Aa
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.
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.
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.
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.
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.
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.
2 Comments
Thank you for your direct experience and comparison between the Acrysoft IQ and Tecnis IOLs! Your personal experience appears to confirm Abbott's claims of the advantages of the Tecnis IOLs, especially higher contrast sensitivity. This is very important for my right eye which needs the best contrast sensitivity possible due to glaucoma.
I've been trying to get reviews comparing both of these brand IOLs for this reason.
I've been trying to get reviews comparing both of these brand IOLs for this reason.
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.
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.
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.
do you know of a doctor in the sacramento, ca area? the flicker is driving me nuts
thanks
thanks
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