Poor YAG Result

[mmmmpppp]

Hi,

I am 51 and had a Crystalens HD500 implanted in my right eye on 7/7/09.  I had had a very advanced PSC cataract.  I have tested extremely well ever since the surgery, usually 20/15 distance, 20/15 intermediate, and 20/40 or better near, and plano.  Before the cataract, the right eye was great.  Since Day 1 with the Crystalens, I had noticed that my distance vision was a little blurry during the day and very blurry at night.  The night dysphotopsias were very bad.  My binocular vision ended up perfect, but I have been worried about what would happen if anything were to happen to my left eye.  It seemed to get a little worse over time, and I started noticing a little double vision in just the Crystalens eye.

I had a YAG Capsulotomy two days ago, on 10/20/09.  Each symptom got a little worse, plus now I have large startbursts, luckily not too opaque, and bad night glare from headlights.  The double vision is definitely more noticable.  The extra blurriness and night effects are harder for my brain to separate out of my binocular vision.

I think my surgeon had warned me that he cuts a very small hole, which can result in a glare problem and require follow-up YAG to enlarge the hole.  So I am hoping that there is still a chance for a good outcome with some enlargement.

Getting a little worried!  Is there still hope for clear vision for me?

Thanks.

P.S.  My vision varies very noticeably just between morning sun and late afternoon sun, even if I am outside.

[John C Hagan III, MD, FACS]

Your problem may require glasses for night driving, glare situations and other things. If glasses do not make the crystalens eye see perfect then get an independent second opinion about your situation

JCH MD

[mmmmpppp]

Thanks!  

[John C Hagan III, MD, FACS]

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[mmmmpppp]

It appears that what I ended up with is that the YAG resolved the dysphotopsias and I am -.50 Diopters.  (I don't know if that makes sense.)  That is to say, a .5D correction makes my vision crisp and clear.

[JodieJ]

I'm glad to know that your dysphotopsia has been eliminated.  I'm curious, though, about whether you continute to have 20/15 vision at distance with a refractive error of -.50.

[mmmmpppp]

Usually 20/13 distance and varying between 20/25 and 20/40 near based on my home testing.  In the doctor's office, they measured my distance at 20/20 but never showed me the 20/15 line.  There's no question that I would have read it easily.

[mmmmpppp]

P.S.  The -.50 was based on a machine that shows spherical aberrations and a bunch of other things, including photos of cars with headlights depicting the actual glare one sees.  Note that this measurement was taken with my eyes dilated.  If I keep my November 6th appointment, which I might not since the dysphotopsias cleared, I will have a refraction test undilated.  Does dilation affect refraction measures?

[mmmmpppp]

P.P.S.  Just realized, they handed me a +.50 lens and my distance was suddenly crisp.  Yes, I was dilated, but I'm sure that the blurriness is close enough to what it was dilated.  (I keep looking for ways to believe that I am still plano--if I ever was.)

[CC450]

Was your glare shiny like someone was shining a light in your eyes and the light had streaks through it? Was the glare in low light situations with a bright light source from the temporal side? If that is the case maybe there is hope for me because that is what I have. It has been almost 2 weeks since my YAG and it seems to be getting worse. I had the glare prior to the YAG, but not immediately following my surgery. I did not notice it until about 2 months after surgery and I was hoping the YAG would resolve it. I did not have glare the day following surgery but it came on day 3.  

[mmmmpppp]

Are you referring to my pre-YAG dysphotopsias or what I called glare the day after the YAG?

The day after the YAG, headlights looked incredibly bright and white to the point that I found it blinding.  They looked like they were overflowing from their sources.  It was like a blinding hot lava.  That is what I called "glare," and I only experienced that on the night one day after the YAG.  The starbursts were gigantic and largely transparent unless emanating from a strong white light.  They lessened a lot by the next night, when the glare was pretty much gone.

Before the YAG, my night vision through that eye was a nightmare.  If I had had two eyes like that, I could not have walked across the street to the store.  Every light source had these dense, choppy, bar and streak-like halos.  My whole night vision was dominated by a blur of these effects.

The "before" symptoms lasted until exactly 4.5 days after the YAG, when I woke up from a nap and it was all gone.  The only starbursts I see now are extremely mild, much, much smaller, transparent, and only in peripheral vision.

[mmmmpppp]

As usual with this eye and its Crystalens---the plot thickens!

Undilated in the doctor's office today, I was 20/15 distance (they don't have tests for better than 20/15) and squarely Plano, not even borderline with anything else.  Both the technician and the doctor tested me.  The doctor was also astounded at how quickly I can read the lines at 20/15.

I had tested -.50 D previously on their iZone machine.  The doctor said that the iZone always thinks Crystalenses are half a diopter off because the machine catches it when the Crystalens accommodates and is misled by that.  I knew that I must still be Plano!  My near vision had not improved in the slightest; so how could I have become more near-sighted?

He recommended that he expand the opening of my capsule and thinks that it will help with some light effects, but he doubts that it will help with the blurriness at distance.  He can't really explain the blurriness.  He just says that no lens is perfect and that I am used to very precise vision and the Crystalens just doesn't provide it for me.  He thinks that a +.50 lens makes my distance vision sharper because of a "telescope" effect, and that explains why, when I hold up the lens, I cannot read at all.

[JodieJ]

Overall, it seems like you have a good Crystalens result.  Perhaps you could get progressive glasses with a +.50 correction for distance and a +1.25 correction for near.  These might help with certain tasks (e.g., night driving, spectator sports, reading menus in dark restaurants) when you wanted to enhance your acuity.

[mmmmpppp]

Thanks, Jodie.  The doctor's office has been suggesting 1.25 readers as well, though I never seem to need them.  I didn't buy any in the spirit of working my Crystalens for the first 6 months to a year.

What are progressive lenses?

For distance I was thinking of getting sunglasses with a +.50 corrected lens, but binocularly, my distance vision is spectacular; so I probably wouldn't wear non-sunglasses.

As usual Jodie, I appreciate your following the twists and turns and helping me out!

By the way, do you think that much blurriness could be an imperfection of the lens, i.e., do you think it could be slightly defective?

[JodieJ]

I doubt that there's an imperfection in the lens.

Glasses are expensive, so I was trying to think of how you could get the most mileage out of yours.  With progressives, you could get both sharper distance and sharper near vision.  If you added transitions to the lenses, you could even use them as sunglasses (except for driving).  So at a daytime sports event, you'd a crisper view of the action, sunglass protection, and the ability to read fine print if you needed to.