Problems with cataract surgery, any advice?

[gwilki0000]

I posted this is a Reddit forum for cataract surgery and a responder suggested I post it here as well:

In December 2021 I had cataract surgery (left eye done first, right eye done two weeks later) and chose the monofocal lens suggested by my ophthalmologist. I was told going into the surgery that I would need readers afterwards and I was fine with that. Having been very nearsighted my entire life I’ve always worn glasses so needing readers seemed like nothing. Immediately after the surgery I reported “issues” to the provider. I am extremely sensitive to light, so much so that I rarely go outdoors. Even indoors I would wear sunglasses I reported experiencing large halos around light sources and in addition to the halos I see rays of light extending out from the light source. I have double vision now which makes the aforementioned light distortions even worse. My eyes feel dry, they burn, they itch. I use eye drops continuously and still get little relief. And I feel a slight degree of pain in my eyes. The last issue, and this seemed to start a month or so after the surgery is that I see a “shadow” to the right side. If I were looking at a line of text or an eye chart the letters to the right are grayed out. The far right also appears distorted or misaligned. I haven’t driven a car since the surgery. My sleep is definitely impaired.

I don’t know if the ophthalmologist who did the surgery really took me seriously. I continued to see him for six months with appointments about every two weeks. I would patiently explain what I was experiencing. He rarely directly addressed my concerns. He didn’t answer questions. He did a YAG laser procedure twice on my left eye and once on my right eye. After six months he said the surgery was fine, nothing was wrong with it, and all of my issues were caused by dry eyes. And he said to return in six months.

I subsequently saw another ophthalmologist in the same practice and was told the surgery was fine, nothing was wrong with it, and all of my issues were caused by dry eyes. That doctor also suggested I try blue or yellow tinted glasses. I did, they do nothing.

My primary care physician referred me to yet another ophthalmologist. I was enthusiastic about seeing a new doctor and the new ophthalmologist seemed eager to take on the challenge. That seemed to fade… I have been seeing this ophthalmologist regularly and he has brought in a retina specialist at another practice to address my issues. I have had several eye infections since seeing this new ophthalmologist and he has successfully treated them. He did start me using serum eye drops. Prior to the cataract surgery I never had an eye infection, since then I have had three. The retina specialist also prescribed Lyrica (Pregabalin) saying he thought I had corneal neuralgia. That has helped with the eye pain, but I’d rather not take a prescription if it isn’t necessary. I’d rather know what’s causing the pain, and the other issues. The retina specialist also suggested that I have a Prokera graft done to each eye. My ophthalmologist did that procedure about a month ago and it has helped with the light sensitivity, I can now spend time outdoors (with a hat and dark sunglasses). But the other symptoms remain; double vision, halos, rays of light extending from light sources, shadows to the right. I’m getting the feeling that my current ophthalmologist is getting ready to say he’s done all he can do.

I know I haven’t provided any real clinical information, and there’s a lot about this I don’t understand, but I’m wondering if anybody else has experienced anything like this. Does anybody have any suggestions about things I can discuss with my ophthalmologist. Any ideas…?

It’s been more than two years since my surgery and I have close to being a shut-in. I regret the surgery and want to try to make things better. Thank you.

I was 60 when I had the surgery.  

The lens used:  Lens AcrySof IQ IOL, +15.5 D (left eye) , +15.0 D (right eye).

Prescription before surgery:  Dist cc 20/60 (right eye), 20/80+2 (left eye), Dist ph 20/50+1 (right eye), 20/60 (left eye).

Prescription after surgery:  Dist cc 20/30-2 (right eye), 20/40 (left eye), Dist ph for both eyes is NI.

[Ron_AKA]

The prescription you posted is actually visual acuity. It would be more helpful if you posted before and after refraction which would be a sphere diopters, cylinder diopters, and an axis angle.

[gwilki0000]

I'm new to reading medical records.  You'd think after 2+ years of this I'd have a better understanding of things, but I don't.  Is this the information you're inquiring about?

Pre-surgery:

Wearing Rx:

Sphere (R) -5.50 (L) -6.0, Cylinder (R) +1.75 (L) +1.75, Axis (R) 173 (L) 009, Add (R) +3.00 (L) +2.00

Cycloplegic Refraction (Subjective):

Sphere (R) -5.25 (L) -6.00, Cylinder (R) +1.75 (L) +1.50, Axis (R) 180 (L) 175, Dist VA (R) 20/50+ (L) 20/50+

Manifest Refraction (Auto):

Sphere (R) -5.25 (L) -6.25, Cylinder (R) +1.00 (L) +0.75, Axis (R) 179 (L) 170

Post-surgery

Manifest Refraction (Auto):

Sphere (R) Plano (L) -0.75, Cylinder (R) +1.00 (L) +0.75, Axis (R) 152 (L) 167

Final Rx:

Sphere (R) Plano (L) -0.75, Cylinder (R) +1.25 (L) +0.75, Axis (R) 170 (L) 170, Dist VA (R) 20/20, (L) 20/20, Horz Prsm (R) 3 BO (L) ---

Please let me know if this isn't the requested information.  Thank you.

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

Your description of your ongoing problems suggest an extremely severed case of sicca syndrome, more commonly known as 'dry eyes' but a more more serious than the everyday dry eye often discussed here.  Ophthalmologists refer to this type of problem as "ocular surface disorder"  There are two types. The tear film has 3 layers like a sandwich. Outer layer is a fat or lipid, middle layer (like the peanut butter in a sandwhich) is watery (aquious) and the inner lawyer is protein.  If the outer fatty layer is deficient, "Evaporative type" the eye waters all the time, poor quality tears.  This is annoying but the less serious of the two. If the inner watery layer is bad it is called "aqueous defficiency" and the eye is dry as a bone, often red, painful, subject to infections, cornea damage, infection, scarring and perforations.  Your symptoms and the treatment recommended strongly suggest severed aqueous deficiency. This problem is more common in women, much more common due to hormones, and may be part of a complex of diseases known as Sjorgren's Syndrome.  This diagnosis would go along with your symptoms, the treatment suggested of artificial tears, autologous serum use, Lycra and an extremely severe case with Prokera grafting done. These problems would cause corneal scarring, irregular astigmatism, reduced vision, ghosting and doubling. Your case is so atypical that discussing IOL types, IOL power calculastions, glasses changes are totally atypical and uninformative.    You should be under the care of the best cornea and external disease ophthalmologist you have access to. It is a chronic problem that can't be cured. There are very serious complications possible, including infection, perforation of cornea, and infection in the eye.  The surgery did NOT cause this, it is a problem that is another type of problem.  Often surgery can cause the underlying disese to flair up.   My strong recommendation would be to confirm this with your present team of physicians, and ask if you could be referred to a tertiary, noted ophthalmology department  (for example Mayo Clinic in USA, or Wilmer Eye Institute at John Hopkins U for evaluation.