Just had cataract surgery - original problem seems worse

On Nov 17, 7:35*pm, Jane <clinton6...@hotmail.com> wrote:
> On Nov 17, 5:45*pm, roberu...@gmail.com wrote:
>
>
>
> > On Nov 16, 12:09*pm, otisbr...@embarqmail.com wrote:
>
> > > Dear Robru,
>
> > > Subject: *Variable results from cataract surgery.
>
> > > I regret your results -- but it usually takes a week before the
> > > replacement lens
> > > "settles out".
>
> > > I had a check on day after surgery, and then took "drops" for a week.
>
> > > After a week, I was about 20/30 to 20/25. *This was far better than
> > > the naked eye vision I had of about 20/600 when my eyes
> > > had a negative refractive STATE.
>
> > > So -- give it some time. *Your results might not be that good, but
> > > there are some very good results from cataract surgery. *From me,
> > > there was not choice -- other than the surgery.
>
> > > Best,
>
> > > On Nov 16, 12:46*pm, roberu...@gmail.com wrote:
>
> > > > On Nov 15, 8:37*pm, Glenn Hagele - USAEyes.org
>
> > > > <glenn.hageleSTOPS...@USAEyes.org> wrote:
> > > > > As Dan said, it is way too early to come to any conclusion about your
> > > > > outcome. Discuss your concerns with your surgeon and please, report
> > > > > back here for others to learn more.
>
> > > > Many thanks, Glenn and Dan. *The flickering has abated somewhat, and I
> > > > am encouraged by your advice. *Will definitely post the results of
> > > > follow ups.
>
> > I went to see my surgeon today, because I also developed a new
> > problem. *Here is a list of all of them:
>
> > 1. Glare is worse. *Lights now show beams or rays going through them.
> > 2. I experience a periodic flutter in my visual field, like a camera
> > being jiggled.
> > 3. I can see a dark arc in the corner of my eye on the right side.
> > 4. I am getting "ghost", slightly double images.
>
> > The surgeon told me everything looks fine. *The IOL is perfectly
> > centered and my eye is healing nicely.
>
> > He explained all of the above by saying that the lens envelope needs
> > to shrink around the new lens, which is much smaller than one's
> > natural lens. *He said this could take up to three months. *That is
> > what is causing every one of the above described "special effects".
>
> > I want to believe him, but if all of this is true, why was I not told
> > about it up front? * I can't help but think he made some kind of
> > mistake during the procedure.
>
> > I am currently scheduled to have the other eye done on the 5th and am
> > inclined to postpone that and get a second opinion. *I now wish I had
> > not had this surgery done at all, as my vision is markedly worse.
>
> Roberu, try googling "dysphotopsia", which is the term for your
> symptoms. *(The article by Randall Olson in "Review of Ophthalmology"
> is particularly good.) *In most cases, these symptoms diminish with
> time due to neuroadaptation; however, sometimes the IOL needs to be
> explanted. *I've read that the problem is caused by a poor fit between
> the IOL and the recipient's physiology. *(You would not want to get
> the same brand of IOL implanted in your other eye.) *It would probably
> be very wise to wait until you're satisfied with the vision in your
> first eye before having a second surgery. *In your place, I'd
> definitely cancel the second surgery for now, and I'd get for an
> independent second opinion.

Thank you, Jane. You're right -- all of my symptoms are a type of
dysphotopsia. And in Googling the term as you recommended I found one
source that says it affects up to 10% of cataract patients. I'll bet
also that these patients -- like me -- do not have very "ripe"
cataracts. If I had been nearly blind with cataract disease, the
artifacts I am now experiencing would probably not be noticed as much
or bother me as much, given the radically improved vision.

Perhaps the surgeon's three-month interval is to allow for
neuroadaptation, which also appears to take care of these problems for
many people. I do find it odd that among the many complications
listed in the consent form, you will not find "dysphotopsia".

Interesting. Thanks again.

