IOL centration

What is the correct way of checking an IOL for tilt and decentration?   I've been told that "you just look at it".

I am 19 months post surgery, and (among other problems) my vision fades in and out, I have a constant grey gauzy shadow on the temple side, dark flickering/strobing shadow on the temple side in especially in bright light or when tilting head forwards or backwards, flaring and beams of light in low light.  With corrective lenses I feel like I have to look towards my nose to get the decent vision from that eye, and even then the vision is distorted.

The IOL is a toric lens.  I also have CME and "mild" ERM, and PCO.

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

Yes that is true, you examine the IOL with a slit lamp and the pupils dilated.
JCH MD

[Moxie67]

Would any of the following symptoms indicate a decentered IOL?   I am 20 months post surgery.

1) I can see the edge of the lens on the temple side.  It is a dark arc shape that flickers and bounces.  This is worse in bright lighting conditions or when I tilt my head forwards or backwards.  It also got worse with pilocarpine drops.

2) In low light conditions, I get long diagonal streaks from light sources especially those at the temple side.  They are very long single streaks of light, not starbursts or halos.

3) There is a diagonal "fold" in my vision that runs approx 8oclock to 2 oclock.  I have to look to the right of this "fold" - towards my nose - to see.

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

It is much more likely that this is due to ERM, CME or PCO or is IOL dysphotopsia than the IOL being tilted or out of position.

JCH MD

[jaysta36]

thats not right mate I had ,halos glares up to 12months post operate,even tho i still suffer with it slightly at night,its lts tolerable to live normal life, i do get slighty flicker arc  feeling to left of eyes,only in certain lights at night mainly dark room with spot lights,but i know that's down to my pupil bleeding over the edge of lens,this can be controlled with alphagam drops,for pupil shrinking,but i choose not to use them due to sore eye side effects,again tolerable to live normal life,this is the question,is it tolerable to live a normal life for you at 19 months its not going to get any better!
if not you need to do something about it,myself i think its down to the type of lens get it checked out by another doctor,due to the one you had it with,will not want to say theres a problem with their work on your eye Good look! p.s your diagonal streaks of light could be down to iridotomty holes,which never heal completely,they holes made to insert your lens into your eyes,light passes through these microscopic holes causes reflections,check it out on google type in iridotomty holes whole page and forum's about it!

[jaysta36]

I mean iridotomy holes good luck!

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

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[Moxie67]

Are iridotomy holes standard procedure with cataract surgery then?  I didn't think I had these - thought the only actual hole that was made was in the front of the lens capsule.
When I look up iridotomy holes it seems like those are made for controlling eye pressure and/or for implantable contact lenses?

[jaysta36]

no you have 3 holes to insert you lens is in front of capsule,these holes never heal fully shut,these let in light with some people and give reflections like white horizontal lines or diagonal especially when you blink

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

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