OptiVue

The first day back to the operating room with my ReSTORed eye! Vision through the microscope was extraordinary. Guy Knolle once told me that he thought after he had his bilateral Array that his depth perception at the microscope was significantly better than it had been previously, and he found that he didn’t have to adjust focus as much as he had previously. From my personal experience in the OR today, I believe this is probably true. My depth perception is excellent and my subjective impression is that less focusing was necessary. Returning to surgery at Day 2 was a breeze and a pleasure.

No halos for night time driving or at any other time! No waxy vision, no glare, no decrease in vision. The vision does, however, fluctuate during the course of the day. The cornea has some mild SPK, which is probably the reason for the fluctuation. Vision following artificial tears immediately improves. Reading vision continues to improve. Visual acuity for near vision under dim lighting is a little difficult. However, stock pages, newspaper and telephone listings are easily readable with good lighting. (No reading glasses on un-operated eye.)

Again, one of the impressive things about the results of the surgery is the quality of vision. Visual acuity in the operated eye is amazing. The term high definition is thrown around quite a bit these days. But, frankly, it really is a term that keeps coming to my mind to describe how remarkable my vision seems to be. The best way to explain the quality is simply that the edges of things are sharp and distinct. The leaves on the trees, edges of lettering, and patterns of roof tiles are all bold.
No discomfort.

I am eagerly looking forward to having my second eye done in a week and a half.

Many of you may be aware that I recently had the incredible opportunity of having multi-focal cataract surgery on my left eye. This was a truly remarkable experience. I’ve been an ophthalmologist for 28 years and have done over 25,000 cataract procedures, including 3,000 multi-focal implants.



I have been involved with multi-focal implants since the IoLab Bulls Eye lens in the 1980’s, and with every multi-focal lens, including the Array, ReZoom, crystalens, ReSTOR (all iterations) and tecnis. Many of you have inquired regarding my experience and how my personal procedure compared to the thousands of patients that I have done in the past.



Truly it was an “eye opening” experience. Many of you have already read the post that I made on line of an Email that I sent to Kerry Solomon two hours after my procedure. I will attempt over the coming days to describe to you day by day how my vision is evolving.



Suffice it to say, I have been blown away by my results so far. Even though I use all currently available multi-focal lenses, I chose the ReSTOR 3 aspheric, Lens SN6AD1, since this is my lens of choice. In order to receive this lens, I actually had to wait (longer than I was comfortable with) because it was not available in the power I needed.



This is not meant to cast a negative aspersion on any of the other multi-focal or pseudo accommodating lenses. I have used them all. They all work, and they all work well. It’s just that my personal impression, after having done so many lenses, is that the ReSTOR lens had the highest probability of giving me the vision that I wanted in the ranges that I was most comfortable with.



I will keep you updated on a daily and weekly basis as to my progress, and if any of you should have any questions that require my personal attention, please do not hesitate to Email me.





Operation Day

My procedure was done in Charleston, South Carolina, by Kerry Solomon. I have always felt the need to have a physician who is not only knowledgeable and skilled, but personable, and Kerry is simply a great guy.



I requested that I receive minimal sedation during the procedure, as I wanted to be able to see as much of the procedure as I could from the patient’s point of view, including whether or not I could actually visualize the procedure itself.



We have all had the experience of patients telling us that they could see this aspect or that aspect of the surgery - they could see the lens, or they could see an instrument. I have always wondered optically how that might be possible and whether or not they were just simply describing some shadow.



Remarkably, I could actually visualize many of the parts of the procedure. The part that was the easiest to visualize was the capsulatomy – the movement of the capsulorhexis forceps was clearly visible: the movement of the forceps and the increasing size of the capsule flap. When the capsulorhexis was finished, I could see the outline of the capsulorhexis as well. (By the way, Kerry, perfect circle.)



Since I had a small amount of cylinder, approximately ½ diopter at 90 degrees, and Kerry would be performing the procedure clear cornea from the temporal position, he elected to perform a small limbral relaxing incision at 90 degrees. In addition to the capsulorhexis, I was able to see parts of the quadrant removal, and I could also visualize the intraocular lens being implanted.



Post-Op Day of Surgery

As noted in my Email to Kerry two hours after the procedure, I was astounded by the speed with which the vision rehabilitated. I was totally blown away. I had expected vision to improve slowly after the operation. However, literally by two hours after the operation the vision in my still dilated operative eye was better than my 20/20 unoperative eye. While there was a considerable amount of glare, because I was still dilated, and some light sensitivity, the difference in vision was clearly noticeable. As the dilation continued to resolve, the vision continued to improve. Walking around Charleston was a true treat, as the vision continued to get better and better. (By the way, if any of you want recommendations for some of Charleston’s finest restaurants, I’m your guy.) As nighttime fell, I was concerned about whether or not I would notice the glare and halos that many patients describe. In fact, both were minimal problems. Glare did not seem to be a problem under most circumstances. However, in walking down a dark street, when looking at blue halogen headlights, what I would describe as a glow, rather than a halo was clearly visible around halogen lights. (At this point, I was still slightly dilated.) Interestingly enough incandescent lights did not have that halo. From my perspective, rather than finding this glow bothersome, I actually found it quite pleasurable. After a good dinner, I returned to my hotel.



At 3:30 a.m., I awakened experiencing a dull, but intense, ache in my operative eye. I used my topical nonsteroidals and antibiotics, took two Tylenol and the discomfort resolved quickly. By the morning, the discomfort had returned, and while the vision was increasingly excellent, the pain while not intolerable was uncomfortable. My vision in the left eye (no reading glasses for the left eye!) was good enough to read the paper as I drank my morning cup of coffee before going to Kerry’s office.



