Light gray and double print after cataract surgery

[Ldg57]

I had cataract surgery 2 wks ago with a Tecnis 3.25 D Multifocal IOL placed in left eye. Distance vision is clear and at 20/20 to 20/30 depending on day. Halos and glare are very apparent around all vehicle lights and signs but don't seem to be problematic as I havent driven yet.  Near Vision is now at J2 on Snellen scale but  reading on computer or magazine copy is only manageable because my right eye takes over. Words are not  clear with mild ghosting, poor resolution (like a stencil that has been picked up and replaced slightly to right of letters)  and print is substantially lighter gray when reading in comparison with the unoperated right eye that is myopic with small cataract. Between lack of good resolution and light gray color of words it is hard to read with this one eye as everything seems out of focus. Reading is still doable with both eyes as my other eye still has good near acuity. In order to retrieve something out of my jewelry box +2.50 readers are needed for this left eye, because I dont seem to have that "sweet spot" no matter how slowly I move forward or back in front of the box.
A small speck was seen on center of multifocal lense when rechecked by surgeon. This may or may not be causing some issues.  Second eye to be done with same lense was canceled until they can figure out what is going on with my first eye. Recheck will be in 3wks to bandaid with glasses.  Plan is for Lasik or PKR at 6month to remove speck of whatever it is.
Has anyone else experienced that very light gray text that used to be black? How does vision check out good but seem so terrible.  Is this just an adaption period? Or does anyone have any idea what may be gong on?.

[Ldg57]

ok.  again, thank you.

[JohnHaganMD]

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[Ldg57]

Yes, sadly, I guess I agree.  Having only ignorance on my side, not really knowing anything much about entire subject, my research did not start soon enough.  Reading ability is important, and yes these new low add lenses seemed to be the shining answer.  I was willing to take the known trade- offs of poor midrange vision, halos and glare,  but not prepared to be surprised with this outcome of feeling like I can't see. wow. Had I found this community forum sooner I probably would have managed to wait longer to have anything done!

Do you also still think I should seek a 2nd opinion after another appt. with my surgeon.  If so, how do I find the best one.  Mine is one of the best and also from what I hear the only MD in the area that even does exchanges.

Trying to staying positive, appreciating the new 20/20 distance and the mainstay of my reading RE along with this forum is sort of holding me together.

[JohnHaganMD]

I would suggest you see how you feel after the visit. If you are still very concerned I would simply ask for a second opinion from a surgeon your present surgeon values. A confident surgeon is never afraid or intimidated by a request for a second opinion. A thoughtful surgeon-physician tries to be the first to offer this option. It builds trust in the relationship.

[Ldg57]

OK and thank you.  I will do that.  From what I gather at this point I should've gone with a standard monofocal and ended up with comparable result and not have to deal with nighttime halos and glare too, let alone save 2,000.00.

[JohnHaganMD]

This goes back and forth, back and forth here.  I've said many times I personally would have only a monofocal or toric IOL and not a multifocal. But there are one or two hyperhappy people that post how wonderful the multifocals are. Unless someone does their research which I encourage they don't perceive the risk/benefit ratio is much higher with so called premium IOLs.

[Ldg57]

Thanks.  In case any earlier posts have caused confusion:

The surgeon is well aware of my complaints in detail.
The original appt with surgeon that I just had on July 5, 2 wk post op, is where he relooked and found the speck on the pupil, that wasnt seen during surgery.  (He said the scope used in surgery isn't as powerful as the one in the office he was using at that moment, so he could now see it with this relook). He was not positive of what it was he was seeing but the optometrist was present, took a look and also was able to note that initial speck at that time.  

This was the base point of observation, that forwards to this new observation at yesterdays appt.- recheck noting slight increase in size. No actual measurements were taken on either appt- just an observation at this point. The goal of this optometry appt. was simply to fit me with glasses and that was done. I think any remarks or discussion of YAG was just a carry over from that first meeting attended   (Does that correction  seem reasonable for my left eye?- If surgeon missed mark, my distance would also have been off?)

From the surgeons perspective during the July 5 recheck:
The plan was set in place at that time for a recheck appt 5 mos future (December 9) at which point he will further determine the course of action- off the cuff  mentioning Laser or PRK was with another team member -the optometrist- in the room at that time. He really didnt seem too concerned (not like me anyway) but definitely cancelled RE til LE is resolved.

This said, do you think there is additional cause for concern and should still reschedule an earlier appointment-Its my understanding from reading through these posts that if it is POC then it would be expected to grow and my vision to become blurrier as a normal course.

- All visits have shown that my multifocal is perfectly centered. On a side note:  the grayness of the print while reading   - if I tip my head way up like looking out the bottom of bifocals the print does seem to become darker (ghosting still there increases slightly with added distortion, but the print actually seems to darken- so I know I can still see black , and "gray" is not the new black post cataract color!  I am sincerely hoping that my problems are related to whatever is stuck on my lens.

I am still dissapointed with my reading ability but have become a little less panicky and feel like between the team and your input this may be under control.  Thanks again for your input.

