ghosting etc following cataract surgery

[jaycat]

I'm in the UK, 51 yr old woman.  I had a cataract removed from my right eye 5 weeks ago, monofocal lens implant to correct my longstanding shortsightedness (my prescription with the cataract in my eye was something like -9, at the last eye test before that 4 yrs ago was something like -7)  I have a small cataract in the left eye which the surgeons would ordinarily have left, for now, but because my eyes are now very 'unbalanced' they are going to remove it in the next few weeks; prescription in that eye is -6.75, and -1.75 astigmatism.

I have very good distance vision in the right eye now in daylight, but have ghosting (mostly of light coloured text/objects against dark background, much worse at night/in dim light but a little during the day, particularly viewing TV etc) & fairly dramatic when driving at night - eg. seeing a cluster of maybe 4 overlapping traffic lights from a distance which converge as I approach.
I'm awaiting an appointment with my eye specialist (National Health Service) to discuss this, but understand from these forums, & a recent consultation with my optician, that this can be a result of otherwise successful surgery, particularly with large pupils which I have.  My understanding is that physically this is likely to be a permanent condition, & that there is nothing that can be done to rectify it, that I have to "get used to it".

I'm in the process of coming to terms with this but wondered if anyone could give any advice about ways of dealing with this, or assisting the process of neuroadaptation - anything psychological I can do to ease the process/train my brain to ignore it.  Or indeed anything physical anyone knows of that might help, even slightly.
I'm also concerned now about the 2nd surgery, as I assume I will have the same problems with that eye; is this likely to make the issue worse, or might it be better when my eyes are 'balanced' again & working together?

One final thing - a few days ago I cried, just a little, 1st time since surgery, & my tears burned my eye so badly I couldn't keep it open & had to keep it shut for at least 15 mins; same thing again the next day when I just got very slightly tearful about something sentimental.  I'm seeing my GP soon but wondered if this could be caused by dry eye, developing since the surgery; I stopped taking the prescribed eye drops after 4 weeks (antibiotics & anti inflammatory, I think)

Any advice appreciated.

[shindi441]

Hi.
Certainly time is healer.My search for dealing with nighttime light issues and dry eyes have lead me to  laser surgery forums and was surprised to find that these problems weretwo of the commonest concerns after surgery. This does make me believe that any surgery to the eye is a major disturbance to all the parts of this intricate organ and they heal at their own speed.On the whole, my experience shows there is slow improvement as time goes by  reduction in glare and sensitivity. But there are set backs after too much exposure to lights at parties, shopping mauls and computer monitors. I must not be embarrased by wearing shades even 4 months after the operation under such circumstances.
Thanks for your words of hope. Best of luck with your surgery for the other eye.

[jaycat]

Hi shindi,
many thanks for posting this - it gives me some hope.  I don't seem to have any dry eye issues, so it may be something I can use.  I'm currently trying to get another appointment or some phone time with my (NHS) consultant before my next scheduled surgery NEXT WEEK - I'm VERY ambivalent about going ahead at present.
I spoke to a nurse at the pre-op clinic last week who told me of a friend who had both eyes done last year, & had to take sick leave from work as she couldn't drive at night.  It took over a year, but she has experienced improvement & is now glad she had the surgery done.  So another story of hope.

[shindi441]

I went back to my surgeon on the 13th 0ctober mainly to sound out my concerns about the horrible nighttime 'light issues'. After a full eye exam ( including pupil dialation and sight test) he said everything was fine and was surprised that I was still having these  issues but did say that my pupils become too large in the dark and as a result the light hits those parts of the lenses which are supposed to be kept in the dark (Lentis Mplus website claims their perfomance to be PUPIL-SIZE INDEPENDANT!)  He prescribed g alphagan 0.2% eye drops to constrict the pupils. My eyes get very soar after the full exam so I had to wait about a week before having the courage to give any further shock to them. Well, I have applied these drops twice- 21 and 22 october. I was told to give 3hours time for them to be effective. I applied them at about 5.00pm. GOOD NEWS- They did not sting, did not cause blurry vision and within an hour I could see that they had lifted the haze or waxy vision that comes in the evening. When I went out to drive the halos and starbursts had shrunk by a third and the road markings were much clearer. However the bad news is that they made my eyes feel very dry and gritty inspite of topping up with systane drops every half hour or so. I woke up with very red and uncomfortable eyes the following mornings and my eyes still feel very traumatised and feel my healing process has been set back. I do not know what ingredient in the drops might have caused this reaction. As these drops do show some promise I will give another shot when my eyes can tolerate them better. I am trying to find out if alphagan p might be better because it does not contain the preservative benzalkonium chloride. There is another name my surgeon mentioned- pilocarpine drops. But he wanted me to try alphagan drops first as they are less harsh. If you have no dry eyes issues these drops should help. Remember I have started with a very low concentration and did find some positive results.

[jaycat]

I've now seen my optician, who can find NO trace of astigmatism & so was unable to reduce the ghosting with lenses.  My vision for night driving seems currently to be worse - seeing multiple ghosted car headlights & taillights, each with glare & starbursts, makes driving outside of town impossible.  Before surgery I could drive at night, & I've still only had one eye done.
I'm finding very difficult to maintain hope at the moment.  I'm worried that things seem to be deteriorating, & am trying to get more contact with the opthalmic team about this.

