Aa
PCO without cloudiness, visual aberrations and afterimages
I had left cataract surgery in may, Alcon mono focal lens set to near. My vision especially color is excellent. My surgeon told me during the surgery that he was not able to scrape all the "sticky stuff" off w/out compromising the capsule and that I would likely develop PCO and need a yag. The next day he said he saw more debris than is usual so I came back a 2nd day to be checked for infection. No infection, he said it was just me. Vision perfect, Alcon soft acrylic lens set to near, BOTH near and DISTANCE improved, colors brilliant.
Last week I started seeing flickers that turned into circles with a ring around it, fades if I close my eyes. Have seen red, green, yellow and blue circles. I mostly see these things when certain light sources hit the left eye a certain way. To better describe, using iPad to write this, not seeing any aberration, close my eyes and I see a bluish white halo., just closed them again, now aberration is blue. My vision is excellent, and NOT cloudy.
I was seen in the office day after Labor Day, complete dilated exam. Lens is perfect position, "fuzz" was seen in the area where he couldn't scrape during the surgery, more than what was left but not a huge amount. He thinks this is likely scatter from the membrane growing and that a YAG will resolve it. He mentioned positive and negative dystrophia but just in passing.
I thought the symptoms of PCO were cloudiness and diminished vision. My vision is great. I also sometimes see flickers of glare out to the left in certain lighting conditions and this can trigger a "vision" round circle thing that fades.
Just wondering if this sounds normal, he asked how much it was bothering me, I guess so he would know how soon I wanted the YAG, it wasn't to bad but waxes and wanes, but I will get the YAG sooner rather than later .
I had the surgery on may 14th at SurgiSite Boston, done with the catalys laser.the cuts had to be done by hand as the laser lens lost suction twice as my eye is apparently small. I WATCHED him vacuume out the broken up cataract and insert the tiny folded lens. It was very cool to see!!!! My ophthalmologist said most people see nothing but I was/am nearsighted enough to see this very delicate work.
Thank you in advance and for what you all do :)
Last week I started seeing flickers that turned into circles with a ring around it, fades if I close my eyes. Have seen red, green, yellow and blue circles. I mostly see these things when certain light sources hit the left eye a certain way. To better describe, using iPad to write this, not seeing any aberration, close my eyes and I see a bluish white halo., just closed them again, now aberration is blue. My vision is excellent, and NOT cloudy.
I was seen in the office day after Labor Day, complete dilated exam. Lens is perfect position, "fuzz" was seen in the area where he couldn't scrape during the surgery, more than what was left but not a huge amount. He thinks this is likely scatter from the membrane growing and that a YAG will resolve it. He mentioned positive and negative dystrophia but just in passing.
I thought the symptoms of PCO were cloudiness and diminished vision. My vision is great. I also sometimes see flickers of glare out to the left in certain lighting conditions and this can trigger a "vision" round circle thing that fades.
Just wondering if this sounds normal, he asked how much it was bothering me, I guess so he would know how soon I wanted the YAG, it wasn't to bad but waxes and wanes, but I will get the YAG sooner rather than later .
I had the surgery on may 14th at SurgiSite Boston, done with the catalys laser.the cuts had to be done by hand as the laser lens lost suction twice as my eye is apparently small. I WATCHED him vacuume out the broken up cataract and insert the tiny folded lens. It was very cool to see!!!! My ophthalmologist said most people see nothing but I was/am nearsighted enough to see this very delicate work.
Thank you in advance and for what you all do :)
Best Answer
MEDICAL PROFESSIONAL
Thanks for your comments. I am a physician that loves talking to patients and I have physicians that care for me that love to talk for me. Because there are more patients to see every year, fewer patients and reimbursements decrease every year I am unable to spend much time talking to patients and my physicians have to be in and out faster and faster each year. Not fair to patients or physicians.
JCH MD
JCH MD
thank you for your reply and encouragement, it really helps keep me calm. depending how the PET scan goes monday & when I can get in to see Dr G again/I assume if its clear he will want to discuss treatment w/me, I am "thinking" about possibly getting another opinion/treatment wise since MEEI only does the proton beam thing; in Phili at Wills Eye Center, have heard good things about them. It will all depend on PET results and timing. I am from NJ and have family near Phili.
