Negative Dysphotopsia with Crystalens HD

[jump007]

Negative Dysphotopsia with Crystalens HD

I had IOL HD500 implant on 24th of March of my left eye. It appeared to be successful, but no I see a very disturbing arch on the left side (dark shadow towards the ear). I contacted my Dr. , he took notes of my complaints, but did not find anything unusual. I contacted Bausch & Lomb. According to them they have never heard about this phenomenon. Controversy to other reports, the dark arch disappears when the pupil is diluted.

I get my right eye don e tomorrow (same lens with same specification). I am now afraid that the same may occure with my right eye.

What are my options?

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

1. Have it done. Likely same phenomenon will be present in second eye.

2. Don't have it done. Get a second opinion. Consider a monofocal aspheric IOL if the negative dysphotopsia is troubling.

JCH MD

[peakhope]

I have two Crystalens HD lenses. When I contract my eye muscles to bring distant objects into focus, I have a sensation of my field of vision is being shrunk by a few degrees on that outer edge. I suppose you could think of it as a dark arch at the outer edge of my left eye. That's the eye that still has stitches in it from surgery.

It is quite subtle for me. It is so small and far to the side that I can't even "see" it...I'm just aware of it. I find it curious and perhaps slightly annoying, but not really a problem. I think I am also getting used to it so it is less noticeable than it was at first.

How large is your shadow? Is it at the very outer edge, so it like a reduction in your field of vision? Is it always there or does it come and go? Did you get LRI's as part of your procedure (I did)? Do you have stitches?

If you would find this hard to live with for the rest of your life, I would wait. As the doc says, it's quite possible your second eye would have the same effect.

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

There is a possiblity that in conjunction with a Staff Neuroophthalmologist and a resident at the University of Kansas medical school department of ophthalmology that we may begin a study of negative photopsia and temporal darkness.

Would you be willing to talk to a resident on the phone to get the details of your case?

JCH MD

[peakhope]

Sure, I could talk with a resident about it. Mine seems so minor that I'm not sure how much I would help.

I just did more reading, and one study found 15% of IOL patients experienced them one day after surgery. In most cases they go away, but not always. I would guess that a lot of people don't notice them but if you ask about them they would suddenly become aware of them.

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

Okay if the study proceedes I'll post a note for you to contact me at my office.

JCH MD

[jump007]

Peakhope, the dark shadow is noticeable, but less when the pupil opens (when there is less light). It reduce the field of view by may be 5%. At the moment I am quite happy with the overall performance of the vision acuity (about 20/32). I have slight double vision on distance (my Dr says I had slight stigmatism before (which I did not on the onset of the cataracts 4 years ago), but he measured the cornea. What can I say? He test with corrective glasses and it was OK.

About the negative disphotopsia; I was quiet surprised that the local rep from Bausch & Lomb have not been aware of it (!!???).

What is LRI?

I got a stitch, that has been removed last Friday. It did not really make a difference, but I noticed still changes of the vision quality over time (I tested the acuity with a vision chart every day), possibly because of the eye drop medication (which - for the left eye has been discontinued today).

[peakhope]

LRI stands for "Limbal Relaxing Incisions" which are small cuts around the edge of your iris, used to correct astigmatism. Some doctors do them without really discussing them with patients. It would be worth asking your doctor if you got them, just so you would know one way or the other.

My shadow is really just a thin sliver, so it sounds like yours is much larger. I notice mine more in bright light, because there is more contrast between the bright background and the dark shadow. I have no idea if it is also related to dilation or not.

Hopefully yours will shrink or disappear over time.

[jump007]

RLI
I just got back from surgery today (right eye same crystalens HD500 same optic). Did not have the chance to speak to surgeon about the RLI, but I will ask him tomorrow, when he inspects the eye.
As I had very good vision (20/16) and excellent far vision before the cataract started, I am a bit wondering whether this has really developed during the 5 years since the cataract onset. I understand it is the deformation of the cornea. Could this develop from pressure of the eyelids? I have some overhang (inherited).

Negative dysphotopsia
The dark arch definitely disappeared altogether when it was dilated.

I decided to get the same lens in today even with the risk that it appears there as well on the following rational: it does not interfere in night driving condition and I am happy with the overall depth of vision (not need any glasses except very small print in dim light).

