imbalance after left eye cataract surgery

[johnatha1]

I had cataract surgery left eye about 14 weeks ago. Had alcon monofocal put in . came out about -1.50/2.00. I have worn contacts for 30 years multifocal in both eyes with wonderful success.

Week before surgery had retinal laser surgery for a tear in left eye. Have a bit of a macular wrinkle in left eye.

My presenting complaints are imbalanced feeling in my head. I have tried to neuroadapt. I feel imbalanced, dizzy and somewhat disoriented all the time. Doctors have tried every kind of contact and glasses and i still feel sick and off-balance. My current pair are toric multifocals.

Should I have the IOL replaced. Have not been able to get back to work because of imbalance. I also cannot think as well and feel depressed. I am getting a second opinion. doctors also tried -1.50 c0ntact in natural right eye with glasses over but still off-balance.

my right eye has a bit of a cataract and is not ready for surgery, If I were to get it done, what would be my best option. I also miss the ability to focus with the left eye. I hate this feeling of imbalance and need to get rid of it to function better. Any ideas?

My biggest complaint is the ability to look into people's eyes when I talk to them,. My job requires it.

Thanks,
Johnatha





This discussion is related to any vision problem with one eye cataract surgery.

[dreadlisa]

I had surgery 3 days ago and i am also feeling inbalanced in my head i never had any problems like this before the surgery this really worries me .. will it go away.. did you ever hear of this and what can be done ..Please Help I just dont feel like myself anymore... :(

[JohnHaganMD]

Yes these are common problems and there are many posts about what its like for some people in the first weeks after surgery. you can access them using the search feature, archives or scanning discussion titles.
Your eyes ARE out of balance. One has a cataract, one has an IOL, the glasses RX on your surgery eye is no longer the correct RX. Discuss with your surgeon there are various solutions to minimize your adjustment problems.

[JodieJ]

It looks to me like there is little difference between your eyes--certainly not enough to cause your symptoms.

A macular wrinkle usually results in a larger image size in your affected eye.  Does a distant object appear larger in your left eye than in your right?

Few doctors are knowledgeable about aniseikonia, particularly if it results from a retinal condition.  If there is a binocular vision specialist (sometimes called a pediatric ophthalmologist, although they see adults)in your area, s/he might be your best bet for a consultation.  (I'd bring a copy of "Retinally Induced Aniseikonia" to the appointment.  This will probably be new information for the doctor.)  I don't think that a cataract surgeon can help you if your problem is retinal.  You would need to see the very best retinal specialist in your area.

I know how frustrating it is.  Have faith that there will be a solution.  

[johnatha1]

Jodie, this does not sound to hopeful. I just came back from my optometrist who is trying to fit me with toric astimgmatic lenses. This has been going on for weeks.

My latest presciption now is:
0D-2.75-0.75X005 IN RIGHT
0S-2.00-O.75X010 IN LEFT.

I will look into surgery. I am going to another cataract surgeon tomorrow for a second optionion. My current optometrist believes I only have sone aneiseetropia or something like that regarding prescription. I mentioned the retinal disparity but he didn't comment.

So what should I do then?

[JodieJ]

I know a lot about aniseikonia secondary to an epiretinal membrane (macular wrinkle) because I have that condition myself.  I did not develop aniseikonia symptoms until AFTER my ERM (macular wrinkle) had been surgically peeled.  It is not clear whether the retinal surgery caused my aniseikonia or just revealed it.

The really bad news about this condition is that it seems to fall into a gap in the ophthalmology curriculum, and there are few (no?) doctors knowledgeable about it.  When I couldn't find anyone in the metro Chicago area who could help me, I started researching the condition myself and wrote to the authors of articles.  According to the few published reports, surgery does not have a good record as far as eliminating aniseikonia.  A very respected retinal surgeon wrote me that including an ILM peeling in the surgery for the macular wrinkle might produce a better outcome.  (This is not typically done in the USA.)  If you do have this condition, your first step should probably be a consultation with a retinal surgeon about possible surgery.  Personally speaking, I would not have the surgery unless an ILM peeling was part of the procedure.

