Dystophia

Doctor,

I want to first of all thank you for your continued time on this board. Your help is greatly appreciated by all and has a unique calming effect.

I had my iols-monofocal, tecnis lens put in on 10-19-07 on right eye only.  Last month, I had 20-15 vision in that eye with a small development in the "back of the bag" that my Dr. does not want to yag b/c of the great vision.

I have been having serious, and I mean serious, dystophia-refractions, reflections, halos, that just pop up.  I have read your posts closely and will just live with them.  It is always interesting to be talking with someone and then a half moon reflection comes in my vision-quite bizarre.

I was wondering if you would ever prescribe any eyedrops because that right eye is still real dry?

Thanks again
CJG

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

Thanks for the vote of confidence and appreciation.

This is how I would approach the problem of the dysphotopsia.

1. Make sure you have an excellent refraction in your glasses and that you have anti-reflective coating and possibly the new aspherically ground progressive bifocals.
2. Make sure the problem is coming from the operated eye and not the "other" eye. You can do this by covering one eye then the other at night while looking at light.
3. Get a second opinion from another ophthalmologist. Ask them to check to be sure the IOL has not gotten decentered  AND ask if there are any folds, creases, opacifications in the capsule behind the IOL.
4. Ask this second opinion ophthalmologist their opinion about doing a Yag Capsulotomy. If you were not a  high myope with a very long eye the risks of retinal detachment are very very small. If you are a high myopie, especially a middle age male the the risks of an RD are significant and you may need to wait on a yag.

As for the dry eyes-here's a recent post on the subject.

JCH

General Information on Dry Eyes

a Schirmer test of zero indicates that you have severe dry eyes. I'm assuming from your posting that you have tried both preserved and unpreserved artifical tears, gels or lubricating ointments at bedtime, environmental modification, etc. Don't discount eye drops. There are over a 100 different brands of artificial tears and they can't all be lumped together. Sometimes one will find the perfect drop. Because the problem is so prevalent the pharmaceutical compies are coming out with new products all the time. Some of the newest are Systane preserved and unpreserved drops and Optive drops.

If you took Restasis you have used the best prescription medication. A "trial" of Restasis is a minimum of 8 weeks of therapy using one drop in each eye twice/day. Because of the way Restasis works, it takes two months to "start working". I have found that many patients use it for a few weeks then conclude it won't help. The medication often stings when therapy is begun--it usually gets better by week three or your Ophthalmologist (EyeMD) can prescribe a mild steroid drop for a couple of weeks. If you did not take for 8 weeks you need to restart therapy. Improvement often continues for up to 6 months.

If you have tried tear duct plugs you should have had all for tear duct openings (puncta) plugged with a permanent plus (not a disolving one). Usually just the lower lids are done with mild dry eyes. If your problem is as bad as you say, you and your ophthalmologist should discuss permanent closure of some or all four of the tear duct openings with cautery.

Additional things that can help include a diet rich in fatty fish (eg salmon, sardines, etc). Fish oil taken by mouth usually 2 to 4/day has been show to help some patients. In addition there are non-prescription pills for dry eyes available at most major drug stores or by direct order from the companies. Thera-tears formula for dry eyes is probably the most widely used. You can use any search engine to pull up the websites of the companies that see these.

In dry eyes associated with corneal damage, moisture retaining goggles are used for sleeping. Be absolutely certain you do not sleep under a fan, heating outlet or situation where air moves over your face during sleep. Make certain you home is humidified in the winter, put a humidity gage in the bedroom. If you cannot maintain a 50-60% humidity put a room humidifier in the bedroom. Run the A/C or heater of your car through the vents on your feet not in your face. Long car or plane trips put your tears in every couple of hours.

If you are menopausal or post-menopausal be sure you and your gynecologist maintain optimal hormonal balance. (Many women with dry eyes have dry mouth and dry vaginal canal). If you have joint pain have that evaluated to be sure you don't have Sjorgren's syndrome. Many medications eg antihistamines can make dry eye worse. You might review your medications with your ophthalmologist.

If you reach a point of exhausting all the above see an ophthalmologist that specializes in "Cornea and External Disease". This is their special area of expertise. A final new treatment that they can often do is “Autologist Platelete-rich plasma” therapy. This uses eyedrops made out of your blood products. (reference Ocular Surgery News: November 1, 2007 page 46  lead author Jorge Alio MD.

Keep digging and moving forward. I suspect you have not exhausted all the ways you can be helped.