John C Hagan suggested to wait and if I can not tolerate it, to implant a monofocal aspheric lens. However, although less complication, better far sight, butI understand it would reduce my range of depth significantly. Hence, I will see what happens. It will probably take a week or so to find out (until the dilation effect is subsided).

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

-

[stick1]

I also had crystalenes hd implanted about the same time. Near was perfect but have not been able to see beyond 5' without double or blurred vision. Dr wanted to do yag. I was scheduled then declined . It seems that during surgery every effort is taken to preserve the integrity of the chamber, it did not make sense to the put a hole in it if lens exchange was being considered. Anyways I have developed especially at night this same type of shadow almost like a mini blinder along with a flickering of sorts. It also is to the outside area towards ear. I still cannot tolerate sun or florescent lighting. I am now considering a aspheric lens Technis. Also has anyone had discomfort do to the plates of the crystalen lens?

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

-

[jvsl]

I have the same effect also with my new crystalens HD.  If I move my hand back beyond the edge of it I get a brief area where I get a double image of my hand.  I decided I am seeing the edge of the lens.  As for the flickering, see my above question about the 'wiggles'.  I think your lens is moving while trying to accommodate, at least I think that is what is going on with me.  If you look fixedly at one thing does the flickering stop?

[jump007]

I am sorry to hear your experience.
I don't understand why your Dr. is suggesting the YAG. Ask him what he is trying to archive. To my understanding the YAG is being used to remove scars or fibroses which is growing behind the lens. I understand it very difficult to do an explantation after a YAG has been applied.
You seem to be very shortsighted now. The most common problem with the Chrystalens seems to be the posterior vaulting (you can look up reports in the FDA's database (my guess 1/3 of the lenses are vaulted posterior;  1/3 broken haptics, 1/3 others). Your Dr must have chosen the wrong optic or the lens may have vaulted. My Dr prescribed 1 drop of Atropine, which blocks the receptors in the muscles of the eye (to let the lens settle – and prevent it from moving). My suggestion, your Dr should talk openly about this – or get a second opinion.

I can see from 14inch to infinity (the left eye is slightly off – 20/20 only with -1 diopters correction, but I can see fairly well without glasses – there is only a slight blurriness starting from a distance of 20 feet without glasses). He implanted a 21.5 HD in the right eye instead of 22 in the left earlier to compensate.

My concern is the dark arch towards the ear, which impairs my field of view slightly. And, it seems to appear also in the right eye - 3 days after operation (as Dr John C Hagan predicted). I have some light flashes when the light comes from a certain angle, but I can live with that.

I have not heard about problems with the plates (are you referring to the haptics?). I can feel only the stitch for a few days after the operation, which usually goes away after a while.

[jump007]

Sorry, I only saw your message in this thread now.

I have not really flickering, what I see - referring to the dark arch – is more or less as I focus. Near objects – it becomes more obvious, far away focus less. It does somewhat appear as a flicker as the eye is making sudden moves, but I still believe it is the same. And, sometimes it appears to be transparent.

Do you experience stronger effects when the iris is constricting? When my Dr did the examination and dilated the eye, it disappeared until the pupil size normalized.

[jvsl]

If you seldom need glasses then you are accommodating, so far I am not.  I have great distance vision but somewhat blurry at six feet and no reading.  I have not been dilated since the procedure (early April) so I can't answer the question.  I do have the dark arch at the edge of my vision on the left, it seems like a curtailment of the peripheral visual field.  It also moves constantly for me.  The most likely outcome is that it will remain, but move less as I am able to focus better, if I am aver able to focus.  Since I requested good distance I have got what I asked for, and I can read the computer with light (+1.00) readers.

[jump007]

In response to your observation in the “wiggle” thread, it appears that we have the same issues; the light reflections as well as the dark arch. The vision acuity may be different, because your Dr choose different optical specification.

As far as negative dyphotopsia is concerned, peakhope (also in this thread) got the same issue. I think it has to do with the small size of the Crystalens (5mm) vs 6mm of standard monofocal lenses. Some reports say it has to do with square vs round edge or the individual antomy of our eyes. I believe I can definitely see the edge of the lens in some situation it appears transparent and I can spot (blurred) objects beyond.

