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Problems after cataract surgery
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Problems after cataract surgery

In January I had cataract surgery on my left eye.  In the follow-up appointment, my vision was 20-25; however, there was a small chip left in my eye.  Two weeks after the first surgery, the chip was removed and a suture placed in the eye.  It was removed four days later, and my vision was 20-40. The surgeon said that would improve, but it has not. Ten days later, a cataract was removed from my right eye.  Both IOLs were Technis aspheric, and the right was set for mini-monovision.  9-1/2 months after the last surgery, I have problems.  There is what I suppose is positive dysphotopsia in both eyes, and I would seem to be one of the few who do not get rid of it.  Day or night, when I come upon a light source which is brighter than the ambient light, I see the edges of both lenses which look like two lighted hoops close together.  The hoops disappear shortly when my eyes have adapted to the light.  In addition, in all kinds of ambient light, when a light with a bright center, such as a light bulb, traffic light, LED light on a computer, clock, etc., is in the line of vision of my left eye, I see a ray of light on both sides of the center of the light source, in a diagonal pattern, together with a halo or haze around the light. The rays do not disappear unless I move so that my left eye does not see the light source.  I have been in places, such as restaurants, offices, etc., with lights so placed that I have had to see light rays for an hour or two with no relief unless I close my left eye or leave.  In March, my ophthalmologist said the dysphotopsia situation should approve and told me to see her in several months.  As for the light rays in my left eye, she did not offer a reason for the problem and spoke of correcting the problem with glasses. Glasses, however,  did not help the issue, and I saw a second optometrist two weeks ago.  There was only a minimal change in my prescription; it is now -0.75, -0.25, 055 for the right eye and +1.00, -1.75, 090 for the left eye.  I had accepted the surgeon’s suggestion of aspheric lenses for better night vision, but I have worse night vision than before and now cannot drive at night or in bright sunlight. Although from what I have read, I can account for seeing the lens edges which shortly disappear, the problem of seeing light rays which are continuous as long as the light is in view, seems to have a different cause. Neither the surgeon nor the two optometrists I saw spoke of a problem with positioning of the lenses or folds when I asked them about those possibilities, nor was I given any explanation as to a possible cause.  I would appreciate any information you can give me regarding the possible causes of the light rings and the light rays.  
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233488_tn?1310696703
You can use the search feature and archives and read the many postings about dysphotopsia.

Suggest you get a second opinion about the problem.

Tecnis aspheric is one of the best IOLs on the market.

JCH MD
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Avatar_m_tn
Dear Dr. Hagan,
I just met with my 1st Cataract Specialist (going to see 3 before I select the one I want doing my surgery).

In the consultation, I had to ask what target he was aiming for and what brand/style of lens he planned on using.  I don't feel like he thought I needed to know the answers to these basic questions.  He did say he uses the Tecnis lens and I said "great, that is what I heard was the best".

Now today when I was on the phone to his clinic manager, I asked again what lens the surgeon decided on, and he said that they don't tell the patients that information and the Dr. just decides and uses what he wants at the time.  I said the Dr. told me he uses the Tecnis brand, and the clinic manager said "yes, sometimes but not always".

What do I make of this ?????  How does one ever know what was used for sure?
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233488_tn?1310696703
1. for "regular surgery" you may not have a choice of what type of standard monofocal IOL you get, it is not practicle to stock a wide variety and then demand a certain brand. Since private insurance and medicare only pay a modest amount the hospital or surgical center often negotiates on volume purchases.

Now with premium IOLs where the patient pays out of pocket as much as $3500 extra for a certain type of lens you can demand a certain type that the surgeon uses for example: Crystalens HD accommodating IOL or a Alcon toric IOL.

In all cases the surgeon owes you an explanation of the target post operative uncorrected refractive error. It is very important to know if the patient wants best distance, intermediate or near vision without glasses. If I were having surgery I would be very upset if an IOL was put in my eye that left me with 20/20 vision for driving (perfect without glasses) but I couldn't read without glasses as I do now. Other people would feel differently. Surgeons should also be able to tell you how the two eyes will work together after cataract surgery. For instance if a person has +3.75 diopers of hyperopia (farsighted) in both eyes and one has a large cataract and the other a small then the surgeon should let the person know that after the first eye is fixed and corrected to a best vision at distance without glasses 0.00  then the eyes will not work as a team due to too much difference between the eyes (post op 0.00 in operative eye and +3.50 in non operated eye).  I generally tell the person this and that they should plan on having the eye with the small cataract operated on about 4-12 weeks after the first "when you are totally pleased and satisfied with the first eye"

If you are not accorded a full discussion of what "target" post operative refractive error is then you seriously need to question your choice of surgeons as good communication and respect of the patient's individual realistic choices are extremely important and an element of "being a good surgeon"..

JCH MD
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