Rob

On Nov 17, 11:25*pm, "David Robins, MD" <trasha...@runbox.com> wrote:
> On 11/17/08 3:45 PM, in article
> d5ee1e66-4858-4829-9923-339c5af56...@s9g2000prg.googlegroups.com,
>
>
>
> "roberu...@gmail.com" <roberu...@gmail.com> wrote:
> > On Nov 16, 12:09*pm, otisbr...@embarqmail.com wrote:
> >> Dear Robru,
>
> >> Subject: *Variable results from cataract surgery.
>
> >> I regret your results -- but it usually takes a week before the
> >> replacement lens
> >> "settles out".
>
> >> I had a check on day after surgery, and then took "drops" for a week.
>
> >> After a week, I was about 20/30 to 20/25. *This was far better than
> >> the naked eye vision I had of about 20/600 when my eyes
> >> had a negative refractive STATE.
>
> >> So -- give it some time. *Your results might not be that good, but
> >> there are some very good results from cataract surgery. *From me,
> >> there was not choice -- other than the surgery.
>
> >> Best,
>
> >> On Nov 16, 12:46*pm, roberu...@gmail.com wrote:
>
> >>> On Nov 15, 8:37*pm, Glenn Hagele - USAEyes.org
>
> >>> <glenn.hageleSTOPS...@USAEyes.org> wrote:
> >>>> As Dan said, it is way too early to come to any conclusion about your
> >>>> outcome. Discuss your concerns with your surgeon and please, report
> >>>> back here for others to learn more.
>
> >>> Many thanks, Glenn and Dan. *The flickering has abated somewhat, and I
> >>> am encouraged by your advice. *Will definitely post the results of
> >>> follow ups.
>
> > I went to see my surgeon today, because I also developed a new
> > problem. *Here is a list of all of them:
>
> > 1. Glare is worse. *Lights now show beams or rays going through them.
> > 2. I experience a periodic flutter in my visual field, like a camera
> > being jiggled.
> > 3. I can see a dark arc in the corner of my eye on the right side.
> > 4. I am getting "ghost", slightly double images.
>
> > The surgeon told me everything looks fine. *The IOL is perfectly
> > centered and my eye is healing nicely.
>
> > He explained all of the above by saying that the lens envelope needs
> > to shrink around the new lens, which is much smaller than one's
> > natural lens. *He said this could take up to three months. *That is
> > what is causing every one of the above described "special effects".
>
> > I want to believe him, but if all of this is true, why was I not told
> > about it up front? * I can't help but think he made some kind of
> > mistake during the procedure.
>
> > I am currently scheduled to have the other eye done on the 5th and am
> > inclined to postpone that and get a second opinion. *I now wish I had
> > not had this surgery done at all, as my vision is markedly worse.
>
> You seem to probably have photosias related to the IOL. The jiggle is the
> IOL vibration in the eye. The dark arc is a known, but less common, ivusal
> effect, less commonly seen than a bright arc due to light reflecting
> internally in the lens. The ghosting may be uncorrected refractive error -
> you still need to get tested for glasses, for example, for residual
> astigmatism, which may causes ghosting. The glare and beams may be faint
> wrinkes in the empty lens capsule, which does need to shrink to make it
> smoother and tighter. If wrinkles stay there and bother, the capsule is
> lasered to make a clear opening. *None of these are necessarily due to a
> surgical problem, just part of the usual.
>
> These visual phenomena are not usually discussed beforehand, as most people
> are not that sensitive to them. If you describe them all beforehand,
> everyone will be looking for them and see most of them.
>
> Might you be an engineer, perhaps?

Thanks, Dr. Robins. I am in computer science. I do tend to notice
things that other's don't, but these artifacts are very noticeable. I
now know that they are relatively common and also that many people
neuroadapt to them. Your explanation of why they are not described
beforehand makes sense. On the other hand, if one expects them, there
might be less of an emotional reaction and feeling that "something
went wrong", which might make it easier to adapt or habituate to
them.

