Post cataract blurred close vision.

Had cataract removed and distance IOL iserted 5 days ago.  On day of surgery, I had to return to Dr's office due to significant eye pain. Dx was corneal abrasion.  Anesthetic drops and patched eye relieved the discomfort. Back to office 2 days later for for post surgery review.  Dr. surprised by lack of acuity improvement. He says this is probably due to remnants of abrasion.  Now 5 days out, and vision seems to be too far sighted.  Street signs and other far details very sharp, No sharp details indoors.  Am I being impatient or is something wrong?

[Forum-OD-MP]

5 days is not nearly enough time to make any visual judgement.  so, probably a little bit of the former...

[aimee37]

You may still be experiencing some post-surgery inflammation.  Give it a little time.

Were you nearsighted before surgery?  Did you get a monofocal lens set for distance (i.e., plano)?  If both of your answers were "yes," you may have to adjust to the loss of some of your pre-surgery near/intermediate vision.  Monofocal lenses set to plano give sharp distance vision but blurry near/intermediate vision.

[aimee37]

Yes and yes. I expected to lose that "remove the glasses and read fine print ability", but I didn't expect to lose so much mid-range sharpness.  Still, it's early days and I can wait.  Also, the reason for going through this process was to eliminate long range ghosting and increase contrast in my dominant eye for driving.  This appears to be accomplished, so I'm satisfied short term.  If necessary I will explore plsno/intermediate varalux for the dominant eye, and keep the current precription in my non-dominant eye.  

[aimee37]

Do you know what kind of IOL you have?  Aspheric IOLs such as Tecnis and AcrySof IQ are supposed to provide sharper distance and night vision than conventional lenses.  But conventional IOLs may give better near and intermediate vision than the aspherics.  (I guess many things in life involve trade-offs.)

[aimee37]

I suspect it is a standard lens,  Card says B&L Ll61A0  Power:-12

[aimee37]

Power is +12

[aimee37]

Yes, it's a conventional lens.  Actually, a small sample study I read indicated that the majority of people preferred their vision from their conventional lens, when an aspheric lens was implanted in their other eye.  (I'm not sure why.  Maybe those IOLs just don't live up to the manufacturers' claims in the real world.)  I have two aspheric lenses, so I have no basis for comparison.

[aimee37]

That is the B&L SofPort AO.  Jodie, it is not a conventional spherical IOL.  It is a neutral aspheric, whereas the Tecnis and Alcon aspherics are negative aspherics.  The SofPort AO is a compromise between the aberrations caused by spherical IOLs and the loss of depth of field caused by the negative aspheric IOLs.  It does not compensate for the cornea's spherical aberrations, but it is not bothered by any IOL shift or tilt.  Spherical and negative aspherics are.  One poster last year got them and had 20/15 distance vision and could read some of the 20/10 letters.  I got that IOL in my right eye last week.  My vision is 20/20 and I can read some of the 20/15 letters.  I asked the surgeon to shoot for 0.25 to 0.50 diopter myopic and he seems to have gotten it between those targets.  I had 0.75D of astigmatism in my right eye before surgery, so my vision may get better after I get my new eyeglasses in a few weeks.  That lens is a safe lens to use because IOL shift will not degrade vision.  That is why I chose it before my first consultation and why my surgeon likes it.

[aimee37]

tipster, I'm sorry.  I got babbling about the IOL and forgot to give you my new vision experience.  I can read my computer without glasses, but it is sharper with 1.00D reading glasses.  I asked for about 0.5D myopic so that my vision would be relatively good over a longer distance range.  My best vision is at about 10 feet, which would put me at about 1/3 diopter myopic.  That gave me 20/20 at the standard 20 feet and I can still see fairly well at 30 inches.  I need glasses for reading and will get new progressive glasses after my eye heals.  I get my left eye done in 1-1/2 weeks and I will be happy if it turns out like the right eye.  The only problem with the right eye is that my posterior capsule has a small wrinkle.  The doctor said that it might go away, but probably not.  It causes a streak from bright lights, but not noticed with most lights.

[aimee37]

Thsnks for all your valuable information, folks.  

I'm still concerned about the corneal abrasion issue.  I have no idea how I could have caused it.  I never removed the shield except to insert post-op drops.  Any input on how this type of injury could affect my midcourse and final outcome.

I'm going back for check-up on the 20th.  Still only 1 week post op.  Will continue to post progress on this thread.

[aimee37]

I had a corneal abrasion about 10 years ago.  I got some dust in my eye while working outside and was stupid enough to rub it.  I'm sure that is not how you got it, but as I recall, it took about a week to heal.  There was some pain for the entire time, so hopefully your cornea will heal in a week or so.  I agree, it is hard to understand how you got it with the shield on.

[aimee37]

Icansee, you're sure right about the B&L lens being aspheric.  I'm glad that it gave you great vision.