If you search in google for “Negative Dyphotopsia” you find plenty of reports, but it appears there is very little knowledge of why that occurs.

Here a link to a study: http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=000107496

[jump007]

I forgot to address the last comment to jvsl

[gixxerjohn]

I had a crystalense hd installed 1 week ago and am experiencing same condition. ear side dark wiggly ark. poor distanse vision. doctor said possibly swelling. See what happens i guess. Did yours resolve after 30 days. Very disapointed if dosent resolve. Had high hopes.

[jump007]

Hi gixxerjohn,

Nothing has changed after one month now. Still dark arches.
My second Christalens has been implanted last week Tuesday. I have the same experience in that eye now. The experts tell me that they have not many cases with Negative Dysphotpsia reported with Christalens.
The “wiggling” is more a reflection on the retina of short movements of your eye (also possibly light flashes from the edge of the lens). I am probably going to live with this phenomenon before I let anyone any invasive actions.

My vision acuity is quite good, both eyes can see about 20/32 (in good light conditions even 20/20).
My night vision is good too, very limited glare (on a scale of 0-10  about 2).

Hence, if nothing dramatically happens, I will just stick with it.

However, I am just curious to what extend others have the same experience (I have some contacts to Bausch & Lomb and will keep them posted as well).

When do you get your second eye done? Let me know whether you experience any changes.

[gixxerjohn]

I have not had the second eye done yet. The outer shadowing/wiggling is very troublesome to me at this time and vision is not good yet.  Will wait for second eye. Maybe just leave it alone. The eye I had done was the worst of my 2 eyes. If condition corrects and vision improves will have second eye done.

[jump007]

Hi gixxerjohn,

My first lens gave me instant good view (however, slightly short). I could read the computer straight away. When the Dr. did the second (right) eye, he reduced the optical specs by 0.5 diopters (from 22 first eye to 21.5 for the right eye). Outcome: I can see fairly sharp (left eye from about 15 inch to about 30 feet; right eye from 24 inch to infinity). Although the lenses are slightly different, this is not considered monovision.

I would be a bit nervous not to see reasonably well after the implantation (my Dr. told me it would be instantly). The acuity keeps changing - I guess from constant eye drops and the healing process (I still have a stitch in my right eye). However, if the lens specs have been chosen correctly, I think it should give you instantly reasonable good vision. Only the range of vision should improve over time. I noticed that the accommodation is starting to work as time progresses.

If the specs are wrong, your Dr. may consider exchanging the lens. As fare as I am aware, they can change the lenses within about 4 weeks. After that fibrosis may start (the surrounding tissue will bond with the implant), which makes it more difficult. Even worse, after a YAG.

What is your Dr’s proposing?

[gixxerjohn]

My visual acuity is good from 2 feet to 20 feet or so. Maybe will improve over time. The computer looks great through it.  My biggest concern is defanitely the outer edge on ear side. It does not seem to be improving. Funny thing is, day after surgery I don't remember seeing it. Maybe just so amazed at seeing out of that eye again. I asked the doctor about it on week follow up. He didnt know thought possably swelling and recheduled for 30 day appointment. What I can tell you is when he had my eyes dialated And I put my hand to left side where the dark area was (not dialated) I cound see more than one hand. When I decided to go with the crystalens hd I went to Bausch & Lomb for a recommended doctor so I am confident it wasn't a sergical screw up. Maybe I am worried about nothing and the eye will heal.

[gixxerjohn]

Looking at my eyes my pupul is not in the center on that eye, its offset. I dont remember the doc ever seeing eye when not dialated.  Maybe its just the way my eye is shaped. I hope not.

[nielk]

OK, I guess I never should have read this forum. I think I do have some of the symptoms of Negative Dysphotopsia on my right eye Crystalens HD. Up until today I didn't notice too much flickering on the side of my eye. But trying to read the paper for the first time this morning was very difficult with the flickering on the right side of my right eye.

It almost seems like my eye wants to go back and forth from the negative mode. I don't get it while reading a computer screen. When I was reading the paper I was next to a window getting lots of natural light. My reading ability/acuity is pretty good.

I think the light aberration that I get at night is also causing daytime acuity problems. But, I'm trying not to get too far out in front of my horse.