As to the wonderful world of healthcare and insurance, I live in Massachusetts where ROMNEYCARE has been in effect for some time. What used to be a 3 week wait to see a specialist in Boston is now 3 months PLUS. There are now so many new patients in the system, who by the way have BETTER coverage than my husband and myself, at drastically reduced rates from the very SAME insurance companies we use, that it is getting next to impossible to be seen by a PCP. They dont need referrals, their premiums are subsidized partially by OUR taxes and its all just a mess.
More and more doctors here are closing their practices and joining places like Lahey Clinic where they are paid a set salary, they do their job, the ancillary staff is provided by Lahey and so it goes...
I feel like a piece of meat or body part rather than a PERSON and deal constantly with overworked, staff and become increasingly frustrated to the point where I dont like going to the doctor unless I absolutely HAVE TO. Now I DO have to and its been a real FIGHT getting the right person to order the right test in a timely manner, I explain my issues to one person who gives me to another who says they will call me back, often they dont and I really have to FIGHT for care. I feel fortunate in that I do not feel sick, a bit emotionally at this time perhaps, but I really feel very bad for those who DO FEEL SICK physically and have to navigate this horror show. I cant really see things improving when the ACA finally is up and running, IMO things will just get worse though I do think its important that people are covered and not dropped by pre existing conditions. I dont THINK insurances could do that here in MASS anyway. We have pretty good consumer protection for these things in this state.
Anyway I hope your knee does well and you have a speedy recovery :) Will keep you updated about me, thanks again for caring, very few Drs seem to,they used to, perhaps they just dont have the time anymore.
Nancy
As to the wonderful world of healthcare and insurance, I live in Massachusetts where ROMNEYCARE has been in effect for some time. What used to be a 3 week wait to see a specialist in Boston is now 3 months PLUS. There are now so many new patients in the system, who by the way have BETTER coverage than my husband and myself, at drastically reduced rates from the very SAME insurance companies we use, that it is getting next to impossible to be seen by a PCP. They dont need referrals, their premiums are subsidized partially by OUR taxes and its all just a mess.
More and more doctors here are closing their practices and joining places like Lahey Clinic where they are paid a set salary, they do their job, the ancillary staff is provided by Lahey and so it goes...
I feel like a piece of meat or body part rather than a PERSON and deal constantly with overworked, staff and become increasingly frustrated to the point where I dont like going to the doctor unless I absolutely HAVE TO. Now I DO have to and its been a real FIGHT getting the right person to order the right test in a timely manner, I explain my issues to one person who gives me to another who says they will call me back, often they dont and I really have to FIGHT for care. I feel fortunate in that I do not feel sick, a bit emotionally at this time perhaps, but I really feel very bad for those who DO FEEL SICK physically and have to navigate this horror show. I cant really see things improving when the ACA finally is up and running, IMO things will just get worse though I do think its important that people are covered and not dropped by pre existing conditions. I dont THINK insurances could do that here in MASS anyway. We have pretty good consumer protection for these things in this state.
Anyway I hope your knee does well and you have a speedy recovery :) Will keep you updated about me, thanks again for caring, very few Drs seem to,they used to, perhaps they just dont have the time anymore.
Nancy
MEDICAL PROFESSIONAL
Well good luck. If you have to have a malignancy an ocular melanoma is generally less aggressive than other types of malignancies. You also are are in skilled and specialized care.
I have nothing good to say about your concerns about health care in the USA. All the problems with trying to get the ACA exchanges up and running will be nothing compared to what it will be like trying to treat or be treated. The amount of "face time" with physicians will be extremely short. Many more patients, fewer physicians lower and lower reimbursement. I am disheartened both as a physician who will have to practice under such a system and a patient of the system. (Just had arthroscopic surgery on my knee 3 weeks ago. Everything sent fabulous. Why would you want to change such a great system? People are living longer and longer. Something is obviously working right!)
a woman I work with told me two days ago that her sister had a malignant melanoma so I've recently reviewed treatment and prognosis (I do not do this type of treatment). My review is that many more treatment options are available, diagnosis is much better, many more eyes are saved and mortality continues to decline.