I got a corneal abrasion when I had retinal surgery.  (I blame the resident who did my sutures, although I really don't know how it happened.)  It really hurt for about a day.  Tipster42, I'm guessing that your abrasion also happened during surgery.  I'm sure that it won't affect your outcome, so don't worry about it.

[aimee37]

How were you able to figure out the type of lens?  I googled the model# and got no reults.  I also went to B&L's site, which was informative  but did not identify my lens type.

I am also pretty sure my doc caused the abrasion, but the pain is gone and if there is no residual damage, so be it.

Visual progress wise, horizontal streaking has disappeared but short/midrange acuity is still below par.

My wife says I'm a bit obsessive (actually a lot):I even printed out my own Snellen chart.  She said I should ask you if this is normal behavior LOL

Thanks again

[aimee37]

You probably Googled the wrong designation.  It is LI61AO - 2 letters, 2 numbers, 2 letters.  In your previous post, you typed in a zero instead of an O.  Also, you can do a search on SofPort AO.  There are several articles on aspheric IOLs that discuss the advantages of each of the 3 brands.

When I scratched my cornea, the scratches were bad, but it healed completely with no long term effects.

Tell your wife that I've got you beat.  I downloaded a scaleable computerized Snellen chart that I can scale to any distance on the computer screen.  Besides the standard letters, it has tumbling Es and open Cs.  Lots of fun.  I'm a retired mechanical engineer and behavior like this is perfectly normal for an engineer.

Intermediate vision is why I wanted to be slightly nearsighted.  If you are plano then your distance vision will be better than mine, but I will see more clearly at shorter distances.  I have worn glasses for 45 years and actually like them.  They protect my eyes in everyday life.  The other reason that some doctors like to shoot for 0.5D myopic is that the results can be +/- 0.5D.  If you aim for plano, then you increase your chances of ending up hyperopic and nothing is in perfect focus.

[aimee37]

I had asked a question in a different post about my horizontal streaks being unusual.  Since someone else answered that post and had them and you also had them, it appears that they are not unusual.  The other person (lightbug) still had them 6 days after surgery and I still have them 5 days after surgery.  It appears that yours are gone now at 7 days.  Did they slowly get better or just rapidly disappear?  Mine are not nearly as bad as my starbursts were with the catatact, but I would rather they be gone.

[aimee37]

The light streaks were very pronounced at first, then became smewhat less obvious but still definately there.  Then at about day 6,I noticed that they had gone.

[aimee37]

Can you give us the link to the scaleable computerized Snellen chart you downloaded?  I am also in the obsessive camp.

tipster, I may be unusual because as an exchange patient, I had two catarct procedures in the same eye in a month and thus additional trauma, but I improved from -1.0 to -0.5 between weeks 5 and 9.  I had previously been told that most doctors do a glasses prescription, if needed, at 4-6 weeks because that is when vision stabilizes.  In my case, that wasn't true.

[aimee37]

Here you go:

http://www.acuitypro.com/Download1.html

[aimee37]

http://www.i-see.org/eyecharts.html
It is the first link, called Interactive Eye Chart - Ultimate Random Snellen Chart generator, version 3.1.  When you unzip it there are 3 files.  The swf file is scaleable.  The top line letter (70 feet) should be 31 mm high to use the chart at the standard 20 ft eye test distance.  Just change the size of the IE, Netscape or Firefox window to scale it.  If you want to check your VA at 10 feet then the top letter should be 31 mm x 10/20 = 15.5 mm.

[aimee37]

Progress report.  Good news and some not so good.  Day 8 doctor visit (I drove; very clear street signs, etc.)  Acuity up from 20/100 to 20/60.  Corneal abrasion healed.  Minor swelling still.  Overall good report

Drove home in dark,  Lots of horizontal streaks and glare (not ready for prime time yet).  My previous post indicating clearup of streaks was in bright in-home lighting, not headlights and street lights.  Maybe distance is a factor.

[aimee37]

I have noticed that my streaks get less noticeable as the day goes on and are worse again the next morning.  I have noticed this for 2 days now, but they are much better in the evening then they were for the first 5 days after surgery.

Perhaps yours are worse when driving at night because your pupils are dilated because of the dark and the wrinkle (if that is what is causing it) is not as bad in the center and therefore not noticed when checking it in a brighter indoor setting.  I go to my optometrist tomorrow.  I will have to ask her about it.  I have also noticed that my vision is a little blurry in the morning.  That might be because I haven't had any steroid drops for about 9 hours.  I guess it is as the forum doctor said - we just need to be patient.

[aimee37]

Your thought about pupil dilation makes a lot of sense.  I'm finding the loss of night driving most frustrating.  We'll see which comes first, post-surgical improvement or summer.

[aimee37]

It's now 2 weeks post surgery, and my unaided vision is now worse than shortly after surgery.  Without glasses I have no sharp vision anywhere in the the range.  I saw my optometrist (not affiliated with the surgeon), and he fitted me with a temporary +2 (pending full healing) lens which makes everything from dashboard to infinity very sharp.  Daytime driving is truly a pleasure.  I have not tried night driving yet, as I still get streaks walking around at night

All the literature says to wait 4-6 weeks post surgery for optimal results, but I can't imagine my acuity improving that much.