[jaycat]

I'll be very interested to hear your experience of using drops; I'm still hoping at this stage to manage without them, but want to know all the options available to me if necessary.  Good luck, I hope they work for you.

[shindi441]

I have been reading your blog with huge interest.I had cataract surgery on both eyes(2 days apart) three and half months ago with multifocal IOLs- Lentis Mplus. I was -4 in both eyes before the operation..My vision is quite good for all distances in good day light but gets very hazy in the evening and nighttime is a nightmare if I have to drive. The halos and starbursts are too disturbing. I have also been plagued with very dry eyes- using PF eye drops and plugs for them. Like you I have developed floaters in the right eye. My main concern at this stage is the night vision. My eyes still keep feeling sensitive,soar and tired at times- especially after late nights.
It was very heartening to read your blog because it gives hope. I too have been prescribed alphagan drops to use prior to driving at night.I will let you know if they have helped.

[uptownbob]

cheers and hands across the water to you, jaycat!
good luck..and relax as much as poss... as the eyes are linked to the brain and as you know our vision is weaker under even normal conditions if we're stressed or tired.
time is a healer.

[jaycat]

Thanks again bob, it is very important to me at the moment to know that there is hope/improvement 'cos I'm currently in a situation where doing the things that matter to me (driving, cinema, TV) were more possible BEFORE surgery than after.
Yeah, not obsessing is MUCH easier said than done ... trying things like acupuncture, resuming meditation again, & spending time with good friends to try & help with that.  :-)
I'm hoping at present that the consultant is right & some of it at least is caused by astigmatism, and so could be reduced at least by lenses.  he's mentioned drops as a possibility to try, but I'll only do that as a last resort, I think.  If lenses help somewhat, I'll feel more able to sit it out & wait for the process, whatever it is.
Really glad that your eyesight is now that of 20 yrs ago.
I might get back to you again if more questions occur to me.

[uptownbob]

p.s
after 3 years my eyesight is that of about 20 years ago and other than floaters in my right eye is how it will be forever so yep, the hell was probably worth it as the alternative would've been far worse...i forgot to mention that i originally had vitrectomy surgery to remove major floaters which caused the left eye cataract to form

[uptownbob]

conventional wisdom says the second eye will be the same as the first ( was with me..buggar) but you have no choice but to go forward and trust in the process as to stop would leave you in an even worse visual limbo-land.
re the ghosting and night refraction of light:you can use alaghan( think that's it) which is a script eye drop which will constrict your pupils down to pinpoint and shut out the refractions but it comes with side effects.
what you're experiencing will go away as the iris grows around the lens and the rest, neuro adaptation will take care of.
alternatively you probably have just enough time to remove the existing lens and risk tearing of the iris etc...but what would you replace it with?
have faith...and don't obsess which is easier said than done...your scenario is redeemable... a lot aren't!
good luck..you'll be fine!

[jaycat]

Thanks for this - it helps to know that improvement is possible.  My problems seem to be getting worse, & my consultant thinks part of it is caused by astigmatism in that eye continuing to change/worsen - which is worrying in itself.
Night driving out of town is currently impossible for me because the severe ghosting of road signs makes them impossible to read.  traffic lights at a distance are a constellation of multiple lights each with starbursts.  Watching TV & cinema is affected.  My LIFE, in other words.
Did you need to do anything to help the change happen?  Has it actually improved, or have you just got used to the abberations?  I'll happily hang on in for 8 months if it'll improve - although still very worried about the 2nd surgery coming up SOON - that if I have it in both eyes it'll be completely unmanageable.

[uptownbob]

i had both eyes done a couple of years ago and went to hell and back with it..i had flickering on the periphery, ghosting, loss of 3-d vision and much more....but the good news, and it is good news , is that if you can just hang in there it all slowly rectifies itself naturally...after around 8 months( sorry about that) you'll see much improvement.
google neuro adaptation as that supplies a lot of answers.
if you're using drops make sure THEY DON'T HAVE PRESERVATIVE in them like most do as they can upset your new lens.
get contact lens drop preferably.
from experience i know how terrible it can be to wake up daily to the the front window of your very being not displaying correctly...get a second opinion always , spend whatever you have to and let the brain do it's thing over time.
do not let anyone use a laser to correct anything...doesn't work in the long run...hope that helps..happy to answer any questions

[jaycat]

Thank you for your suggestions.  I've read that constricting drops may increase the risk of retinal detachment, as can cataract surgery itself, & short-sightedness.  If this is the case I think I would be hesitant to use constricting drops.  I'd appreciate your opinion.  Many thanks.

[Ray T Oyakawa, MD]

See if  a hard contact lens over refraction eliminates the ghosting.  If so you have some irregular corneal astigmatism.  You may need to use constricting drops.

Dr. O.

[jaycat]

Dear Dr O,
Thanks for your reply - the optician didn't seem to be able to eliminate the ghosting with lenses during my standard eye test, she said I'd have to get used to it; is there something else she should/could have checked?  I'd be delighted if it could be fixed with glasses.

[Ray T Oyakawa, MD]

You probably have a mild refractive error.  This can be treated with glasses or constricting drops at night.

Regarding you eyes burning with tears; you may need the anti inflammatory drops.  See you eye doctor.

Dr. O.