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problems with flickering vision after cataract surgery
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problems with flickering vision after cataract surgery

I am 49 years old and had cataract surgery on my left eye 11 months ago.  The lens used was a Acrysof IQ Intraocular lens.  After the surgery I experienced flickering light resembling strobe lighting in my vision with this eye.  I returned to by surgeon after 3 months and was was told this would subside in 6 to 12 months as my brain adjusts to the new lens.  It has subsided a little but I continue to have problems under florescent lighting. Under florescent lighting condition my vision in this eye  feels like I am looking through a wet eye. Again it is the feeling of mild strobe lighting .  I find I am blinking all the time and find that this eye gets teary under florescent lighting conditions whereas my other eye does not.

What is causing this and given it has almost been a year, will this ever stop.  I feel as if I have traded one eye problem for a new one.  Is this a common complaint after cataract surgery.
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233488_tn?1310696703
Get a second opinion. Find another Eye MD surgeon at www.aao.org  the problem is called dysphotopsia and is very common with certain types of IOLs.  Options might include special glasses, IOL removal/exchange/repositioning.

Use the archives, eye topics and search feature to read the many posts on "flickering" after IOL surgery.

JCH III MD
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Avatar_f_tn
I have this also.  I had heart tests the other day and the techs had to do a lot of them in almost darkness as I could not stand the overhead lights. I was tearing and smarting and vision distorted.  I have a call into another doctor to remove the cataract lens ASAP as I would rather have dim vision than this mess.  I was never told this could happen to me. Shame on me.
I wish you the best.
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233488_tn?1310696703
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Avatar_n_tn
I had cataract surgery done in my left eye last Weds.  On Thrusday night I started experiencing pain in my eye and sensitivity to light.  Any time I get inb the light my eye flickers and it's annoying.  I'm seeing my eye doctor tomorrow.  I'm 62 and have glaucoma.  Granted, my vision is 20/20 with no blurring, but I'm taking pain pills andd wearing sun glasses every day.  this is day 5 and somethng doesn't feel right.
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233488_tn?1310696703
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Avatar_m_tn
I too have this flickering problem and it's been 6 months and the surgeon seems to believe time will take care of the problem.  Is this problem associated with any particular lenses?  My lense was an AMO model ZCB00.
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Avatar_f_tn
Time certainly hasn't helped in my case.  It's been over 2 years for me and it is not one bit better and no one is willing to even acknowledge there is a problem never mind help me, and I am getting seriously depressed.  
I want my life back.
I want to drive again.
I want to be able to grocery shop without my husband tagging along.
I want to be able to select restaurant seating based on the location of the table, not the orientation to the lighting.
I want to be able to use the computer for more than 10 minutes without having to close my eye.
I don't want to miss yet another year of skiing.

Why won't anyone help me?
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233488_tn?1310696703
There are several world famous ophthalmologists that deal with IOL problems from all over the world. At the Cincinnati Eye Institute Robert Osher MD and in Los Angeles  Samuel Masket MD    

JCH MD
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Avatar_f_tn
Thanks for the names, one of them is already on my list.

I'll just have to keep trying until someone is (a) willing or (b) able to figure out what the problem is.



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Avatar_m_tn
Im at 2 years after surgery,I still get flickering very controllable now,you just get use to it,you had imperfections with vision before surgery.i.e blurry vision,reflections in lenses of glasses,watery vision sometimes with contacts...remember these surgeries are man mad ,synthetic  vision,not natural perfect vision as we want,we are one of people who have a defect,you just need to adjust thats all, having it taken out with a new replacement ,may not solve the problem and cause another.i.e blurry vision,eye pressure ..etc if you vision is good keep with it,it will ease,and very adaptable..there are things you can take,alphagam eye drops,parcarpine eye drops, whichwill shrink your pupils enough to stop the flickering,the flickering is the pupil bleeding over the margins of the lens in certain lights..or you can take tramadol,does the same thing,but these are short fixes,body and eyes will get use to it,best bet just get on with your life and forget about it,its there for good ! then it will disappear,by camouflage in the brain
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Rickyboy

I am sorry that I seem to have hijacked your thread.  