My question are:
1.  Could deterioration continue?
2.  Is this much of a miss from plano common?
3.  What remedy (Other than contacts/ glasses) is there?
4.  Since ghosting/ blurring has been eliminated, should I just shut up and enjoy what I've got.

[aimee37]

I have read that missing the target, whether it be plano or somewhat myopic, is not unusual to +/-0.5D.  My surgeon confirmed this, but added that the goal could be missed by more.  He did not give me reasons why.  Since a +2D correction gives you good vision from dashboard to distance, it sounds like you ended up, at least at this time, between 1.5D and 2D hyperopic.  That seems like a lot.  I have no idea what the chance of missing by that much is.  My optometrist checked my eye condition and my correction after 1 week and said that vision can continue changing for 4 to 6 weeks.  Mine does not seem to have changed since the day after surgery almost 2 weeks ago.

What is your schedule for your steroid drops?  My schedule is 1 drop 4 times a day for 4 weeks and then stop.  I have seen that some doctors taper by 1 drop per day each week after the first week (3 drops 2nd week, 2 3rd weeks, etc).  If you are on a tapered schedule, could it be that your eye is somewhat inflamed.  I'm not sure what effect that would have, but you might want to ask your doctor.  I'm guessing that is the main reason why vision does not necessarily stabilize for 4-6 weeks.

I have not tried night driving yet, so I don't know how my streaks will be at night.  They seem to be mostly gone with the bright lights at home.  My surgeon told me that he could get rid of the streaks, if they don't go away, with YAG laser on the posterior capsule.  I didn't ask him if this would be the standard capsulotomy they use for "secondary cataract" or just a slit to relieve the haptic pressure on the capsule.

I don't know if the forum doctor looks at these older posts and will answer your questions.  I go for my left eye surgery tomorrow.  I wish you the best of luck with the way your vision finally ends up.

[aimee37]

Had my 2 week checkup yesterday, and my eye is still inflamed.  Trying a stronger steroid drop Econopred plus.  Schedule is 4 times a day for 1 week, then tapering off.  Dr. thinks that inflamation (inflammation) is probably contributing to blurred vision.


Thanks for your interest.  Good luck with your second eye. Keep me posted on your progress.

[aimee37]

Econopred Plus is the steroid that I have been on since the start.  It and Pred Forte are the strongest as far as I know.  Even with the E+ I had slightly blurry vision the first few mornings until I got my first dose of E+ for the day.  Hopefully that does it for you.

I hope I'm typing everything OK, as my second operation was about 3 hours ago.  That eye is still bandaged shut and I can't wear my reading glasses for the other eye because of the shield, so the words are a little blurry.  I get to take the bandage off in about an hour and start the drops.  Keep me posted on how you are doing after a couple of days of E+.

[aimee37]

Just returned from the surgeon 3 weeks post.  He is very happy with my progress.  No more inflamation (inflammation) and tapering off Econopred+.  2 drops daily for one week, then one drop daily for 1 week. He recommended visit to optometrist at end of March for final fitting of progressive spectacle lens.  He says by that time IOL will have adjusted as much as can be expected. I may get a second opinion on that, depending on chnages over the next couple of weeks.

We discussed light streaks at night.  He prescribed 1 drop of brimonidine tartrate ophthalmic solution 0.2% 1/2 hour before night driving.  This medication minimizes pupil dilation in dark conditions.  I'll try it tonight and let you know.

How is your second eye doing?

[aimee37]

Good to hear that the E+ has helped your inflammation.  My second eye is doing about the same as the first.  Looking at a bright LED set up on the mantel in the living room in the evening, my left eye has the same horizontal streaks as the right eye did after surgery.  They seem to be less in the left eye now after 1 week.  The streaks were gone after 2 weeks in the right eye and have not come back using this LED test.  I have not had a reason to drive at night yet, but I will have to test it in another week.  The day after the left eye surgery, I was 20/20 in the right eye and 20/25 in the left eye.  I have about 1D of corneal astigmatism in the right eye and about 2D in the left, so that is probably the reason for the difference.  I go to my optometrist tomorrow morning for the 1 week checkup on the left eye.  I will ask her when I should be fitted with new eyeglasses, but I think I have read that it should be a minimum of 6 weeks post-op.  End of March would be 6 weeks for you.  I will be out of town on the 6th week, so I will probably wait until at least 7 weeks.

On the E+ tapering, it seems that some doctors recommend tapering and others don't.  The reason to taper is so that there is no inflammation rebound after stopping.  I asked both my surgeon and my optometrist about this and they both said that this is sometimes necessary, but not for me.  I don't know why, but I had already bothered them both with lots of questions and didn't want to ask one more.

[aimee37]

Just tried a night drive with anti-dilation drop.  No streaks, no haloes, no nottin!  Hopefully I won't need the drops forever, but for now it's a major hurdle overcome.