I think the second opinion will help reassure me about the current
situation.

I appreciate your comments.

Rob

On Nov 17, 6:45*pm, roberu...@gmail.com wrote:
> On Nov 16, 12:09*pm, otisbr...@embarqmail.com wrote:
>
>
>
>
>
> > Dear Robru,
>
> > Subject: *Variable results from cataract surgery.
>
> > I regret your results -- but it usually takes a week before the
> > replacement lens
> > "settles out".
>
> > I had a check on day after surgery, and then took "drops" for a week.
>
> > After a week, I was about 20/30 to 20/25. *This was far better than
> > the naked eye vision I had of about 20/600 when my eyes
> > had a negative refractive STATE.
>
> > So -- give it some time. *Your results might not be that good, but
> > there are some very good results from cataract surgery. *From me,
> > there was not choice -- other than the surgery.
>
> > Best,
>
> > On Nov 16, 12:46*pm, roberu...@gmail.com wrote:
>
> > > On Nov 15, 8:37*pm, Glenn Hagele - USAEyes.org
>
> > > <glenn.hageleSTOPS...@USAEyes.org> wrote:
> > > > As Dan said, it is way too early to come to any conclusion about your
> > > > outcome. Discuss your concerns with your surgeon and please, report
> > > > back here for others to learn more.
>
> > > Many thanks, Glenn and Dan. *The flickering has abated somewhat, and I
> > > am encouraged by your advice. *Will definitely post the results of
> > > follow ups.
>
> I went to see my surgeon today, because I also developed a new
> problem. *Here is a list of all of them:
>
> 1. Glare is worse. *Lights now show beams or rays going through them.
> 2. I experience a periodic flutter in my visual field, like a camera
> being jiggled.
> 3. I can see a dark arc in the corner of my eye on the right side.
> 4. I am getting "ghost", slightly double images.
>
> The surgeon told me everything looks fine. *The IOL is perfectly
> centered and my eye is healing nicely.
>
> He explained all of the above by saying that the lens envelope needs
> to shrink around the new lens, which is much smaller than one's
> natural lens. *He said this could take up to three months. *That is
> what is causing every one of the above described "special effects".
>
> I want to believe him, but if all of this is true, why was I not told
> about it up front? * I can't help but think he made some kind of
> mistake during the procedure.
>
> I am currently scheduled to have the other eye done on the 5th and am
> inclined to postpone that and get a second opinion. *I now wish I had
> not had this surgery done at all, as my vision is markedly worse.- Hide quoted text -
>
> - Show quoted text -

You are about 3 days post op!!!!!!

The eye needs to heal. Have you ever had a bruise heal in three
days? There is inflammation in the eye and you cannot expect it to be
cleared up until after you have finished with your post operative
drops, about 4-6 weeks from now.

If concerned, postpone the Dec 5 procedure. A second opinion doesn't
make sense unless you still have problems 6 weeks from now.

