A Tale of Two Eyes with Restor IOL - Why the difference?

[Mike_bo]

Five years ago, I started getting symptoms of a cataract in my right eye.  My vision was getting more and more hazed; initially I thought my glasses were dirty.  I then had cataract surgery in my right eye, replacing the lens with a Restor  IOL (Model SN6AD1, power 9.0 D).  The surgery was successful, my only complaint was that there were ringed halos around bright lights at night.  My surgeon told me that this effect usually receded over a few months because of neuroadaptation, and he was correct.  After a few months , the rings reduced in size.  About a year later, I started getting hazed vision in the right eye, which was diagnosed as PCO and successfully treated with a YAG laser. Five years later, and I am quite happy with the visual improvement in my right eye.

Now for my LEFT eye.  For the five years after my surgery, my prescription for glasses was -8.0 for my left eye, and +0.5 for my corrected right eye.  (My left eye was always very myopic).  This prescription worked out quite well for most distances.  About one year ago, my left eye started developing double vision; that is, if I closed my right eye and looked at something with my left eye I saw double.  This was also diagnosed as a cataract in my left eye, which surprised me since the symptoms were very different from the hazed effects of the cataract I had in my right eye.  Over the span of 6 months, the vision in my left eye deteriorated to a point where my glasses would no longer correct the left eye's vision.   So I opted for cataract surgery again.  Based on the successful surgery five years before, I opted for a Restor  implant (Model SN6AD1, power 14.5D).

It is now two weeks later, and the results unfortunately, are very different.  My main complaint is that there is a "cloud" that moves around my left eye's vision, and at times hazes my left eye's vision significantly.  (It's almost as if the cloud is a large "floater").  If I move my eyes, there are patches that seem clearer, but generally the cloud is centered in the left eye's field of vision, so it is quite disturbing.  This is most evident with close or intermediate vision, such as computer work, and usually leads to a headache caused by the strain.  It is almost as I have some PCO in my left eye, but I read that PCO usually occurs several months after surgery at the earliest.

I've also noticed that instead of the ringed halos that I had with my right eye, the halos around lights are not ringed, but rather just a fuzzy ball.  

I discussed this with my opthamologist during the follow-up after surgery. He ordered a corneal scan, and checked the placement of the lens.  Both indicated no problems, so he suggested that this may be part of the healing process.  Based on my earlier experience with the reduction of ringed halos in my right eye, I am hoping that the cloud in my left eye will also dissipate over time.  However, I would probably opt for an explant should the condition not improve over the next 6 months.

My questions are:

1) Has anyone else had cloudy (non-PCO) related visual issues right after cataract surgery?  If so, did they dissipate over time?

2) Could this have been caused by the difference in cataract symptoms between the two eye?

Thanks.

[Mike_bo]

Thanks for the reply doctor.

I returned to work this week after the two week convalescence my surgeon gave me.  (I work as a software engineer, so spend at least 80% of my work time on a computer.)

The fluorescent lighting and the screen glare is very bothersome.  After about 45 minutes, my cloudy conditions worsen, sometimes with a headache and I have to take a break for 30 minutes.  Fortunately, I can then go to one of the computer labs where the lighting is not as harsh.  I modified the colors to use the Windows High contrast dark palette and that helped somewhat, however, there is not much I can do about the fluorescent lighting in the main office.  I ordered some yellow filtered glasses that are supposed to cut back on blue glare; they should arrive next week and I hope they will alleviate the symptoms somewhat.

I have also noticed a sensation as if there is some debris in my eye at times, as if an eyelash has lodged itself under my eyelid.  I have checked with a light and can see nothing that would cause the irritation.  This sensation is not always present, but it is frequent.  I am not sure if this could be caused because I stopped the PostOp eye drops (Vigamox/Nevanac/Maxidex) this week (as directed), or if they are caused by the environmental irritation at the office.

My eyes are also very dry and have a hard time tearing.  I have read some other posts that seem to indicate that this is normal for a time after surgery.

As mentioned in my previous post, I am willing to wait months as long as this condition in my left eye gets better over time.  My concern is that the IOL will be harder to extract if I wait too long.  What is the general time span after which extraction is not recommended?

Thanks again.

[JohnHaganMD]

Read the posts on dry eye and there is an article on my home page among blogs. You know a skilled surgeon can generally remove an IOL even many years after insertion. The one thing we say is not to have a yag capsulotomy before removing. Dry eyes can also cause a "foreign body" sensation

[JohnHaganMD]

When you have same surgery on paired organs be they eye, hips, knees, etc they are usually not clones of one another. That's just the way it is like raising kids.  PCO can be present at the time of surgery as some cataracts discolor the posterior capsule. Your surgeon should be able to tell you if this is a problem. The cloud moving does not sound like PCO or IOL problem which are usually stationary and in one position. When something moves like that you do think of floaters which can be quite large especially in someone as myopic as you. Often they are not seen prior to surgery as the cataract obscures them. (like seeing furniture in a dark room when you turn the light on). You can ask your surgeon about that or even ask for a referral to a retina surgeon to confirm this.  

[Mike_bo]

Forgot to mention in my post that another difference with my left eye surgery was that I had elevated ocular pressure.  My surgeon prescribed three days of Acetazolmide to alleviate it.