Based on everything I've read and learned, Dr. Gerard de Witt of the Netherlands is currently the world authority on aniseikonia secondary to retinal disease.  He was the first to recognize that the condition is field-dependent (i.e., the image size difference changes according to the location/size of the image being viewed, with more aniseikonia in smaller, more distant images).  The optical correction he suggested for me (glasses over a contact lens) based on the results of online testing dramatically reduced my aniseikonia symptoms.  (You can read more about all this at the opticaldiagnostics website.  You can also download Dr. Witt's paper "Retinally Induced Aniseikonia.")

Unfortunately, if your symptoms are the result of a retinal problem, wave-front contacts, LASIK, PRK, etc. won't help.  There is one article in the literature which suggests using occlusion foils (or scotch magic tape) over your glasses lens to blur the vision in your affected eye (to something like what it was like before cataract surgery).  This option didn't help me, but it might be worth trying.

Best of luck.  Feel free to contact me.      

[johnatha1]

I am only 53 and a very young 53 at that. Very active, love to dance. I have not been able to return to work because of this imbalance. My presenting complaints again are an off feeling, dizziness, and nervousness.

My last contact prescription was
-3.00, 0.75, xoo5 right
-1.75 D.S. left

some doctors have set the right for 2.75
the left for no astigmatism and some with. each optometrist of which i have been to 10 already has come up with different prescriptions.

Also would CRT, PRK, or making a contacts using wave-front technology help .because of the wrinkle. I would even consider RGP contacts if it would sharpen the vision.

Can a macular wrinkle be surgically corrected?

[johnatha1]

I do have astigmatism in both eyes. Left eye had limbic incision which brought astigmatism down to o.50. In right is 1.00.

Jodie thought that the anisekonoa could be due to the macular wrinkle. I went to the optionsdiagnostics site for anisekonia and and it did scare me regarding the wrinkle and correcting the problem. I can't live this way forever.

Vision correction in left eye has been 20/20, right eye 20/30.

Thank you,
Johnatha

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

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[JodieJ]

I'd like to add a little information to my post above.  Try looking at an object across the room, closing one eye and then the other.  Is the object the same size in each eye?  If it is, skip the remainder of this post.

If the object is a different size in each eye, then you do have aniseikonia.  My best guess (and I'm not an eye care professional) would be that it is larger in your left eye with the macular wrinkle (aka epiretinal membrane).  I've read about other cases where a macular wrinkle didn't cause problems before cataract surgery (when vision was blurred), but then caused symptoms like yours after cataract surgery when vision was sharper.  

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

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[JodieJ]

All of your complaints are symptoms of aniseikonia, or a difference in image size between your eyes.  If this turns out to be your problem, it may be due to the diopter difference between your eyes post cataract surgery, or possibly to your retinal laser surgery or your macular wrinkle.  The treatment would depend on what's causing the problem.  There is information about aniseikonia at www opticaldiagnostics com (click "products" then click "background information-aniseikonia").

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

You did not tell me what the vision is what the correction in front of the eye (ie 20/20 or 20/66 etc). Also tell me your age.

Your glasses RX does not have a correction in it for astigmatism so I'm not sure why a toric Contact lens CTLs.

Let me know and I'll try and give you a good answer.

JCH MD

[johnatha1]

my best corrected vision started out as -3.50 in left eye after surgery for glasses. The left eye is at -1.50/-2.00. The optometrist keep undercorrecting my right eye for glasses to -2.75.

Every imaginable combination of contacts ihas been tried frp monovision to modified monovision to Torics for just distance.

I currently have toric multifocals in from B&L. I will find out the prescription. I do not have good distance or anything with them.

I feel my depth perception is off and I do not have binocular vision. I desperate;y try to look in people's eyes when I talk to them but cannot seem to do this. It makes me feel alienated from people/ I am an artist and a photographer and this surgery has really traumattized me. I am only 53. The type of cataract I had in the left eye was posterior polar. And as stated, my right eye is loosing it' s abilty to see in the dark/

I will find out current prescription for contacts and post tomorrow. This is making me crazy the imbalanced feeling/ I wonder is having had a technis iol or accomadating would have been better.

Again, why can't I look in people's eyes? Is it because of the disparity in prescription, lens clarity in one. I am beside myself most of the time because of all this.

Thank you,
\Johnatha

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

To answer this I would need to know your best corrected vision and exact glasses RX in the eye that had surgery and the same for the other eye.

Please post.

JCH MD