[JohnHaganMD]

If your LE RX is plano and you see 20/20 at distance and that was targeted for distance. HOWEVER something is really wrong if you need a +2.50 add. Presumably the multifocal IOL has a build in reading add and you should not need reading glasses at all. Some multifocal IOL patients might use a +0.50 or +0.75 add   Our motto is "if the patient is concerned we're concerned" thus I would schedule an apt with the surgeon instead of waiting 5 months.  If for nothing else to ask why you need a standard reading add (+2.50) and not the much smaller that is used with multifocal.

[Ldg57]

  Week 4 after left eye cataract surgery, Tecnis multifocal 3.25. Optometry appt. today. Left eye reading is still blurry with ghosting and light print but tests out at about 20/25 near. Again most comfortable but still hard to read begins on J5 for me.  Improves with effort. Distance is 20/20.  Prescription for reading glasses and distance glasses was done today.  Left eye OS is plano and +2.50 ADD.  (Rt eye OD- unoperated-still with small cataract script is sphere -1.25, cylinder -0.25, axis 125 and ADD +2.50.. This script brings me to 20/20 both eyes. The ghosting was still apparent throughout testing in left eye.
The small speck (POC) has increased -direct center of pupil to approx. 3mm.
The optometrist feels that removal of this in 5 mos (YAG capsulotomy) will improve the ghosting and print may be darker.

Per your advice, had the OCT done, no edema.  (Thank you so much)
Are you in agreement with these observations?.  
Again, I am holding off on right eye surgery as long as possible.

I really appreciate your valuable time and input.  Thank you,

[JohnHaganMD]

Given the 4 week post op it is unusual for a 'speck' on the posterior capsule to increase in that brief time to 3 mm. You need a visit with the surgeon, not the optometrist, to discuss your complaints and for the surgeon to assess the signficance of the PCO (posterior capsular opacification) and the need for a Yag capsulotomy. If you don't have an appointment with the surgeon make one. The optom is not the person to be advising you that is the surgeon's job and responsibility

[Ldg57]

thank you very much, I am looking forward to my next appt. wednes 7/20.  I have no problem speaking with my surgeon.  We in fact had a group discussion on week 1 to address my concerns.  The team is highly qualified and experienced.  It is difficult to put your eyesight in anyone's hands without some trepidation and anxiety and therefore have seeked additional support and information in this Community site.  Thanks again will repost with new findings.

[JohnHaganMD]

OK

[JohnHaganMD]

Several things would be important. 1. be sure you dont' have swelling of the macula (cystoic macular edema)  need macular OCT for that. 2. what is your vision at distance and near without glasses LE  3. What does a glasses test (refraction) correct your vision to and does the gray-ghosting go away? If so you may need glasses all the time over the IOL  4. If things don't get better over the next 3-6 weeks seek a second opinion outside that office.. 5. Don't do the RE until things are resolved and you are happy.

[Ldg57]

thank you for your fast response. I sincerely appreciate your interest in helping.  No improvement last few days. If anything slightly increased blurry near vision or i am just more frustrated..

I am also wondering if perhaps calculations were also off, resulting in refraction error.  My next eye appt. is wed. 7/20 . That is 4 weeks post op.

I will definitely be more informed to update and correctly answer your questions after that.  In the meantime, specifics on my IOL implant card: Tecnis model zlb00, diopter: +14.0D (+3.25D), 0T:13mm, 0B:6mm.

In direct reference to your response:
1. CME, wow I hope not.  I am currently doing ilevro 0.3% one gtt daily. Prednisolone ac 1% BID. Will definitely have OCT.

2. Uncorrected vision LE: Snellen VA
Last appt. at  2wk post-op distance was 20/25 or 20/30, I am not sure what my near vision was logged at,  started best paragraph on J5. Noting that this was not 'comfortable' but the most easily readable, then worked down from there with increased difficulty but could make out most J2.

3. Will carefully note refraction test and ghosting responses 7/20. However,  drugstore readers at +2.50  clarity seems improved as does ghosting but is still there.  

4. Waiting to see how my 7/20 appt. goes, I will then seek 2nd opinion. How do I seek out the Best ophthalmologist in my area (Albany,NY)?  

5.  I am appreciating my RE with its cataract and blurry distance more than ever and will make no move to give up its near vision.

Side note: I saw your post on the Symfony IOL FDA approval.  I have been watching this lens and am wondering if that would have been a better fit. I questioned this lens prior to my surgery and was told I would not have good near vision with this lens. Near vision is important to me.   I thought I might have a little freedom from glasses with the Tecnis ZLB00. Between my poor near/intermediate clarity and lack of midrange coupled with the nighttime halos and glare maybe this new lens would have been the easier way to go.

[JohnHaganMD]

If you will use the search feature and the archives you will see your observations and concerns are rather common especially in multifocal and accommodating IOL.  It takes the eye and brain much longer to adjust to this 'new way of seeing" its called "neuroadaptation'.  I would frankly discuss your worries and concerns with your surgeon. If you are still concerned I would just ask the surgeon if a consultation is appropriate. Both of you be honest with one another