JCH MD
I have nothing good to say about your concerns about health care in the USA. All the problems with trying to get the ACA exchanges up and running will be nothing compared to what it will be like trying to treat or be treated. The amount of "face time" with physicians will be extremely short. Many more patients, fewer physicians lower and lower reimbursement. I am disheartened both as a physician who will have to practice under such a system and a patient of the system. (Just had arthroscopic surgery on my knee 3 weeks ago. Everything sent fabulous. Why would you want to change such a great system? People are living longer and longer. Something is obviously working right!)
a woman I work with told me two days ago that her sister had a malignant melanoma so I've recently reviewed treatment and prognosis (I do not do this type of treatment). My review is that many more treatment options are available, diagnosis is much better, many more eyes are saved and mortality continues to decline.
JCH MD
Somehow part of what I wrote got left off. What was NOT EASY was getting a PET scan scheduled with nothing in writing that I ever was there, I WENT directly to my PCP but she couldn't order it with no documentation to justify to insurance, after she and. Y eye dr spoke and called MEEI yesterday I got a call that MEEI had faxed her something today and I am booked for the CT Monday . Otherwise she was going to send me to an oncologist to order the test. I have had drs give me test orders on a prescription pad so I don't know why DR G could not do this.
I wrote this right before I spoke about the laughing fellow but apparently it didn't come out
I wrote this right before I spoke about the laughing fellow but apparently it didn't come out
BAD NEWS :(, I saw Dr G yesterday and he said I have a tumor in my eye that is definitely MALIGNANT :( the issue is that he said he can't tell if it is a primary tumor or mets from somewhere else. He wants a PET scan to R/O cancer somewhere else. It was NOT EASY because MEEI never gave me any paperwork and his fellow said he would write a letter to my PCP but kind of laughed and said it might be at least a week. OK......
I understand that if the tumor is primary, he can take care of it with the proton beam procedure. I heard his fellow say it is 2.5 mm high and my eye dr who I saw for new F and F in the other eye/was PVD, no tear, he looked at it and estimated it at 4mm
Dr G and his fellow left before I had a.chance to ask him anything!!! I have no idea what that means if anything. I had the US before I saw him and a flourisceine angio, and OCT AFTER he left. I know he is a famous expert but do you think it is possible for the last two tests to do anything to modify the diagnosis. If it was a melanoma do you think he could know SURE today.
I had no chance to ask him the type of tumor, didn't think of it once I heard malignant. It was absolutely like a machine part zoo being there, the waiting rooms are PACKED, there are people everywhere from all over the country . The US tech (her daughter got married the same day as my son) told me he only sees pts non/tues 8-12 , they used to see 18 a day, now they see 50!! I am no expert but I bet it has to do with insurance , everything does sigh,,,
All day yesterday I alternated between crying, shaking and feeling peaceful which I found odd kind of. Today I became proactive and did some calling, faxing and other things between some 'sniff cry" episodes. I work from home on the PC and plan to start back tomorrow in moderation because I notice an imbalance close up between the 2eyes.
I am so scared and wish he were more personable, kind of bites to be told you have cancer then 5 minutes later taken into a room for an angio, and be told your BP is " a little high" Ya think..... I just wanted to let you know what was going on since you seem to really CARE and have been so nice to me. My dystrophia issue in the other eye is NOTHING compared to this and he said I can NOT get my other cataract done .
Thank you again for your kindness and for the service you provide . It's comforting to know that there is a place online where you can get LEGITIMATE expert advice. Especially in this age where drs HAVE to see so MANY patients to just break even and i KNOW some don't even do that. My eye dr/former boss told me that insurances pay NOTHING near what is billed and Medicare is one of the worst!! IMO it really takes away from what I used to think of as the ART of medicine, i can't even think of a word to describe what I mean!!!!! Coming here IMO gives people some of the attention and accurate information that the DR 's we see don't seem to have time for.
Nancy
I understand that if the tumor is primary, he can take care of it with the proton beam procedure. I heard his fellow say it is 2.5 mm high and my eye dr who I saw for new F and F in the other eye/was PVD, no tear, he looked at it and estimated it at 4mm
Dr G and his fellow left before I had a.chance to ask him anything!!! I have no idea what that means if anything. I had the US before I saw him and a flourisceine angio, and OCT AFTER he left. I know he is a famous expert but do you think it is possible for the last two tests to do anything to modify the diagnosis. If it was a melanoma do you think he could know SURE today.