When I arrived at Kerry’s office, I was curious to know the level of my visual acuity. Vision was measured by Kerry’s technician: 20/20+ in the operative eye and J1+. The big surprise however, was that the IOP was 38! The technician instilled a couple of drops of Cosopt and further testing was done to determine the status of my left eye. Within an hour, the intraocular pressure had lowered to 20 and the aching discomfort was long gone. The rest of my day for post-op day #1 was spent walking around the city of Charleston. (By the way, I highly recommend Charleston as a place to visually rehabilitate. There are very few cities that are more beautiful in the United States, and it was a true pleasure spending my day walking through the streets, as my vision continued to get better.)



One of the most remarkable things about this procedure, as far as I am concerned, is that even though my vision is currently approximately 20/15, it almost seems as if every day the quality continues to improve. Certainly, this is something that we have told patients for years. However, I had not expected to see the continued improvement when my vision was already at the level of 20/20. I’m sure this has something to do with the continued resolution of cell plus flare in the anterior chamber, but it continues to be a delightful surprise to me.



By the time I had returned to my home in Toledo, Ohio, it was late night. Driving from the airport to my home, the first thing that I noticed was – no halos! Only twenty-six hours after the procedure had been done, no halos. No halos whatsoever. In addition, no glare. There is some minimal “spoking” around pinpoint light sources. However, I actually have more spoking in my unoperated right eye, and I have less spoking in my left eye than I had previously experienced with glasses or contacts, even when I was younger. For me at least, glare and halos are not an issue.



Let me make one thing perfectly clear at this point. I call myself the poster child for this procedure. While all of us have had the experience of patients recuperating quickly, most of us realize that the experience of most patients is a slow, steady process toward better vision. In fact this is what we tell patients pre and postoperatively. Nothing in my reporting of my own personal experience should suggest this is a universal experience. It is not. Clearly, I am doing much better than the average patient normally does, and I am enormously grateful and enjoying every minute of it.

Many of you may be aware that I recently underwent cataract surgery in my left eye with the ReSTOR implant. In fact, it was two days ago! Outlined below is correspondence I sent Kerry Solomon two hours after my procedure, and it is pretty much self-explanatory. I am going to try and update my status on a daily or weekly basis, as things progress. However, day one my visual acuity was already 20/20+ and J1+.

All I can say is, "Wow!"


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September 22, 2009

Kerry Solomon, M.D.
Storm Eye Institute
167 Ashley Ave.
Charleston, SC 29403

Dear Kerry:

I am enormously grateful for the gift that you gave me this morning ? the gift of vision. I am walking around Charleston (two hours post-op) and, while still dilated, can already see better out of my operated "new" eye than I can out of my 20/20 "good" eye. I can read distant signs and intermediate objects better out of my operated eye, and my reading vision with my right eye (with no reading glasses) is at least the equivalent of my left eye with reading glasses. (Did I mention that my right eye is still dilated?)

As I am sitting here writing, the vision is already better now than when I started writing this note just a few moments ago. (And, I'm still dilated!) Much has been said about the chromaphore in the ReSTOR®. I had been told (by reps from other companies) that patients object to the "difference" between the eyes when the ReSTOR® is coupled with lenses without chromaphore. I know from personal experience that this is not true. I have done several hundred patients with paired ReSTOR®/ReZoom™, ReSTOR®/Crystalens®, or ReSTOR®/TECNIS®. The only complaint in general that I hear from these patients is regarding quality ? the quality in the ReSTOR® eye seems to them to be better than the opposite eye. I can now tell you from personal experience that color perception is truly remarkable with my ReSTOR® eye: whites are crisp and bright, colors are vivid and intense.

The entire experience was a true pleasure. Your new facility is beautiful, comfortable and efficient. The staff is well trained and personable, and they put me at ease. They treated me with kindness and warmth, even when they didn't know I was an ophthalmic surgeon. (By the way they, rightfully, worship the ground you phaco on.)

Over the years, I have had the privilege of performing over 25,000 cataract surgical procedures and over 3,000 multifocal lenses. Refractive lens surgery has always been one of the most gratifying and rewarding parts of my practice. I have used every multifocal and pseudo accommodating lens since the IOLab Bull's Eye in the 1980's (Array®, ReZoom™, ReSTOR®, Crystalens® and TECNIS®), and I have been tempted to have one of the other lenses implanted in my own eyes, even though the ReSTOR® is my lens of choice. (As you know the ReSTOR® was not available until recently in the power that I needed.) Wow, am I glad that I waited!

There is, however, one serious downside to the experience that I need to complain about:

We should have stuck with our original plan to do both eyes two days apart, instead of two weeks! What was I thinking?

I am looking forward to seeing you again in two weeks. I am a very happy ReSTORer!

Gratefully,



William G. Martin, M.D., FACS
Chairman of the Division of Ophthalmology
Associate Professor of Ophthalmic Surgery
University of Toledo College of Medicine

WGM:lms

P.S. I don't know if you're aware that one of my hobbies is writing and selling jokes. I've had the pleasure over the years of selling jokes to many professional comedians, television and on line. The following is a joke that I recently sold, which I think you'll find appropriate:

This guy goes to the eye doctor to have eye surgery. The doctor asks him, "Why are you here?" The guy says, "I'm here because my wife thinks eye surgery will help me to see better." The doctor asks, "Well, what's wrong with your vision?" The guy says, "I don't see things the way she does."

Unfortunately, the surgery was unsuccessful.