Distorted / small vision after cataract surgery

[thefunkyjoint]

Hi,

I'm 38 years old and i had cataract surgey in both eyes about 4 months ago. The procedure was made first in the left eye and then one week after, in the right eye. Before the procedure i had about 4-5 degrees of myopia in both eyes and in both a Bausch and Lomb Envista IOL was inserted.

One month after the surgery i had a vision test and had a residual myopia of 0.75 in the right eye and zero on the left, and a little degree (0.50) of astigmatism in both eyes.

Now about 2 months after the procedure, my left eye is still great. But i noticed my right eye now sees everything a  smaller than the left eye (maybe about 20-30% smaller) and worst, it has distorted vision. It's hard to explain, but if i cover my left eye and look to a square only with the right eye, i don't see the square straight as it should be ; i see its edges a bit 'curved'. Also the right eye has poor vision in dark ambients / at night, even with only 0.75 degree of myopia, i can notice a big difference between both eyes in situations of few light. It's like the right eye receives less light than the left eye.

I went to the doctor that did the surgery and he says the issue it's 'normal' because i had high degree of myopia prior to the procedure, but specially the distortion it's annoying me a lot. So i scheduled to see another doctor and get a second opinion.

What could be the cause of this problem on my right eye ? Am i a good candidate i replace the IOL on the right eye ?

Even with this problem i had great improvement on my vision when compared to the vision i had prior the surgery. But i just like to know if i have any chances to improve it more or i just need to live with this issue.

Thanks in advance !

[CBCT]

I have a similar problem.  In my case, it is caused by an epiretinal membrane (ERM) which can both distort images and alter image size.  Do a google search for an Amsler grid, and test your vision for distortion -- your mention of a curved image suggests a distortion that can be documented with this simple at-home test.  I suggest a consultation with a retinal specialist.  They should do an OCT and a visual field test.  Although my ERM is mild with minimal distortion, my image size difference is measured at 13%. My surgeon described it so:  "Your rods and cones should stand straight like a windless wheat-field, but an elephant had crushed the wheat, separating the stalks, which makes images look smaller.  I found this article to be very helpful
http://www.opticaldiagnostics.com/info/ri_aniseikonia.pdf
Best wishes.

[JohnHaganMD]

You might ask your newest consulting physician that made the DX of CSR to send a report to your original surgeon to hopefully help him learn something that may help the next patient that comes in with a similar problem.

[thefunkyjoint]

Today i had the OCT and retinal mapping in a good eyecare center of my city. The doctor concluded i have 'central serous retinopathy'. He said although it's causing me bad vision, it will get better by itself eventually. I could see in the OCT the difference between my left (good) and right (bad)  eye, the right has a hole on the macula. He says there is no treatment, told me to stay calm, avoid stress and make monthly visits to evaluate the problem progress. I'm not happy because i'll need to live with this problem for while, but at least now i know what i have and it's not a most serious problem like a macular degeneration... So thanks God !

[JohnHaganMD]

Glad we recommended the macular OCT and 2nd opinion.  Note your surgeon was off base and should have done a macular OCT when you had your complaints.  There is a lot of material on this website about CSR which you can access and read. I'm hoping that the "doctor" that saw you today was an Eye MD ophthalmologist hopefully with a specialty in retina/macular problems?  Is that the case?

[thefunkyjoint]

Yes, i went to one of the best eyecare centers of my city. So i hope i can trust in his opinion...

[thefunkyjoint]

And i agree with you that my surgeon was very carelessness and i won't see he again. I've been suffering from not knowing what i have for the last 3 months, i've been thru a LOT of stress and this could be avoided (or relieved) if i knew since the beginning what has happening. It's a shame, but now i will make monthly visits to the new doctor and hope my situation gets better over time.

[thefunkyjoint]

I can't tell if it's getting worse in the last weeks or if i started to pay more attention to the problem, but one thing i'm sure is right after the surgery i did not have this problem. I will keep the schedule for next week, let's see what the doctor says. I hope this is not a serious problem, i can live with it specially because my left eye is OK and when i look with both eyes, i nearly can't notice the problem. Hope it's nothing serious...

I will post the results here, thanks for your attention.

[JohnHaganMD]

Okay, best of luck

[thefunkyjoint]

I went to the same doctor that did my surgery today. I explained to him in details what i'm seeing and apparently, he did not worried at all. He says the distortion it's caused by an astigmatism after the surgery. After i insisted in a more in-depth investigation and he agreed to schedule the exams, but only had availability for next Sept 21. It's very frustrating when you go to a consult and the doctor acts like you are worried for nothing and even don't want to investigate the problem further. I will schedule with another doctor because i don't want to wait 3 weeks to have an answer.

[JohnHaganMD]

Okay well let us know how the tests turn out

[CBCT]

This does not sound like an emergency.  Waiting a week should not be a problem.  Best wishes.

[thefunkyjoint]

I forgot to mention i did the Amsler Grid test. I see the lines a bit 'curved' , but not in a fixed way ; when i move my eye, a part that seems curved then seems straight and vice-versa. Also, the distortion is not related to a fixed position in the grid (not in the center, for instance). But i cannot tell if this problem is getting worse with time.

I'm worried this could be a serious problem... do you think i should try to schedule my visit to the doctor before next week ? Would somedays make a difference ?

Thank you !

[JohnHaganMD]

You have had this problem for quite a while per your post. If there is no recent change you can leave as scheduled. However if it has recently gotten much more distorted than you can report to your 2nd opinion ophthalmologist and try and get in sooner.

[thefunkyjoint]

Ok, thank you very much !

[JohnHaganMD]

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[thefunkyjoint]

Hi,

Thanks for the answers guys.

The problem happens with or without glasses ; after the surgery i needed to use reading glasses. The distortion / small vision in the right eye is present anyway.

I already scheduled a visit to another doctor next week and post here what happens.

Let's hope for the best.

Thanks

[JohnHaganMD]

To get the most out of your second opinion be sure a macular OCT is done and that the pupil is dilated and the IOL and the membrane that holds it in place are checked for cloudiness.