perhaps somebody should actually pay attention to the individual and treat them as something other than a cross between a guinea pig and a MASH patient.

Shall respond in further detail soon and in due course, 'admin', but I am using an iPad Air just now and as I always do. I am lying in bed and it is 11.30 pm. I do not know much about IP Addresses but could you perhaps send me the various IP Addresses and I shall enquirer of Apple Technicals to seek an explanation.
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admin: Your IP address for this post is in Worcestershire. If you'd like to email me I'm happy to discuss with you. Confidentiality guaranteed re your name and contact details 'Al'...

Al Faretta wrote: I am a potential Multifocal lens patient as is my wife who has an early cataract… my wife has to have her eyes sorted by early next year if she wants to continue to drive.

Obviously I have read all your posts, including the ones I didn’t approve because of your blatant and irresponsible promotion of unnecessary surgery, advising people to go ahead and take the risk regardless of the consequences.

I am not going to say too much as I’m sure other people will respond to your post, but I would like to point out that if your wife has a cataract preventing her from driving then she is entitled to an NHS operation.

My friend is 54 and had cataract surgery at Moorfields NHS hospital two months ago, he didn’t wait long for surgery and is very happy with the results.

Al Faretta wrote:
I was quoted silly money by the Moorfields Clinic but at the same time we don't want to compromise care in any way.

Many of the Moorfields NHS surgeons are also in private practice, some across the road at Moorfields Private, and although not Multifocals, your wife will get same expertise.

Regarding your own plans to undergo lens exchange, no mention of cataracts, I am surprised that having done so much research you would even consider this, let alone in a clinic where there "is a busy waiting room”.

Having spent so much time reading OERML you know that a busy waiting room cannot be compared to a busy restaurant!

There’re unlikely to be many people eating if the restaurant doesn’t serve good food, whereas I’ve been in OE’s busy waiting rooms on numerous occasions (before they banned me) when the majority of people were patients left with problems!

You’ve obviously invested a significant sum of money paying for consultations, saying, "It needs a lot of research to ensure we take the right decision and not subject ourselves to an 'experimental' procedure.”

Surely this contradicts your post on 3 December?

Al Faretta wrote: Multifocal vision technology cannot be considered 'experimental' any longer if it has been around for 10 to 15 years.

You’re unusual Al, because the first thing most people wanting treatment do when they find OERML is to ask me for advice, but you haven't, in fact you've been offering advice.

Btw, you might be interested to know that your varying IP addresses all coincidentally match the locations of Optical Express clinics.

Small world

I am a potential Multifocal lens patient as is my wife who has an early cataract. We have been researching this surgery for the last over one year as I have a prescription of +6.5 and my wife is -2 approx. I have seven friends and relatives who have had Multifocal lens surgery over the years since 2008 and we have been to five consultations - a Moorfields Private Consultant, an NHS consultant in private practise, Optical Express, Optegra and Optimax. We have gone through all the information and the Consent forms given by each clinic. I am keen to avoid glasses but did not do well on the Mono-vision trial. It needs a lot of research to ensure we take the right decision and not subject ourselves to an 'experimental' procedure.

I was quoted silly money by the Moorfields Clinic but at the same time we don't want to compromise care in any way. In general I would instinctively prefer a clinic with a busy waiting room for obvious reasons. Pretty much all clinics use the same pool of Multifocal lenses and the results of the surgery primarily hinge on that single factor. I am reconciled to some degradation of the quality of vision on using Multifocal lenses and they inevitably cause some glare, haloes and ghosting but the degree to which that can occur, I am told, is not definite as it is very individual and subjective.

So my search goes on for the moment but my wife has to have her eyes sorted by early next year if she wants to continue to drive. There is a profit motive in all Multifocal lens surgery as it is considered non essential and so not offered on the NHS. I am sceptical of some of the hype and it's best to have lower expectations to avoid disappointment. That’s what everyone tells me.