I had no chance to ask him the type of tumor, didn't think of it once I heard malignant. It was absolutely like a machine part zoo being there, the waiting rooms are PACKED, there are people everywhere from all over the country . The US tech (her daughter got married the same day as my son) told me he only sees pts non/tues 8-12 , they used to see 18 a day, now they see 50!! I am no expert but I bet it has to do with insurance , everything does sigh,,,
All day yesterday I alternated between crying, shaking and feeling peaceful which I found odd kind of. Today I became proactive and did some calling, faxing and other things between some 'sniff cry" episodes. I work from home on the PC and plan to start back tomorrow in moderation because I notice an imbalance close up between the 2eyes.
I am so scared and wish he were more personable, kind of bites to be told you have cancer then 5 minutes later taken into a room for an angio, and be told your BP is " a little high" Ya think..... I just wanted to let you know what was going on since you seem to really CARE and have been so nice to me. My dystrophia issue in the other eye is NOTHING compared to this and he said I can NOT get my other cataract done .
Thank you again for your kindness and for the service you provide . It's comforting to know that there is a place online where you can get LEGITIMATE expert advice. Especially in this age where drs HAVE to see so MANY patients to just break even and i KNOW some don't even do that. My eye dr/former boss told me that insurances pay NOTHING near what is billed and Medicare is one of the worst!! IMO it really takes away from what I used to think of as the ART of medicine, i can't even think of a word to describe what I mean!!!!! Coming here IMO gives people some of the attention and accurate information that the DR 's we see don't seem to have time for.
Nancy
MEDICAL PROFESSIONAL
Most are benign, do not grow and require no treatment. Other things it could be including old scar, macular edema. you're in good hands.
Best of luck.
JCH MD
Best of luck.
JCH MD
UPDATE
the visions seem to have lessened some but now i have another issue in my right eye...sigh
noticed over the weekend that straight lines appear slightly wavy or bowed.that symptom spoke WET armd, amsler grid, so i did one and the lower left was subtly distorted. called and was seen last night by my ophthalmologist. dilated exam showed that i have an amelanotic chroidal lesion, which i assume is a nevus that is very near the fine vision center. i am being sent to see Evangelos S. Gragoudas, MD @ mass eye and ear in boston for a 2nd opinion and probable ultrasound
can you shed any light on what an amelanotic chroidal nevus might be in as far as it being a BAD thing?
thanks in advance
Nancy
the visions seem to have lessened some but now i have another issue in my right eye...sigh
noticed over the weekend that straight lines appear slightly wavy or bowed.that symptom spoke WET armd, amsler grid, so i did one and the lower left was subtly distorted. called and was seen last night by my ophthalmologist. dilated exam showed that i have an amelanotic chroidal lesion, which i assume is a nevus that is very near the fine vision center. i am being sent to see Evangelos S. Gragoudas, MD @ mass eye and ear in boston for a 2nd opinion and probable ultrasound
can you shed any light on what an amelanotic chroidal nevus might be in as far as it being a BAD thing?
thanks in advance
Nancy
my iol is acrysof IQ acrylic Model SN60WF set to near
having been nearsighted since age 20 & as i will be 60 next month, I thought the less the "old" brain had to learn/adapt to the better! from what i understand about dystrophia, the brain can/will eventually adapt to filter these things out; i also think that the less I FOCUS/look for the "visions" the easier it will be to do if indeed i have this condition. i will google, find and read your articles. overall even with the "visions"(note i shall NOT personalize them!!) i am quite pleased w/the outcome of my surgery, the improvement in my vision is just wonderful!!! its a beautiful COLORFUL vibrant world.
i hope the yag will help, i have never seen ANYONE have a bad issue from it/i did not see patients post yag but certainly would have heard about it in the office. that practice always sends patients w/emergent issues/ what they cant handle to Mass Eye and Ear/Tufts and MERSI (for uveitis) where the drs have ongoing relationships with sub specialists.
thank you again for all of your help & for this wonderful website.will keep you posted. safe travels :)
Nancy
having been nearsighted since age 20 & as i will be 60 next month, I thought the less the "old" brain had to learn/adapt to the better! from what i understand about dystrophia, the brain can/will eventually adapt to filter these things out; i also think that the less I FOCUS/look for the "visions" the easier it will be to do if indeed i have this condition. i will google, find and read your articles. overall even with the "visions"(note i shall NOT personalize them!!) i am quite pleased w/the outcome of my surgery, the improvement in my vision is just wonderful!!! its a beautiful COLORFUL vibrant world.
i hope the yag will help, i have never seen ANYONE have a bad issue from it/i did not see patients post yag but certainly would have heard about it in the office. that practice always sends patients w/emergent issues/ what they cant handle to Mass Eye and Ear/Tufts and MERSI (for uveitis) where the drs have ongoing relationships with sub specialists.
thank you again for all of your help & for this wonderful website.will keep you posted. safe travels :)
Nancy
MEDICAL PROFESSIONAL
Congrats on the wedding. May they live long and prosper.
