Eye jiggling? or too much reflection perhaps...after cataract surgery and insertion of multifocal lens

[JustJeanne]

I am two weeks post cataract surgery with a multifocal lens.  Since the first day, I had the sense that my eye was "moving."  Others could see this movement also...although the doctor didn't see it and said he'd never heard of my complaint.  At this point, I don't believe that my eye is moving, but rather, too much light is reflecting "in" my eyes and it is the reflection that others are seeing and that I am seeing within my own eye.  It is very disorienting.  With any movement of the eye my vision seems to be flickering.  Is it possible that light is reflecting off from the multifocal lines that are in the lens?  If so, will this go away?  In addition, while my distance vision is terrific during daylight hours...as soon as dusk/evening arrives, I can't see beyond 2-4 feet.  Is this normal?  Are the two problems related (i.e., too much light in daytime causing eye reflection and not enough light in the evening to focus properly)? The flickering can also be desribed as temporarily having a bee's vision or having prisms in the eye. Has anyone heard of this problem before?  I have been given the multifocal Restor lens and I have a great doctor...he just hasn't heard of the problem I'm describing.  I'm concerned by all of this as prior to surgery all I've ever needed was reading glasses.  

[John C Hagan III, MD, FACS]

JustJeanne,  your vision may continue to fluctuate for several months (in some cases even longer). The multiple image and flickering problems are quite common (please see the eyecare archives of MedHelp and even the recent messages on this ophthalmology forum.) The surgical procedure of inserting a multi-focal 'premium' intraocular lens (IOL) is more complex and the recovery more involved and longer than with standard single focus IOLs.

I'm glad you  have a good doctor-patient relationship, your surgeon will be your primary source for information on 'how am I doing'.  Two weeks is a relatively short period of time for the adjustment to multifocal IOLs, many people with problems like yours are ultimately very happy with their surgical result.

JCH MD

[JustJeanne]

Thank you for your response.  I do understand that dealing with multifocal lenses is more difficult both for the patient and the doctor.  It worries me some that my doctor has not heard of what I am describing, and therefore, has no suggestions or opinions on whether it will all just go away with time or whether it may be permanent.  I will continue to follow up with him on this but I have posponed the opposite eye cataract surgery until I talk with him again.  I truly do not understand why my excellent distance vision goes away at dusk and continues into the night.  Two to four feet for distance is not good enough for night driving.  I've never had to wear distance glasses, only reading glasses.  Is it possible that I'm now going to need distance glasses only for night time?  That seems odd given that the Restor lens is touted to be an excellent choice for both near and distance vision.  I wouldn't mind having to continue with the reading glasses.  But, if I now suddenly have to wear both distance for night as well as reading glasses, then all cataract surgery did was remove the cataract and provide for clearer/crisper vision with a decrease in all around distance vision.  I didn't think that was supposed to happen?

[JodieJ]

You're right, that's not what's supposed to happen.  But you're only a couple of weeks out of surgery, and it's now believed that it takes from 9 to 12 months for your brain to adapt to vision with a multifocal lens.  I think that you'll see (literally) a lot of improvement in the coming weeks.  It's probably a good idea, though, for you to postpone surgery on your second eye until you're happier with the outcome of your first eye.

[Dr.MJ]

Jeanne, with the Restor, the vision can change depending on your pupil size (which changes according to surrounding light.)  Chances are your that your near vision and distance vision are pretty good during the day.  At night, when your pupils dilate, your distance vision will not be as good.  Driving at night may be very difficult.  Also the flickering effect will improve - its simply your eye and brain getting used to seeing through a whole new lens.  Everything you have mentioned is something many, many multifocal patients experience early on.  I've heard all these things before.  The lens technology is very good - but has some limitations (ie night driving) that you were informed of before surgery.  You just need some support and have a talk with your doctor.  Your real decision is if and when to have the other eye done.

[K-D]

Jeannie,

Multifocal lenses change for a long time after surgery.  I experienced all the problems that you are mentioning. All went away, except I could only see outside in bright light. It was miserable.  I was repeatedly told that Restor was not pupil dependent, but Rezoom was, and that was the reason that my vision kept changing depending upon the lighting.  I was so extremely sorry that I decided to have a Rezoom multifocal.  Then I saw a different doctor and my problem was not pupil dependent.  It was a problem with my capsular bag not letting in enough light.  I had a simple procedure and in minutes, for the first time in 14 months, I could see clearly INSIDE.  
I truly believe that the multifocals are so new that many docs do not know how to address many of the problems that many people experience with a multifocal.  I was debating a risky explant and went through 14 months of misery which was completely reversed in 5 minutes when seeing another doctor. Now I see so clearing inside and out.  The reflection is not worth mentioning.  I still have the halos but can see so clearly that that is no longer a problem for me.  You are early on.  Many problems will clear on their own with the multifocal.  If you still cannot see when the lighting is not bright, I would search for another doctor who can diagnose and treat the problem properly.  Best wishes.

[JodieJ]

Online EyeWorld articles state that the ReStor lens is pupil independent.  (The ReZoom lens, on the other hand, is pupil dependent.)  I'm not an eye care professional (just a knowledgeable consumer), but I believe that the difficulties in night vision that sometimes occur with ReStor, especially early in the adaptation process, are related to glare and halos.  Correct me if I'm wrong, but I don't think that it's normal for someone with ReStor to have distance vision of only a few feet at night.  (I suspect that JustJeanne's night vision will improve with time.)  And I can't imagine that there would be many ReStor lenses implanted if prospective patients were actually informed that they would need glasses for night driving, watching movies on the big screen, finding the bathroom at night, etc.)  There's so much wrong information out there about multifocal lenses; let's not add to it.  (Your post makes ReStor implants seem so undesirable that I question your affiliation with Crystalens.)  

[VeeMercer]

I've found the problem with "lens jiggling" (not pupil diliation or eyeball movement, but a glittery jiggle in my mother's eye after cataract surgery). From day one and now 2 months later, the jiggle is the same. My searching has turned up the following from ASCRS - American Society of Cataract and Refractive Surgeons. Check it out...my mother has to take it to her surgeon to prove it is not normal.
http://www.ascrs.org/publications/jcrs/csoct8.html

Language is technical and you may need to actually bring it to your surgeon.

[JustJeanne]

Thank you all so much for your comments.  I've since seen my doctor again...and he is most concerned about the loss of distance vision beginning at dusk...but now also on cloudy days.  I have another appointment in two weeks...he wants to do some additional testing.  He talked of an eye drop (that may cause headaches) that I believe works on the pupil.  He agrees that loss of distance vision in low lighting situations (in malls, restaurants, etc.) is not normal.  He was going to do some research on it himself and when I see him again in two weeks, he'll do more testing, perhaps the eyedrops, and maybe he will have found other information on the problem.  He believes the "jiggling" that people see in my eyes is a reflection and I believe that also.  However, when I'm seeing it through my eyes...it does cause alot of confusion, it's as if the eye is trying to focus on several things at once.  The brighter the lighting...the more the eye reacts.  I'm willing to believe that this is, as many of you say, a matter of the brain adjusting to the new lens.  My doctor agrees with postponing the second surgery (he says there's no rush) until we can solve the mysteries of the first eye.  I'm so thankful I have a doctor who is willing to listen to the problem and work to find an answer.  That makes all the difference in the world.  Again, thank you all for your comments, personal experiences and support.