Hi,

I had these Oculentis Mplus 1.5 lenses implanted in March 2012 at Moorfields private clinic by a top recommended eye surgeon. I was -11. in each eye + some astigmatism and a long time wearer of gas permeable contact lenses since 1986. I am now 56 years old. I suffered from haloes, gash, contrast loss everything then severe dry eyes kicked in as the nerve endings grew back abit. In april 2013 a left eye laser capulsolotomy and then right eye lasek to restore missing distance vision. Severe dry eyes ever since. Am active in sports and work all day at computers and am now trying to get Scleral lenses to work to bandage my corneas. I signed the consent forms of course and did not do my homework. Should have had mono-vision as near vision requires additional reading glasses with sclerals or other multifocal glasses without sclerals. An ongoing never-ending saga !

Yes, it is an interesting response. Let's examine it.

The assertion that 'multifocal lens technology cannot be considered experimental' is contradicted by the assertion that 'it is negligent not to do ones own due diligence.' Which assertion are you supporting? The two are mutually exclusive.

I think unfortunately that you are also confusing a search engine with an image editing application. In OE's literature and for that matter on the Oculentis web site I do not see any examples of visual artefacts presented to prospective patients. The way you would do this is to take an image, a photo from a mobile phone would suffice, and have a Photoshop artist sit with the patient and work with them until they had produced a representation on screen of the image the patient is seeing. Or, if patient happened to be familiar with Photoshop, they could do it themselves. It is not, as they say, rocket science. Whether or not I searched for the end result is rather beside the point.

I am however somewhat disturbed that you seem to think the onus is on the patient. Are you suggesting that searching Google in some way constitutes informed consent? Or that these companies should be permitted to abdicate responsibility for their actions and for their products because their grandiose claims are contradicted by negative posts on forums and in blogs? Or that social media is in some way an acceptable substitute for regulation?

There is I suspect a very considerable gulf between our two perceptions of the problem. You seem to think that it is acceptable to pass lenses, which by your definition are at best a work in progress, off as ubiquitously suitable is acceptable. My eyesight with glasses and contact lenses was orders of magnitude better than with multifocal intraocular lenses. Nobody told me that even with successful surgery my quality of vision could end up significantly worse.

I'm afraid I find the idea that multifocal lenses have not to be experimental simply because they've been around a while to be risible. I would like to see where the specific process by which the brain adapts to MFIOLs is described and documented. It is not understood, therefore these lenses are experimental.

Another case in point. When I spoke with an optician at OE regarding the increase in floaters post-surgery I was told: 'sorry, we only deal with the front of the eye.' The rest of the eye was deemed not to be their problem. This is indicative of the kind of selective care provided. It is not, as you have actually described in your post, of a merchandisable quality, let alone of an acceptable medical standard.

And sorry - what's your motivation for defending MFIOLs in this context? Have you been implanted with them? Are you satisfied?

Al Faretta wrote: In these days of Smartphones and the Internet, Google can provide more info than Photoshop. It is negilgent not to do ones own due diligence.

a) Not everybody uses the internet but if my GP told me to Google the answer to my problem to save his time I would be horrified!

Imagine a cardiac surgeon telling you to Google the information instead of personally explaining all the pros and cons before open heart surgery!!

b) It is not the patients responsibility to do due diligence it is the surgeons responsibility to FULLY INFORM the patient!!

Multifocal vision technology cannot be considered 'experimental' any longer if it has been around for 10 to 15 years. Like any technology it will be going through a process of evolution which will lead to continuous improvement of successive lens models. Any of us would need to get on to the band wagon at any stage determined by when we deem it expedient to do so. In general the longer you wait the better the lens will be, just like computers or cars. But none of us are growing any younger.
All we can do is educate ourselves as much as possible and then take the plunge. In these days of Smartphones and the Internet, Google can provide more info than Photoshop. It is negilgent not to do ones own due diligence.
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admin: Al Faretta (aka Al Farretta), it would be appreciated if you please declare your interests as Anon did.

Interesting thread and feel I should probably chime in. Please excuse the point form of my response.

