Just had cataract surgery - original problem seems worse

Discussion in 'Laser Eye Surgery' started by roberubin, Nov 16, 2008.

  1. roberubin

    roberubin Guest

    Hi everyone

    I knew I was developing cataracts and when my optometrist told me he
    could not do anything more with glasses to correct my deteriorating
    vision, I had the surgery. Just had it on my right eye; left eye is
    scheduled for a few weeks from now.

    I had the Clariflex monofical IOL done yesterday. Today I had the
    bandage removed. I did not notice any improvement, in fact felt that
    my vision is now worse. Doing an A-B comparison with my "new" eye and
    the old one, the halos and starbursts from bright lights seem much
    worse. Also, I know see flickering in my visual field in bright

    I am disappointed and quite upset. Does anyone have experience/advice
    to share?

    roberubin, Nov 16, 2008
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  2. roberubin

    Dan Abel Guest

    The next day is too soon to assess very much. Did you see your doctor
    today, and did the doctor mention any problems? Did the doctor seem
    happy with the surgery results? Did the doctor do anything to improve
    your vision? I had halos and starbursts after the second cataract
    surgery. I don't remember them from the first, but they were five years
    apart. The halos and starbursts either went away or I stopped noticing
    them (it's been several years).

    If you aren't feeling comfortable with your vision on Monday, I would
    suggest calling your doctor.

    Although I've had cataract surgery in both eyes, I am not a vision
    Dan Abel, Nov 16, 2008
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  3. roberubin

    roberubin Guest

    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.
    roberubin, Nov 16, 2008
  4. roberubin

    otisbrown Guest

    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.

    otisbrown, Nov 16, 2008
  5. roberubin

    roberubin Guest

    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.
    roberubin, Nov 17, 2008
  6. roberubin

    Ms.Brainy Guest

    Some of your symptoms are typical to retinal tears or detachment,
    especially the "arch". I suggest that you see a retina specialist
    ASAP. I am sorry to say that many cataract surgeons are butchers, and
    they certainly are not equiped for a thorough examination of the
    retina. Retinal detachment is a medical emergency -- that is if you
    want to save your vision. Don't delay!
    Ms.Brainy, Nov 18, 2008
  7. roberubin

    Dan Abel Guest

    When I hear "visual field", I immediately think of "visual field test",
    which is a test of just the peripheral vision. Is this what you mean,
    or is there fluttering everywhere in the vision of that eye?
    I don't know what to say here. I had some of #1 with my second cataract
    I know that there is a lot of healing and growing happening in there.
    That's long time. I know I had to wait 4-6 weeks to be tested for
    corrective lenses, in order for healing to take place, but my vision was
    pretty decent.
    I would want to believe him also.
    Sounds good to me. I have always thought it was strange to have both
    eyes done at once, although many people do this. If your vision is so
    poor that you can't see anyway, maybe it makes sense. But if you aren't
    comfortable with the vision in your operated eye, it would make sense,
    to me at least, to wait until you have acceptable vision in your
    operated eye before having the other one done. A second opinion sounds
    good, also.
    One of the reasons this surgery isn't often done until the vision has
    noticeably deteriorated, is just so that there will be a noticeable
    improvement after the surgery. My vision was much better, even a day
    later, other than the starbursts and halos. Since I have always
    disliked driving at night, this was not much of a problem.
    Dan Abel, Nov 18, 2008
  8. roberubin

    otisbrown Guest

    Dear Rob,

    How bad was your vision -- before your surgery.

    Even "corrected", I was close to not being able to pass the State DMV
    test. I could see this
    myself. There was no question as to the necessity of it.

    Because of the induced "paralysis" drug for testing, I saw some of the
    effects you

    Under certain circumstances (sun, and glint) I could see the lens
    "move" and its effect.

    Typically the will wait about six weeks betwen the first and second

    You should request this delay.

    It is always a difficult "call" to say when surgery is necessary.

    That is a matter of you received information about the risks of the

    I was provided with them:

    1. Risks of a failure.

    2. Risks of a detached retina.

    3. Blindness.

    4. Etc.

    But after reviewing this with friends, and the 'track record" of this
    particular ophthalmogist - I knew he was the best.

    Hope this helps.

    otisbrown, Nov 18, 2008
  9. roberubin

    roberubin Guest

    Thanks for your responses, everyone.

    In answer to Otis's question, my vision was not that bad. I was
    having trouble reading and driving at night so I went to my
    optometrist. He told me that he could not correct my vision any
    longer with glasses and I needed cataract surgery. I went to the
    surgeon he recommended. I really should have gotten another opinion,
    but I had known people who had this surgery and they were so
    enthusiastic about it and I had read that it is so safe, that I did
    not think of doing that.

    I'm going to get one now -- and will postpone the other operation.

    Thanks again, everyone, for your input.

    roberubin, Nov 18, 2008
  10. roberubin

    Jane Guest

    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.
    Jane, Nov 18, 2008
  11. roberubin

    roberubin Guest

    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.

    roberubin, Nov 18, 2008
  12. roberubin

    roberubin Guest

    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

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

    I appreciate your comments.

    roberubin, Nov 18, 2008
  13. roberubin

    Dr Judy Guest

    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.
    Dr Judy, Nov 18, 2008
  14. roberubin

    roberubin Guest

    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.

    roberubin, Nov 18, 2008
  15. roberubin

    otisbrown Guest

    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
    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?)

    otisbrown, Nov 19, 2008
  16. roberubin

    Neil Brooks Guest

    Not too often, Dear Boy, or you'll go blind!
    Best guess? The voices, in your head.
    Neil Brooks, Nov 19, 2008
  17. roberubin

    roberubin Guest

    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.
    roberubin, Nov 28, 2008
  18. 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.
    David Robins, MD, Nov 29, 2008
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