Just had cataract surgery - original problem seems worse

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
light.

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

Thanks.

 

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
professional.

 

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.

 

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,

 

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.

 

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!

 

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
surgery.

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.

 

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
described.

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
surgery.

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
operation.

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.

Otis

 

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.

Rob

 

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

 

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

 

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,

 

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

Best guess? The voices, in your head.

 

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.