On Nov 18, 12:11*pm, Dr Judy <mpac...@rogers.com> wrote:
> On Nov 17, 6:45*pm, roberu...@gmail.com wrote:
>
>
>
> > On Nov 16, 12:09*pm, otisbr...@embarqmail.com wrote:
>
> > > Dear Robru,
>
> > > Subject: *Variable results from cataract surgery.
>
> > > I regret your results -- but it usually takes a week before the
> > > replacement lens
> > > "settles out".
>
> > > I had a check on day after surgery, and then took "drops" for a week.
>
> > > After a week, I was about 20/30 to 20/25. *This was far better than
> > > the naked eye vision I had of about 20/600 when my eyes
> > > had a negative refractive STATE.
>
> > > So -- give it some time. *Your results might not be that good, but
> > > there are some very good results from cataract surgery. *From me,
> > > there was not choice -- other than the surgery.
>
> > > Best,
>
> > > On Nov 16, 12:46*pm, roberu...@gmail.com wrote:
>
> > > > On Nov 15, 8:37*pm, Glenn Hagele - USAEyes.org
>
> > > > <glenn.hageleSTOPS...@USAEyes.org> wrote:
> > > > > As Dan said, it is way too early to come to any conclusion about your
> > > > > outcome. Discuss your concerns with your surgeon and please, report
> > > > > back here for others to learn more.
>
> > > > Many thanks, Glenn and Dan. *The flickering has abated somewhat, and I
> > > > am encouraged by your advice. *Will definitely post the results of
> > > > follow ups.
>
> > I went to see my surgeon today, because I also developed a new
> > problem. *Here is a list of all of them:
>
> > 1. Glare is worse. *Lights now show beams or rays going through them.
> > 2. I experience a periodic flutter in my visual field, like a camera
> > being jiggled.
> > 3. I can see a dark arc in the corner of my eye on the right side.
> > 4. I am getting "ghost", slightly double images.
>
> > The surgeon told me everything looks fine. *The IOL is perfectly
> > centered and my eye is healing nicely.
>
> > He explained all of the above by saying that the lens envelope needs
> > to shrink around the new lens, which is much smaller than one's
> > natural lens. *He said this could take up to three months. *That is
> > what is causing every one of the above described "special effects".
>
> > I want to believe him, but if all of this is true, why was I not told
> > about it up front? * I can't help but think he made some kind of
> > mistake during the procedure.
>
> > I am currently scheduled to have the other eye done on the 5th and am
> > inclined to postpone that and get a second opinion. *I now wish I had
> > not had this surgery done at all, as my vision is markedly worse.- Hidequoted text -
>
> > - Show quoted text -
>
> You are about 3 days post op!!!!!!
>
> The eye needs to heal. *Have you ever had a bruise heal in three
> days? *There is inflammation in the eye and you cannot expect it to be
> cleared up until after you have finished with your post operative
> drops, about 4-6 weeks from now.
>
> If concerned, postpone the Dec 5 procedure. *A second opinion doesn't
> make sense unless you still have problems 6 weeks from now.

Thanks for the advice. I hope you are right. I do think that surgeons
should warn patients about the potential for dysphotopsia. They warn
about everything else, and dysphotopsia is far more frequent than any
other kind of complication.

I would also advise anyone who has been told by an eye examiner
(optometrist, etc.) that he/she requires cataract surgery to get a
second opinion. Just because you have cataracts does not mean you
require surgery.

Rob

Dear Rob,

Subject: My judgment.

I AVOIDED it -- until it was obvious that there was no choice at all.

Thus, when it "succeeded" I was indeed impressed.

Judy is correct. Give it time.

It was at least one week before things "settled out".

I am certain your naked eye was far better than mine -- so for
me it was a profound success.

I know this operation will strike each of use differently -- but
for me, I have discarded my minus lenses -- permanently I would hope.

Some people "object" to using the "plus" for me. Not me -- I think
the
engineering "trade off" is perfect.

But even here some people will COMPLAIN about there "near vision" and
the fact that they use a plus at near.

So, you can't please everybody -- so you got to please yourself.

(Where did I hear that before?)