From the information I have gathered over the past couple of years, about negative dysphotopsia, for some people it does go away with time.  Positive photopsia tends to go away on it's own more often than negative dysphotopsia.  

Negative dysphotopsia is where you perceive a shadow on the temporal side of your vision.  Positive photopsia is where you get light rays and streaks from light that reflects off the edge of the IOL ("edge glare").
It's not known what causes it but it's been theorized that it happens more often with: acrylic IOL, square edge IOL, high power IOL.   There has also been some evidence that the edge of the capsulorhexis is somehow involved.  Capsularhexis is the round opening that is made in the capsular bag to allow for cataract removal.  The IOL gets inserted and the edges of the opening overlapped onto the IOL.
From what I understand, Dr. Masket has had some success treating this condition by moving the IOL forward and tucking the edges of capsularhexis behind the IOL.
If this is what you have, and time turns out not to be the healer, don't let anyone tell you it's in your head.  It's a real and documented condition and it can be very distressing.

Best wishes to you from a fellow sufferer.
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Jaysta

Interesting that you had relief with the pupil constricting drops.
I found the opposite, it is much worse when the pupil is small, whether from the drops or bright light.
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Avatar_m_tn
It is possible that your IOL may be slightly decentered.  If this is the case you might want to ask your opthalmologist about argon laser pupilloplasty.  Perhaps you have already investigated this, but if not you can find some information on the technique on the internet.  Essentially the pupil is "shifted" by small laser pulses to the iris, hopefully resulting in better alignment of the IOL with the pupil..  You can also read more about the technique on some of my journal entires on this site -- just click on my profile.  I had this technique performed and it did help my vision some, although in my case the goal was to provide clearer vision rather than an issue with the IOL edge.  

Pupil costricting drops like pilocarpine or aphagan can help, but most practitioners do not recommend taking them for long periods of time.  

Best of luck to you!
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Avatar_f_tn
If getting used to the phenomenon is impossible, you might--seriously--want to consider, at least at times, the eye patch you jokingly mentioned.

A friend underwent successful surgery for a benign brain tumor, which left her with the unfortunate side effect of two functional eyes that no longer saw quite the same image.  The discordance turned out to be uncorrectable, so being a practical, get-on-with-it sort of person, she has resorted to a colorful selection of eye patches coordinated to her wardrobe.  As it happens, she is a beautiful woman, and the patches do make quite a statement, while providing monocular vision that is functional and no longer distressing.
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Avatar_f_tn
Yes, there have been times when I have thought that I would be doing much better if I had lost the vision in that eye altogether.  I think I would have been able to adjust to it by now.
The flickering is such torture.  Imagine being in a room with a strobe light going off for over two years.  
I do often simply put my hand over the eye to get some relief.   I also have distorted vision, uncorrected refractive error and astigmatism, image size difference between the eyes and zero depth perception.

I have other issues in addition to the negative dysphotopsia.  And they are in fact in my eye, not in my head.  I have epiretinal membrane, intermittent CME, large vitreal floaters, wrong power IOL implanted, loose zonules, previous lasik, and the beginnings of Fuch's corneal dystrophy.

I have often wondered if the IOL is decentered, but every doctor who views it says it's in a good position.

On a positive note, I have just obtained an appointment with a very reputable opthalmologist in Toronto, and he has so far

a) taken the time to review my records

and

b) ordered up some tests that so far no one else has seen fit to do, likely because they (incorrectly!) assume that my problem is a psychciatric one, and/or they just don't want to be bothered trying to figure out what's wrong.

To those doctors I say:  if you want to cherry pick for a living, go pick fruit.  Otherwise, listen to the patients that come to you for care, try your best to help, and if you aren't comfortable helping, direct them to someone who can.

