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In the far IOl eye, can dry eyes effect far vision but not near?????

9-10 days since wife's cataract operation, far IOL RE eye vision keeps fluctuating from a range of 1 to 3 meters (10 feet) to 1 to 15+ meters (50+ feet). It goes anywhere from 20/25 vision to 20/70 vision.

BUT the first 1 to 3 m/10 feet have always stayed sharp throughout the 9-10 days!


Currently I have only 2 post operation readings. Day 1 it was +0.25. Day 4 it was -0.25. IOL is well centred. Capsule is in perfect condition. Some cornea dryness was noted on Day 1 and Day 4 visit to the surgeon and his ophthalmologist. Since day 2 we have been on Bausch + Lomb Vitamin A gel, Bausch + Lomb Viscous tears gel and Lacri vision liquid drops.

.Just now when I was about to post, wife again put lubricating gel and she was again able to see far and this time 20/20! It keeps going around in circles though.


QUESTION-1: If it is IOL movement related then how come the first 3m/10 feet always stay sharp?

Ok when IOL is near to plano then you could technically read all the way to near/ intermediate, but when it moves nearer you won't see far but continue to see near/ intermediate.That could explain it?

QUESTION 2- It does seem dryness related to some extent but why is nearer/intermediate vision not impacted? This I don't have an explanation for!!!!!

QUESTION 3- Do we need to worry or just be patient? The other eye had become stable after 7 days.


The two drops that she is taking against infection/inflammation are (eye looks visually perfect)

    Dexamethasone (steroid)
    Bromfenac (Yellox)

Both the above drops seem to have dry eyes as a possible side effect. Surgeon had said take only the steroid drop due to the dryness/reaction she had to the disinfectant that was used during surgery.

On day 4 surgeon's clinic opthomologist said we can take Bromfenac (Yellox) as it won't do any harm and because wife could handle the same combination on the previously operated near left eye.

I am thinking of stopping Bromfenac (Yellox) temporarily as long as we are still on steroid drops (4 more days of steroid drops left). Rational being to help the dry eyes go away (if it is dry eyes related). Restart Bromfenac (Yellox) in 4 days time when 2 weeks of steroid drops time is up.

    Any insight? PLEASE!!!!!
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177275 tn?1511755244
What type IOL did you finally decide on putting in the eye?

I suspect the IOL is not moving that the variations are normal and  due to corneal changes. The cornea usually has 3 incisions put into into so it moves/changes more than the IOL.

Don't make any changes in the prescription drops without clearing with the surgeon.  
Helpful - 0
Avatar universal
Thanks Dr Hagan. Ok we will wait patiently :-)

We went with Mini-monovision. The LE had ZEISS CT ASPHINA 509 installed 5 weeks ago. At last check it was at -1.75. Near vision is excellent with it and has been stable since day 7.
The RE had same Zeiss IOL installed and at last check it was at -.25. The range of vision is really great and adapting to the diopter difference was not a problem. At one point difference was 2.25 Diopter and even then she loved it and had no issues. Only issue is the RE taking longer to settle.
Thanks once again. You played a very important part in this journey.
Helpful - 0
177275 tn?1511755244
your thinking is flawed. The bromfenac is the most important to prevent cystoid macular edema so don't stop it unless the surgeon says. Steroids do NOT reduce CME like NSAIDS.  Be patient. Usually takes 3 weeks for things to stabilize.
Helpful - 0
1 Comments
Won't stop anything. Thanks.
Avatar universal
Yes noted. Won't stop anything and continue with all drops.
Helpful - 0
5 Comments
=
Today day 13.

Wife's vision on the -0.25 targeted far eye is consitently showing 20/25 (on non rear illuminated simple paper wall test chart), which is an improvemnet from 20/50...20/70 vision from few days ago.  The far vision is not sharp though, if she puts eye drops for dryness then she sees very far and sharp and hits half the alphabets of 20/20 line. I have 2 simple questions if anyone would be so kind to atleast answer a simple YES/NO.

1- Let us assume that target was missed and the far eye is sitting at say -1.0. Can a -1.0 eye do 20/25 on a test chart? I mean can eye drops make a -1.0 eye act like an almost plano eye temporarily?
2- Can dry eye cause autorefractor readings to be inaccurate?
Thanks.
If the vision sharpens with instillation of artificial tears the problem is surface dryness, often a problem in the first 2-6 weeks post surgery.   Otherwise quit overthinking this and just let the eye heal.
Here is the latest situation with wife's eyes...


Left near eye is stable at -1.75 (2 months since operation). See super sharp with it, all perfect.


Right far eye has hit the target of -0.25 (6 weeks since operation)
Wife can read 20/16 ALWAYS on Snellen chart and sometimes 20/12.5. Her far vision though is still blurry and not super sharp. From 60cm/23in  TO  4m/13ft with the eye is very good. Once in a while she starts seeing really far sharp too but it lasts for 1 day maximum. 90% of the time it is not sharp far away.

We saw surgeon few days ago and he said the cornea still has some erosion on one side and that could be the cause. He has put her back on 1 drop of Dexafree steroid daily (before bed) --> for 2 months. We have to see him again in 3 months. He can't guarantee that far vision will become sharp though.

Eye pressure is 11...

Any opinion or advice Dr Hagan?
Follow your surgeons advice and give it time.
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177275 tn?1511755244
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