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TOPIC: Refractive Lens Exchange (RLE/NLR)

Multifocal lenses and why you shouldn't. 03 Dec 2015 15:19 #91

  • Michael Clayton
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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 !

Reply to Al Faretta 03 Dec 2015 13:33 #92

  • Carl G
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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?
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Refractive Lens Exchange (RLE) 03 Dec 2015 13:19 #93

  • Pythagoras
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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!! :ohmy:

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

Refractive Lens Exchange (RLE) 03 Dec 2015 12:11 #94

  • Al Faretta
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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.
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Refractive Lens Exchange (RLE) 02 Dec 2015 22:19 #95

  • Anon
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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.

Multifocal lenses and why you shouldn't. 02 Dec 2015 13:23 #96

  • Carl G
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admin: Moved to BUPA thread :kiss:
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.

Multifocal lenses and why you shouldn't. 01 Dec 2015 14:54 #97

  • adam
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Carl G wrote: As in 'previous lenses were completely rubbish, these are marginally less so.' I think all implanting surgeons, at onset of presbyopia, should be required to undergo refractive lens replacements. What percentage of implanting surgeons favour MIOLs over reading glasses?


Carl, your suggestion that all these surgeons should have their own lens replaced before they touch anyone else's is an important point as I have not seen a single OE surgeon without glasses.

Cataracts and severe short/long sight are the only good reasons to undergo RLE. I know one person who did this because of his severely compromised vision and he did benefit from the surgery, but he now has halos, double vision and glare, and he is not able to drive at night.

It is completely CRIMINAL when they operate on people who have perfectly good vision like you and I did and they ruin it for what? Money! I would gladly have given them money, its my loss of my beautiful vision that I mourn.

NHS repair service 01 Dec 2015 13:44 #98

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Fitted with MPlus X lenses in 2014, like so many others Mr Z was left with severe side effects and poor vision.

Last year an independent surgeon advised he should undergo an explant, but at approx £11,000 this does not come cheap! Hence why I advise anyone left with problems to pursue legal action, so they can at least afford to pay for reparative treatment if it's an option.

As I advise all damaged patients, Mr Z had asked his GP for a referral to an NHS eye specialist, and last week I accompanied him to a consultation at Moorfields Eye Hospital - not to be confused with Moorfields Private which is an exclusive wing for fee paying patients.

At least one hundred NHS patients were waiting to be seen by only four consultants, though time is saved with standard eye tests conducted by an optometrist, followed with an examination by an ophthalmologist who notes details for the consultant’s examination.

The examination area in the NHS clinic is divided into approximately a dozen, side by side, open cubicles, each partitioned off with glass dividers. One of the benefits of this layout is that each doctor is able to call on a colleague for another opinion if need be. In fact Mr Z was examined by not one but three ophthalmologists, two of them consultant surgeons.

I had met the named consultant looking after Mr Z when I attended a Grand rounds* last year, who I will refer to as Mr F.

NHS surgeons are not happy about offering explants to patients because, quite rightly, it should not be the NHS who have to bear the significant cost but the private providers responsible for causing the issues.

Mr F said something had to be done for Mr Z as he could not be expected to go on with the vision he has, but I was very surprised when he suggested the option of an explant provided by the NHS!

Mr F stressed that he would ensure Mr Z was fully informed of his options, and the accompanying risks before he agreed to further surgery.

Totally supportive of what I am doing, and critical of the high street industry, he added that it was obvious Mr Z had not been fully informed by OE and he would not let that happen to him again.

He advised Mr Z that there was no guarantee that retreatment would improve his vision, that it could make it worse. He said he therefore wanted two weeks to confer with colleagues and explore at length the possible benefits and risks of further surgery.

If an explant is agreed it will be at significant cost to the NHS, and once in writing this will set a precedent for countless more patients to follow suit.

Perhaps when Jeremy Hunt realises exactly how much this could cost the government he will start listening, instead of passing the buck to the CQC, GMC and RCOphth.

Money is what grabs people's attention - especially when they’re losing it :kiss:

*Grand rounds are an important teaching tool and ritual of medical education and inpatient care, consisting of presenting the medical problems and treatment of a particular patient to an audience consisting of doctors, residents and medical students.
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Multifocal lenses and why you shouldn't. 01 Dec 2015 09:25 #99

  • Carl G
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I've just read this again:


www.simovision.be/en/producten/presbyopia-lentis-m-plus-t-3/

I'm trying to reconcile the difference between my experience and this description. "In particular reflections, image jumps and loss of contrast sensitivity... will be avoided. Glare effects and halos will be significantly reduced"

Like hell they will.

I can only assume that the comparison is made with the benchmark being an unacceptably low baseline. As in 'previous lenses were completely rubbish, these are marginally less so.' I think all implanting surgeons, at onset of presbyopia, should be required to undergo refractive lens replacements. What percentage of implanting surgeons favour MIOLs over reading glasses?

I also despise the fact that this is constantly referred to as an 'industry,' with all the profit-related connotations that brings. What this 'industry' needs is regulators with teeth, not the cosy old-boys (and girls) club that currently prevails.
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Multifocal lenses and why you shouldn't. 30 Nov 2015 22:53 #100

  • Adam
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Hi Carl,
You make excellent comments concerning the debilitating results of these lens. Nature perfected our vision over millennia yet greedy manufacturers and butchers employed by sociopath businessmen brainwash people to believe they have bettered the natural lens within the past 10-50 years!

OE and their ilk are nothing but evil. Unfortunately for those they have damaged I cannot imagine how they can get justice when the organisations such as RCOphth, GMC, CQC and MHRA all seem to be singing from hymn sheets written by the cowboy eye surgery industry.