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Avatar_f_tn
Wow - thank you Dr. Hagan. It's 14 months since my cataract surgery and I still have flickering/shimmering and others can see it shimmer when the light hits my eye a certain way also. I have been told by a couple ophthalmolgists that my brain will get used to it and adjust. It has not. I am so happy to see you recommend an eye surgeon at CEI. I live in Cincinnati. Thank you so much!!
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Avatar_m_tn
The sad thing is no one is ever told that this strobe light effect is one possible side effect from cataract surgery.  So I don't say shame on you I say shame on the doctors and the manufacturers for not listing this at the top of a possible negative side effect from cataract surgery.  And, if you were like me you already knew people who had had cataract surgery with no complications and it never occurred to me that I would have to live with this for the rest of my life.  I have been 1 year 4 months since my first surgery and it is still a problem.  A specialist told me just ignore it and it will go away - will apparently he has never been subjected to a disco party all the time in his eye.
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Avatar_n_tn
Thanks for your contribution:  I live in Toronto and have an eye problem after corneal transplant, a good opthomologist is my next step. Would you mind giving me the name of the one you went to in T.O. and did he help
Thanks DonnaL Toronto
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Avatar_m_tn
After surgery, my wife complains of the image in her eyes not aligning properly. Also, the image of the post-op eye is tilted, as a painting that has been hung carelessly.  Any ideas or suggestions here?
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Avatar_f_tn
do you know of a doctor in the sacramento, ca area? the flicker is driving me nuts
thanks
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Avatar_m_tn
I have the same problem, surgery 6 weeks ago with a reputable Toronto ophthalmologist, he says that he doesn't know what is going on and reacted like I'm the first one with this kind of problem.  I can't go anywhere without wearing sunglasses,  I cancelled the second eye surgery for now. Going for some tests next weeks. Very depressing.
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Avatar_m_tn
I posted in my thread about the Symfony lens that I have issues with what subjectively I first described as "flickering", sort of like being in bad fluorescent lighting. Paying closer attention its more that the image itself is moving due to the constant small movements eyes are making all the time (or that the flickering is tied to the movement at least).  if I concentrate hard for instance on just looking at one particular letter without moving my eyes then I can get it to subside (or almost do so). It seems to be both eyes, though the eye that was more myopic beforehand seems to be worse. I will repeat the info I found on this thread since its more relevant here.

I hadn't read about this concern beforehand as being at all common, but while researching it now  I ran into a good free ebook overview of cataracts&surgery which mentions a minor innocuous   version of it some might notice. It mentions in passing:

http://david-richardson-md.com/wp-content/uploads/ctb.pdf
"It's okay to read, but your vision may seem "jiggly". Because the lens capsule has not yet contracted around the IOL, there may be a slight jiggle of the lens with each eye movement. This is most noticeable when reading and will improve over the next few weeks."

In my case it sounds like its far more noticeable, problematic and has lasted 6 weeks postop at this point. The eye constantly makes small movements, especially while scanning to read, and the subjective impression of the image jiggling to me appears like the flicker of bad fluorescent lighting. Its likely mostly the lens needing to heal in place but it may be partly the eye&brain adapting to differences from the natural lens (in the case of your natural lens, the brain actually suppresses vision for a fraction of a second while the eye moves and while the natural lens jiggles a bit to a stop).  

On this Medhelp page its mentioned:
https://covdblog.wordpress.com/2014/02/10/science-and-splash-my-eyes-couldnt-rest-for-a-minute/
"You also need to know that once your cataractous lens is removed and an IOL placed in the capsular bag, the bag is floppy so to speak. Over a period of six weeks it will encapsulate the IOL or shrink wrap it.

In the meantime you could have what is called pseudophakodonesis which is simply movement of your lens until it settles into place. If you are myopic or have a large eye it would happen more than a hyperopic or small eye. Once the capsule shrinks and it stabilizes it goes away."

This notes that among those where it is bothersome (and I have all the risk factors):

http://en.allexperts.com/q/Ophthalmology-Optometry-979/2011/1/Flickering-Vision-IOL-Implant.htm
"You may experience some flickering of light or shimmering as the lens implant seats permanently into the capsule of the eye, and this may take up to three months. You may also see some edge glare during the first few months, typically in low levels of illumination.

These symptoms are more common in blue eyed patients, patients with higher levels of preoperative nearsightedness, and patients with large pupils.

