Double or ghost images after cataract surgery

I asked this question a few days ago, but must have done something wrong because I didn't see it posted. So here goes again.  After having a cataract removed and an IOL implanted three weeks ago, I now see double, or ghost, images with the affected eye. (The higher the contrast, the more pronounced the doubling).  I also seem to see the corner of the eye socket in my peripheral vision.  Before the surgery I noticed no such problem and my vision, while clouded, seemed more acute.  I had been able to read computer screens, typescript etc. in good light, needing magnifiers mainly for small print or dim light.  I now need magnifiers to read anything.  The surgeon has told me that I have astigmatism which was probably obscured by the cataract, and that I will now need either further surgery or corrective glasses.  Does this make sense?  I have a cataract in the other eye as well, but am reluctant to have it removed, fearing that my vision may become even worse in that eye as well.  Some people say that my vision should gradually improve.  The surgeon says no.  Is there any chance that my vision might improve with time?  Does the pre-existing astigmatism diagnosis make sense?  Is there any way to tell whether I risk the same outcome with the other eye?

[John C Hagan III, MD, FACS, FAAO]

A reasonable goal of cataract surgery is to see good at all distances with glasses. At times some people may have good distance, intermediate or near vision without glasses but with monofical IOLs will not have all three clear.

Many cataracts make an eye nearsighted so that before surgery they can read without glasses. If a IOL is put in the eye to make the distance vision good without glasses then glasses are neede to read.

At three weeks more than half the healing is done.

Discuss your concerns with your surgeon. If you don't feel comfortable then get a second opinion. Unless special IOLs or used or corneal incisions down cataract surgery doesn't correct a lot of astigmatism.

JCH III MD

[foureyes]

I am not a doctor, but my first thought after reading the first sentence of your post was, astigmatism. Why don't you get glasses and then see if your vision is still bad? If the surgeon promised you that you would see well at all distances without glasses, he/she misled you. (More likely, they just didn't tell you in detail what would happen.) If you had some ability to change your eye focus from distance to up-close before, you have lost that ability with the operation. The IOL has no flexibility; if you can see distance without glasses, you won't be able to read without glasses. That sounds like your situation since you are using magnifying glasses to read.

[catblur]

Thanks for your comment.  I can understand that, after the implantation of a fixed focus IOL, corrective glasses would be required to adjust the focal length for near vision.  I had been prepared for that.  What I still can't understand is why, although I had never been consciously bothered by astigmatism, it should suddenly affect vision so dramatically after cataract surgery -  to the extent of  producing double images or, in the case of point source lights, sort of bright box-shaped trapezoidal outlines instead of a sharp point.

[John C Hagan III, MD, FACS, FAAO]

Some of the light show and doubling can be due to the IOL (dysphotopsia) and it tends to get much better in the first 4-8 weeks. Remember that a monofocal IOL corrects for far- and near- sightedness but not astigmatism so the astig becomes more of a problem.

JCH III MD

[rjd232]

A related discussion, Cataract IOL/Monofocal/Astygmatism was started.