Flashing and Shadows after Cataract Surgery

[Egore]

I had cataract surgery on both eyes in June 2007. My right eye is fine; however, my left eye is causing some grief.
I see a shadow and flashing lights under certain lighting conditions. It has caused me to leave stores where the lighting intensifies the flashes. Also reading is a problem as it is constant strobe effect as I move my eye left to right. My eye surgeon says it’s nothing to do with the Cataract surgery despite me not having this issue prior. In fact he looked at me as if I was from another planet! There is no indication of retinal detachment so I know it’s not that.
I have seen some notes on this forum about this problem but the thread is closed.
Can someone tell me if they have had this and how long it lasted please? This is now 3 months on and it’s affecting me significantly.

Thanks

[roseteresa]

I have been to a corneal specialist, a retinal specialist and now I am being sent to a neuro opthamalagist.  I too am seeing light refracted from the side of the eye that I had a lens surgery.  I noticed it when I am in dim light and walk past my night lights.  I am also getting a pulsating in my same I that is in pace with my heart beat.  I had an MRI in June so I don't think it is serious, but the running around with no answers is driving me crazy. This same eye also has a pterigium which will be removed in January. I do feel that the reflection is from the replacement lens.
Teresa

[jdoll]

I have the same issue - had surgery in May 2007 - its so horrible I wish I had just lived with the stupid spot....would love to know where your surgery was done - as i had the same kind of experience with the surgeon that did mine.

[Eye-Kant-C]

I have the same extreme edge glare/flare (central flash) and arc problem with my Crystalenses. I did not have cataracts, so this was just a refraction procedure. My surgeon also acted like he didn't know exactly what I was talking about and said the Crystalens doesn't usually cause these problems at all. I think he means like the ghosting and double images that some people have with multifocals. He gave me the Allergan drops to reduce pupil size and it did nothing. I saw his associate (my regular opthalmologist) and told him about my problems and he said, you mean edge glare and seemed to understand perfectly. I asked if opaque contacts could help cover the edges of the lens and he said possibly -- and ordered them. I'll let you know if they help at all. Otherwise I may have to get a lens exchange myself. I can't stand this. Why doesn't anyone warn you about this??? I thought most manufacturers have fixed this problem with the edges?

[JodieJ]

I'm not great at spelling, either.  Google toolbar has a spell check feature that will work on any website (including this one) with just a click.

We appreciate the time you take answering our posts.

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

EGORE  Spelling is not one of my forte's and there's no spell check on the website. The spelling of the IOL we use is TECHNIS aspherical.

JCH III MD

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

Hello Egore,     While any operation carries risk, I would not call a IOL exchange "highly risky". In most communities there are ophthalmic surgeons that are often referred cases like yours and become quite proficient at IOL exchange. If the surgeon you were referred to has done over 100 of these cases then he's extremely experienced.

When you contemplate a surgery you have to balance the risks of the procedure versus the benefits. In your case if you haven't been able to return to your job that is severe disability in anybody's calculations.  Given same or similiar cicrcumstances in my practice I would refer my patient for a lens exchange to our group expert.

The newest generation of anti-aberation IOLs are mono-vision highly aspheric in design. There are several good types, our greatest experience is with the Tecnis IOL.

Good luck, from what I've heard on this board about the Canadian medical system, if you have a chance to have the reginal expert do this surgery in the not too distant future you might take advantage of it as other Canadian posters say they may have to wait 6-9 months languishing on the surgical wait schedule.

Sincere good wishes.
JCH III MD

[light show]

Hello - I live in  Canada too.  I also received the same treatment from my ophthalmologist...for the first six months post surgery he was nothing short of rude. Once I started my own research, his attitude seemed to change. I pursued a second opinion through my family doctor but became caught up in 'physician politics' I guess .
Finally, after two years my ophthalmologist sent me to a specialist at Toronto Western Hosp.. after a $50. corneal topography (this test maps how light is reflected), I now have a diagnosis of dysphotopsia in my right eye and high order aberrations (glare, streaking,flare, arcs) in my left eye.
This specialist told me that an iol exchange COULD possibly correct my vision problems but MAY only result in a  little more comfort than I am experiencing now. He has completed 100's of surgeries of this type. I was also prescribed eye drops to close up my pupil a bit but they don't seem to help.
I have also had an ultrasound done on my eye about a year ago. I haven't been able to return to my job of 15 years nor can I drive at night due to wide and various lighting conditions.  I have a glare guard shield on my LCD monitor and sunglasses on  just to give you an example of my sensitivity.
My iols are Alcon SA60AT (I visited Alcon too).
I am contemplating a lens exchange but it is very risky surgery.  The new lens have been developed to combat disorders such as ours.  Or do I wait and see what advances are made over the next few years????I'm still fairly young.
And thank you to Dr. JCH III MD - you have been soooo helpful in answering my queries.
  

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

Assuming the "doctors" you saw were MD physicians ophthalmologists I would have nothing to add and would just suggest following it for changes, If you saw optometrists (non-physician, limited eye care providers) then you need to see and Eye MD.

If they were a retinal and corneal specialist its unlikely it's serious. I would follow it carefully. Maybe print out an Amsler Grid and follow daily.

JCH III MD

[roseteresa]

I have been to a retnal and corneal specialist for a problem that has just developed. I had a cataract implant done in 1998.  I also have a pterigium in this same eye. Saturday night I developed what appeared to be a branch image to the right of my vision and on Sunday morning the branch effect was gone but what appears to be a half circle from the left to the right is in my vision. The line is very fine but there.  Both doctors could not find anything wrong with the retina or cornea.  Do you have any idea as to what it may be.

rma

[John C Hagan]

If you can get in rather quickly by declaring an emergency that consider doing so: 1. rule out retina problems but 2. at the same visit it should be possible to determine if the IOL is decentered or the posterior capsule turning cloudy. In the meantime do your own research both on this website and with an Internet Search engine.  Dysphotopsia and lights, arcs, streaking, glare and flare, ghosting are well known and common problems after cataract surgery. In fact some IOLs have been modified to make this less of a problem by modifying the edge of the IOL and aspheric design of the IOL optic.

You can also enter the IOL manufactuer and the model type (In the USA this information is given to the patient in a card to take home) you should be able to get it from the eye surgeon's office by phone. Manufactuer, model, IOL power. Enter the first two and "glare and night vision problems" in a search engine and look up the track record.

JCH III MD

[Egore]

Thank you for your reply.
My family doctor is sending me for a second opinion, however, that will not be for 3 to 6 months(I am in Canada)
The IOL's are from the same manufacturer. One thing that is different is that I have mono-vision and the left eye is my reading eye (not sure if that counts). The Surgeon did not give me a card about my IOL, just that they we from the same company.
I am just mystified why this guy said he had never heard of this. Very unsympathetic even when I told him the impacts to my job and hobby (digital photography)
He does not want to see me until Oct 16th. Do you suggest I treat this as an emergency? Just in case it is my retina?
Regards

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

I would seek a second opinion. You first of all need to be sure your retina is okay. The most likely cause is abnormal reflections from the intraocular lens (IOL). There are a variety of terms for the problem of which dysphotopsia is probably the most used. The consult should confirm a health retina, that the implant has not gotten out of proper position, that the membrane behind the IOL has not opacified and that you have the best possible refraction or glasses prescription.

Do you have the same style IOL in both eyes? You should have been given a card with the manufacturer, implant model and implant power. IF they are different, it increases the likelihood of the IOL causing the problem.

Over time these  IOL light symptoms tend to get better but in rare cases an IOL exchange is indicated.

JCH III MD Eye Physician & Surgeon