Best,



On Nov 18, 5:13*pm, roberu...@gmail.com wrote:
> On Nov 18, 12:11*pm, Dr Judy <mpac...@rogers.com> wrote:
>
>
>
>
>
> > On Nov 17, 6:45*pm, roberu...@gmail.com wrote:
>
> > > On Nov 16, 12:09*pm, otisbr...@embarqmail.com wrote:
>
> > > > Dear Robru,
>
> > > > Subject: *Variable results from cataract surgery.
>
> > > > I regret your results -- but it usually takes a week before the
> > > > replacement lens
> > > > "settles out".
>
> > > > I had a check on day after surgery, and then took "drops" for a week.
>
> > > > After a week, I was about 20/30 to 20/25. *This was far better than
> > > > the naked eye vision I had of about 20/600 when my eyes
> > > > had a negative refractive STATE.
>
> > > > So -- give it some time. *Your results might not be that good, but
> > > > there are some very good results from cataract surgery. *From me,
> > > > there was not choice -- other than the surgery.
>
> > > > Best,
>
> > > > On Nov 16, 12:46*pm, roberu...@gmail.com wrote:
>
> > > > > On Nov 15, 8:37*pm, Glenn Hagele - USAEyes.org
>
> > > > > <glenn.hageleSTOPS...@USAEyes.org> wrote:
> > > > > > As Dan said, it is way too early to come to any conclusion about your
> > > > > > outcome. Discuss your concerns with your surgeon and please, report
> > > > > > back here for others to learn more.
>
> > > > > Many thanks, Glenn and Dan. *The flickering has abated somewhat, and I
> > > > > am encouraged by your advice. *Will definitely post the resultsof
> > > > > follow ups.
>
> > > I went to see my surgeon today, because I also developed a new
> > > problem. *Here is a list of all of them:
>
> > > 1. Glare is worse. *Lights now show beams or rays going through them.
> > > 2. I experience a periodic flutter in my visual field, like a camera
> > > being jiggled.
> > > 3. I can see a dark arc in the corner of my eye on the right side.
> > > 4. I am getting "ghost", slightly double images.
>
> > > The surgeon told me everything looks fine. *The IOL is perfectly
> > > centered and my eye is healing nicely.
>
> > > He explained all of the above by saying that the lens envelope needs
> > > to shrink around the new lens, which is much smaller than one's
> > > natural lens. *He said this could take up to three months. *That is
> > > what is causing every one of the above described "special effects".
>
> > > I want to believe him, but if all of this is true, why was I not told
> > > about it up front? * I can't help but think he made some kind of
> > > mistake during the procedure.
>
> > > I am currently scheduled to have the other eye done on the 5th and am
> > > inclined to postpone that and get a second opinion. *I now wish I had
> > > not had this surgery done at all, as my vision is markedly worse.- Hide quoted text -
>
> > > - Show quoted text -
>
> > You are about 3 days post op!!!!!!
>
> > The eye needs to heal. *Have you ever had a bruise heal in three
> > days? *There is inflammation in the eye and you cannot expect it to be
> > cleared up until after you have finished with your post operative
> > drops, about 4-6 weeks from now.
>
> > If concerned, postpone the Dec 5 procedure. *A second opinion doesn't
> > make sense unless you still have problems 6 weeks from now.
>
> Thanks for the advice. I hope you are right. *I do think that surgeons
> should warn patients about the potential for dysphotopsia. *They warn
> about everything else, and dysphotopsia is far more frequent than any
> other kind of complication.
>
> I would also advise anyone who has been told by an eye examiner
> (optometrist, etc.) that he/she requires cataract surgery to get a
> second opinion. *Just because you have cataracts does not mean you
> require surgery.
>
> Rob- Hide quoted text -
>
> - Show quoted text -

On Nov 18, 9:28*pm, otisbr...@embarqmail.com wrote:
> So, you can't please everybody -- so you got to please yourself.

Not too often, Dear Boy, or you'll go blind!

> (Where did I hear that before?)

Best guess? The voices, in your head.

On Nov 19, 7:21 am, "Mike Tyner" <mty...@mindspring.com> wrote:
> <roberu...@gmail.com> wrote
>
> > I would also advise anyone who has been told by an eye examiner
> > (optometrist, etc.) that he/she requires cataract surgery to get a
> > second opinion. Just because you have cataracts does not mean you
> > require surgery.
>
> OTOH, people choose to have LASIK electively. Complication rates are pretty
> similar between the two procedures and there are arguments for using
> cataract surgery as a treatment for refractive error.
>
> On cataract surgery the best advice used to be "you need surgery when you
> can no longer see to do the things you want to do."
>
> But it's appropriate to consider surgery at an earlier stage, if there is a
> big refractive benefit.
>
> -MT

Here's an update - two weeks after surgery.