In the interests of disclosure:
1) I am in the business of ophthalmology and refractive surgery - an area I enjoy tremendously and one I take very seriously ensuring patients are selected carefully and appropriately
2) I consider myself a proper doctor who considers the best interests of patients. I am not a "technician" - something that BUPA would have all their members believe about consultants.
3) I use multifocal or accommodative lenses in 95% of my patients, have done so for the last 10+ years.
3) Multifocal lenses vary considerably in terms of performance and in making a decision the patient/s occupation and lifestyle must be considered. Additionally corneal optics and derived aberrations play a considerable part as do other factors like e.g the presence of dry eye. in not considering these issues, there is a considerable risk a patient will be implanted with a lens where this actually is relatively contraindicated. The use of these types of lenses is an "art-form". Furthermore patients must be counselled well and must be allowed time to digest the information and make an INFORMED DECISION.

Sorry to hear of your problems Carl G. BUPA do not have enough medical knowledge to advise their members and redirect them in terms of referral. They are a 3rd party reimburser and should in my view stick to that role. They are also financially motivated to send patients to true "technicians" and this can only be considered a conflict of interest. Additionally in the same way I as a doctor am not qualified to indicate to you who to choose as a private medical provider (and could be seriously liable), BUPA are in a similar position when it comes to giving medical advice. In reality they have an agenda to "break in" doctors and have them become subservient to BUPA in order to survive in private practice (they are the largest insurance provider and monopolise the space). BUPA members should question whether this behaviour is appropriate and in their interests. Doctors (senior, experienced and not likely to play ball) that some need the most are thus likely to be excluded from choice by BUPA members - unfair.

As BUPA redirected you, from an ophthalmologist recommended by your GP then perhaps they are liable for your less than ideal outcome. I would therefore include them in your legal action and arguably you probably have better chances against them than OE or your surgeon.. You would not have been in this position if it had not been for BUPA. The Financial ombudsman does not understand this issue of medical responsibility, however if you challenge the Ombudsman and ask them whether BUPA are appropriately qualified medically to redirect, they will have to ask for an expert or a body like the GMC or BMA to comment.

M Plus lenses are zonal refractive multifocal lenses which can produce major issues with visual quality. Like all multifocal lenses there is considerable dependency on brain adaptation - probably more so and in a number of cases this does not happen. As to whether there is any liability on the part of OE and your surgeon -that is debatable.

Bottom line is you need to have the lenses replace with another variety of multifocal (diffractive) or monofocal implant. The former is possible and patients have obtained excellent outcomes. Since BUPA got you into this mess convince them to pay for your corrective surgery and get seen by someone who does this regularly.

admin: Moved to BUPA thread
www.opticalexpressruinedmylife.co.uk/ind...6048-bupa-aviva.html
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You're quite right Adam. What also disturbs me is the way the focus of this so-called industry has changed. When I asked my GP about my cataracts he referred me to an independent surgeon, who would have given me an unbiased opinion as to whether I needed surgery, stronger reading glasses or whatever. Instead BUPA declined to cover the cost and sent me to Optical Express.

That's an entirely different conversation, although course I didn't realise it at the time. OE simply needed surgical patients, never mind whether the patients actually needed surgery. BUPA's rule changes have had a subtle but profoundly disruptive effect on the entire landscape of eye care in the UK, and they too need investigating.

I know what a hiding to nothing that is though. I complained about BUPA through their internal procedures, and then followed this up with the Financial Ombudsman Service. About now you may be going - eh?

This is a part of the layers of obfuscation that surrounds the industry, and why it needs proper regulation. BUPA, despite the fact they have made what is ostensibly a medical decision with respect to suppliers, are not answerable to any medical authority. Instead they are regulated by the Financial Conduct Authority.

In making the decision to direct me to Optical Express, BUPA moved me from a medical referral into a treatment path that is broadly categorised as 'cosmetic surgery.' I mean, WTF? It's like needing a cardiologist but being sent for a face lift. BUPA, by virtue of their position, influence medical outcomes, and yet they are not regulated as a medical supplier.

Inevitably the Financial Ombudsman supported them. They hadn't contravened any of the rules of insurance broking after all. The fact that they had completely changed the nature of my medical treatment and not mentioned it was neither here nor there. It's another example of the subtle lies which permeate this so-called industry.