1. Folds in the posterior capsule present no problem during yag capsulotomy.
2. I'm on the road and working out of an iPad and iPhone. Use any internet search engine, search "Hagan, Kutryb and dysphotopsia" the articles should be available in the past issues section of the journals they were published in.
3, Dysphotopsia may be present immediately after surgery and get better with time, (usual course) or not get better or get worse. It can also develop in the weeks and months after surgery. Much more common with multifocal IOLs then accommodative IOLs and lowest in aspheric monofocal IOLs.
JCH MD
1. Folds in the posterior capsule present no problem during yag capsulotomy.
2. I'm on the road and working out of an iPad and iPhone. Use any internet search engine, search "Hagan, Kutryb and dysphotopsia" the articles should be available in the past issues section of the journals they were published in.
3, Dysphotopsia may be present immediately after surgery and get better with time, (usual course) or not get better or get worse. It can also develop in the weeks and months after surgery. Much more common with multifocal IOLs then accommodative IOLs and lowest in aspheric monofocal IOLs.
JCH MD
One other question, i apologize in advance; is it likely for one to develop dystrophia after several months post op? It seems more logical imo that this would happen early, but perhaps the changing/growing PCO has finally gotten to the point that would cause dystropia symptoms?
TY again in advance :)
Nancy
TY again in advance :)
Nancy
Thank you for your reply, it makes me feel better that you agree that PCO is likely causing these "visions" My concern was that these aberrations began after almost 4 months post op, and I have no change in vision/cloudiness.
I DO have astigmatism and have trouble tolerating the RX so they dont put it in. They refracted me unusually early in the process imo, and said I had little change so I didnt fill the new glasses. Is it likely that if I get a RX w/astigmatism correction that the aberrations will lessen even though I "see" them whether I WEAR glasses or not? I will LEARN to adapt to the correction if it will stop these "visions" which are actually PRETTY when they are not scaring me :)
My son is getting married next weekend so I will be calling my surgeon the following Monday for another apt and possible YAG. I dont want to risk any possible complications post yag before that. Believe it or not I used to work for this group of ophthalmologists & assisted in numerous YAGs, but I did not work for the cataract service, so I dont know enough about cataract after issues. BUT I probably do know to much for my own good yet not enough if you know what I mean.
One more question please, if there is a FOLD in the posterior capsule is a YAG likely to fix this?
Thank you so very much for your time and attention. This is a wonderful website and you are very kind :)
Nancy
I DO have astigmatism and have trouble tolerating the RX so they dont put it in. They refracted me unusually early in the process imo, and said I had little change so I didnt fill the new glasses. Is it likely that if I get a RX w/astigmatism correction that the aberrations will lessen even though I "see" them whether I WEAR glasses or not? I will LEARN to adapt to the correction if it will stop these "visions" which are actually PRETTY when they are not scaring me :)
My son is getting married next weekend so I will be calling my surgeon the following Monday for another apt and possible YAG. I dont want to risk any possible complications post yag before that. Believe it or not I used to work for this group of ophthalmologists & assisted in numerous YAGs, but I did not work for the cataract service, so I dont know enough about cataract after issues. BUT I probably do know to much for my own good yet not enough if you know what I mean.
One more question please, if there is a FOLD in the posterior capsule is a YAG likely to fix this?
Thank you so very much for your time and attention. This is a wonderful website and you are very kind :)
Nancy
I DO understand that these physicians likely have their OWN practices in addition to what they do here
MEDICAL PROFESSIONAL
You posted this to the other eye forum. They will answer. JCH MD
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Common things occur commonly so its likely the PCO. Sometimes the PCO causes folds in the posterior capsule which can act like a prism and cause geometic, colorful images.
JCH MD