TOPIC: Refractive Lens Exchange (RLE)

Hi

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?

Many thanks
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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.

Meanwhile, contact Tweedledum - This email address is being protected from spambots. You need JavaScript enabled to view it. - and insist that you see Alex George (aka Dr Duck) asap! If this is not arranged then you must contact the GMC.

If you need further help please send an email

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.

Happy New Year, I hope.

(These posts will seem out of order because of image upload limit; please read backwards

Reading example:



Street vision shows up some very annoying artefacts too. This is bright ambient light but note the double image and variable sharpness of edges:



Watching TV is not fun; this is about three metres away:



Driving at night will be on the next post.

@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.

www.eyenews.uk.com/features/ophthalmolog...k-into-the-iol-space

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).

400 Swedes injured by faulty Oculentis lenses!
www.thelocal.se/20181127/over-400-swedes...ty-artificial-lenses

www.ncbi.nlm.nih.gov/pubmed/28780781

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?

I wasn't.

www.ncbi.nlm.nih.gov/pmc/articles/PMC5682778/

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.

Two years after my lens op performed by Dr Jan Venter, many letters of complaint ignored, term and conditions thrown at me, awful after-care, £50 charge for appointment after 1 year - I am in constant pain with both eyes, but the right one is considerably worse.
My eyes are watery, they feel sore and prickly. I feel like they are constantly being strained. In the morning my right eye is stuck together. My sight for reading is becoming increasingly difficult (this was the only part I was originally happy about)
When I read my eyes become painful, blurry and I can see something I can only describe as ‘blobs’.
My distance was never good after the op, but I feel it is deteriorating. I can only work on the computer for short periods of time. I intended to work full time after this op to help pay back the loan. I haven’t been able to do this, as my work consists of reading and modifying for profoundly deaf students and I know the pain would be too much.

Optical Express use hard selling tactics and then cover themselves in the small print.
My eyes are ruined, I’m in constant pain. I’m in debt. I paid a lot of money for a product that has not worked and put me in a worse situation than before the op financially and physically.

I am left with very painful eyes, SPK, clouding behind one eye and still wearing glasses. Nightmare!!!

This is just a brief summary of my experience. I thought 7 pages may be too long!
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Hello,
I thought i would use this forum to give you my horror story with Optical Express (OE) so that others going through this awful experience know that they are not alone.

I work for the emergency services and decided to go to the free consultation with OE as they seemed like a reputable company that carried out a lot of eye surgeries successfully. When i arrived at the consultation with the idea of getting laser eye surgery to reduce my dependancy on glasses for my job, i was quickly informed that my eyesight was far too poor for that surgery however, i could get RLE surgery. When i was told it would cost me in excess of £6,500 i laughed and walked out as my public servant wage did not deliver those monies.
Within days i was offered a lower price with a better payment plan. I see the sales tactic now but at the time i was blind to it - no pun intended. My wonderful elderly father gave me the cash as an early inheritance and i booked the surgery, as i trusted what had been told to me. I was told of the minimal chances of any or all complications being less than 1% and told in the majority of cases these complications diminished as the patient healed. This included the minimal risks of haloes/glares/starbursts.
Within a day post op i knew something was not right. My vision was poor near and distance, i had day time glares and severe night time glares/haloes and starbursts, so much so that i could not return to work as the alleged 3 day recovery quoted suggested. In fact it would be three months before i returned to work. During this period I was frequently told that these symptoms would dissipate as time passed as it was very rare for them to remain. It was all down to my brain neuroadapting. Now this is a word that i had never heard of pre-op. After 9 months of having poor day time sight and having to wear glasses plus awful night time vision and a significant drop in confidence when driving at night, i was finally told i would need the multifocal lenses taken out and replaced with monofocal lenses. The risks were high. Higher than the previous surgery but i was advised it wasn't an uncommon procedure carried out there.
Obviously by this time i had lost all trust in OE and thankfully had found this site, so i started to research more into this phenomenon and found out the chances of haloes/glares/starbursts was nearly 40% in some studies!! In fact one of the OE surgeons stated he usually tells all his patients that they will experience these symptoms after this type of surgery as it is so common!!
If i had known about this i would NEVER of had the surgery as i am facing the prospect of losing my job if i don't have the risky explantation surgery. People may say, well its obvious why you say that now, hindsight is 20:20 (sorry). However, prior to the surgery i discussed monofocal implants instead of multifocal implants with the OE staff, as it was a cheaper option but decided against it as i was told my brain had to adjust to the lenses being at different focal lengths (which made sense) and this could take an unspecified length of time. This shows that i would have decided against any surgery that had a significant risk to getting back to my work quickly. And i was repeatedly told the risk of any complication was 1% and a percentage of that 1% had a risk of glares/haloes with an even smaller percentage of them not recovering. So going by that the risk of having glares/haloes permanently was less than 0.5%. Plain faced liars.
Currently i am weighing up my choices of whether to have the risky explantation surgery (10-20% chance of blindness) within the NHS or keep the eyesight that i have been left with and lose my job that i have loved for 20 years. Not an easy choice to make......

Guy From North Wales wrote: Can I say thank you to those of you that have replied, sometimes you can read stuff and think how can they get away with all this. We live in a country where so much stuff is questioned under wether its politically correct and yet here is a company getting people to sign with no idea what they are signing because they are so carried away with this idea of better vision, the quality of the establishments that yes most of us get dragged in. But this isnt our nails or bigger breasts, its not cosmetic this is one of the most important things our vision. So for me some replies have really really helped and I can see I am not alone and indeed reading through the forum can actually see I am probably quite lucky.
Claire Foley I am going to try the doctors, mainly because I have psoriasis which is also stress related and this isnt in anyones interest the fact I am worried about my vision and losing one eye sight and not being able to drive. I went private rather then asking the NHS so now it has gone wrong I am not going to be proud but ask for help.

Hi,
I'm in a similar position to yourself in that I had rle surgery and suffer from.bad glares/haloes which mean I need explantation surgery through the nhs. However the risk of retinal detachment [20%] terrifies me. Is this the kind of figures you received?