The shimmering/giggling problem is gone. What remains are glare
problems at night and the negative dysphotopsia. On the glare
problems -- which are manifesting themselves as rays coming out of
bright lights -- my surgeon echoed what Dr. Robins said earlier in
this thread -- that wrinkles in the lens capsule could be the culprit,
and these should resolve as the capsule contracts around the iol.

I talked to my surgeon about replacing the lens and he recommended
strongly against it. The lens is a Clariflex, which has an edge
design that is intended to provide the advantages of square-edged iols
in minimizing post-cataract lens capsule clouding while also
minimizing dysphotopsia. He said that round-edged iols, which I
understand from the Medhelp forum and other places have the least
chance of causing negative dysphotopisa, are never used anymore due to
the lens envelope clouding issue. I am not sure that this is true.
However, as the other symptoms are abating I am going to hope that the
negative dysphotopsia will as well. Still going for a second opinion.

I think part of my problem is that no one prepared me mentally for
these after effects, and I did not do any research beforehand.

So I'd like to offer thanks to all for your advice and info.

On 11/28/08 11:42 AM, in article
63a31fce-7657-4aa6-aafd-57bb90b87a4c...oglegroups.com,
"(E-Mail Removed)" <(E-Mail Removed)> wrote:

> On Nov 19, 7:21 am, "Mike Tyner" <mty...@mindspring.com> wrote:
>> <roberu...@gmail.com> wrote
>>
>>> I would also advise anyone who has been told by an eye examiner
>>> (optometrist, etc.) that he/she requires cataract surgery to get a
>>> second opinion. Just because you have cataracts does not mean you
>>> require surgery.
>>
>> OTOH, people choose to have LASIK electively. Complication rates are pretty
>> similar between the two procedures and there are arguments for using
>> cataract surgery as a treatment for refractive error.
>>
>> On cataract surgery the best advice used to be "you need surgery when you
>> can no longer see to do the things you want to do."
>>
>> But it's appropriate to consider surgery at an earlier stage, if there is a
>> big refractive benefit.
>>
>> -MT
>
> Here's an update - two weeks after surgery.
>
> The shimmering/giggling problem is gone. What remains are glare
> problems at night and the negative dysphotopsia. On the glare
> problems -- which are manifesting themselves as rays coming out of
> bright lights -- my surgeon echoed what Dr. Robins said earlier in
> this thread -- that wrinkles in the lens capsule could be the culprit,
> and these should resolve as the capsule contracts around the iol.
>
> I talked to my surgeon about replacing the lens and he recommended
> strongly against it. The lens is a Clariflex, which has an edge
> design that is intended to provide the advantages of square-edged iols
> in minimizing post-cataract lens capsule clouding while also
> minimizing dysphotopsia. He said that round-edged iols, which I
> understand from the Medhelp forum and other places have the least
> chance of causing negative dysphotopisa, are never used anymore due to
> the lens envelope clouding issue. I am not sure that this is true.
> However, as the other symptoms are abating I am going to hope that the
> negative dysphotopsia will as well. Still going for a second opinion.
>
> I think part of my problem is that no one prepared me mentally for
> these after effects, and I did not do any research beforehand.
>
> So I'd like to offer thanks to all for your advice and info.

The silicone rubber Clariflex IOL also has less edge problems than the
higher index of refraction acrylic IOLs, such as the Alcon Acrysof. The IOL
exchange of preference when the Acrysof is a problem is to put in a
Clariflex, in an article I read by David Chang, one of the IOL experts. The
Clariflex is an update of the older SI-40, a rounder-edged IOL, but unlike
the Acrysof that has a 90 degree angle edge,t eh Clariflex is purposely a
slightly oblique angle to minimize internal reflections, but is is sharp at
its posterior point of contact with the lens capsule, so it purportedly
gives the advance of the square-edged IOLs regarding reduced opacification,
coupled with fewer dysphotopsias.