Only a very small percentage of patients will notice these symptoms after three months, perhaps less than 1%."

Another source notes that other parts of the visual system can be looser at first as well:

http://www.science-bbs.com/150-med-vision/3cfabedd0bbe1663.htm
" Your lens is gone and with it goes some of the stabilizing support for your   iris. Without it, the iris "jiggles" after saccades. We see it happen in the  microscope. Normal, no biggie.  "

Although it may be normal to some degree and "no biggie", in some cases like mine it is problematic when reading, but odds are it will go away soon (though it does take longer with a minuscule minority of people who do post around the net). If it doesn't resolve before then, I have an appointment with an eye surgeon on Feb. 2nd to have him look at the issue, where I may simply hear that I need to give it a bit more time. I'm uncertain what the remedies are other than time,  if they manually move the capsule around it or suture or glue it in place better, or what.
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Avatar_m_tn
This problem seems to be a common occurrence with the AcrySof SN60WF lens as demonstrated by many posts and articles on the internet.  It is not something that occurs with ALL lenses.  

I had IOL replacements about 3 weeks apart.  Due to insurance needs of accomplishing surgery before the end of the year--the deductible was met--my surgeries happened in two different surgical centers, but by the same ophthalmologist.

My first lens was an Abbot Technis Z9002.  What a beautiful lens.  Clear, free of any spherical aberration, and excellent intermediate resolving capacity.  The lens was a +13D power.  The second lens was this AcrySof IQ at +13.5D.  Interestingly, my surgeon did not give a thought about mixing these lenses--particularly that the IQ has an integral blue filter.

I am not the least impressed.  Flickering and a vague crescent shadow on the posterior periphery of my left visual field are aggravating and distracting to say the least.  Comparison between color or contrast perception of the two reveals that the IQ has a smaller contrast factor--and reduces and muddies the luminance of colors via its reduction of blue and short blue-green wavelengths.  Some really odd shimmering and visual effects occur after dark depending on the illumination.  Sodium vapor lighting is reasonable but made heavily orange--mercury vapor lighting results in large 'black' zones that are outright dangerous for night driving on a wet road.

Also of interest, a manifest refraction of the IQ eye does not solve the "soft" resolution problem of the lens.  Although both eyes are now capable of 20/15 vision--the overall performance of the IQ just does not supply the same edge and contrast of the Technis.  

What is surprising according to my ophthalmologist is that this lens has about 60% of the market share.  I suppose that if they had been installed bilaterally, I would have not noted their poor transmission characteristics compared to the Technis.  We have already discussed the options--and no, my brain is not going to accommodate the issue.  The AcrySof will be explanted in a few weeks and replaced with a Technis--a lens not noted for this shimmering or dark border issues.
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Avatar_m_tn
re: "has a smaller contrast factor"

Yup, the Tecnis lenses use a material with a higher Abbe number which reduces chromatic abberation which may help with that, as an article in this industry publication notes:

http://eyeworld.org/supplements/EW-December-supplement-2014.pdf
" Cataract surgery with an IOL with an Abbe number greater than that of the natural lens (47) can improve CA, so that our cataract patients could actually experience better vision quality than they did as young adults. "


re: "It is not something that occurs with ALL lenses.   "

Threads around the net seem to indicate it happens with quite a few different lenses, though it may relate to the fact that the description of "flickering" is vague enough to relate to a variety of different phenomenon. It may be partly movement of the lens in general, but also some people have reflections off the edge of the lens when it moves. That is impacted by the design of the lens (in addition of course to its position in the eye and the tissue surrounding it). The Tecnis lenses (whether monofocal or other types)  I recall have  have edges designed to minimize reflection.  The Symfony lens I have the flickering issue with is a Tecnis lens which does have that better edge design.

Overall I do see better things written  about Tecnis lenses than the AcrySoft lenses, however I do have to wonder if the difference you see between your eyes in terms of flickering is entirely due to the lens model difference, or might be in part due to merely whether one lens might be looser than the other and perhaps not yet have healed into place since it sounds like it may only have been a few weeks since your surgery.

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