cataract post-operative pupil dilation

I had an Alcon Acrysoft Spheric IQ Toric IOL implanted on my left eye 22 days ago. I'm a 30-ish yo male, no other health issues, exercise a lot, and have had congenital cataract on both eyes.

During daylight everything is just perfect. I had never seen this clear before in my life. But when night comes or the room I'm in gets darker, oh well... it gets really blurry -- things in distance seems to be out of focus. I only have a good near sight vision at night. But when I enter somewhere with strong artificial light, things get all clear again.

I had had a thorough retinal examination (besides other tests) before the surgery so I don’t believe it could be related to RD.

After the surgery, I've been to the doctor's office twice already and he says everything's all right and the surgery went well. He just commented that my pupil is big after  I told him what's been going on.

It's slightly bigger if compared to my other eye. And my eyelid is just a little bit "droppy" (nothing very noticeable, but it’s there).

Reaction to light is a little bit slower if compared to the other eye.

I also noticed things (blurriness) got a little bit better around  the 17th day (5%-10% better).
A different issue is that when I look at some bright lights, a little bit of “ghosted vision” appears depending on the distance. I have a confirmation that I have no traces of astigmatism left after the surgery (only a 0.5D myopia).

I mostly concerned about the night blurriness. Is this a common issue? Should I be worried? What should I expect?

Kind regards to all.

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

Your problem could easily be explained on the basis of the way the pupil helps correct myopia (nearsighted). If the pupil is small as in bright light it can help correct myopia and also healp near and intermediate vision due to pinhole effect.

WHen the pupil is large(r) in a dim or dark room the eye loses perhaps 20-30% of its abililty to correct myopia or focus at near and intermediate due to the myopic shift with a large pupil. This would help your uncorrected reading vision something you've noticed.

Even people with perfect eyes and no surgery often experience this and wear glasses for driving at night (night myopia).

The answer is likely going to be no line progressive bifocals to be worn when you need them (whether for distance, mid or near vision)

JCH MD

[tandrade30]

I forgot to mention that as soon as I wake up in the morning, even in a darker room, it doesn't get blurry. After 30 minutes or so the problem starts.

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

Your problem could easily be explained on the basis of the way the pupil helps correct myopia (nearsighted). If the pupil is small as in bright light it can help correct myopia and also healp near and intermediate vision due to pinhole effect.

WHen the pupil is large(r) in a dim or dark room the eye loses perhaps 20-30% of its abililty to correct myopia or focus at near and intermediate due to the myopic shift with a large pupil. This would help your uncorrected reading vision something you've noticed.

Even people with perfect eyes and no surgery often experience this and wear glasses for driving at night (night myopia).

The answer is likely going to be no line progressive bifocals to be worn when you need them (whether for distance, mid or near vision)

JCH MD

[tandrade30]

Doctor, thank you a lot for your answer! I went back to my doctor's office and he prescribed me a -0.5 contact lens. It doesn't make a big different during the day but at night, wow! The problem was completely solved. Now I feel fine about having the second surgery performed.

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

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