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Problem with ReStor lens
Has anyone had an issue with feeling like text is jumping or moving when reading after ReStor lens implant? I know that the halos are common but I can handle that. This sensation is worse in Florescent lighting. My 2nd implant was almost 6 weeks ago and this is very concerning.
There are a few threads on sites around the net with people with unexplained flickering issues with a variety of lenses, including monofocals and the Crystalens and not just multifocals. The text jiggling issue seems even more rare past the initial few weeks. Often they resolve themselves within a few months, but not always. You haven't mentioned what your doctor has said about the concerns, I'd suggest having a followup visit and asking for them to check for things like pseudophacodonesis or iridodonesis and to suggest what other issues might be at play if not those. If your doctor isn't a high volume surgeon familiar with the various potential problems, you might wish to find one who might have more experience. Unfortunately it is likely the advice will be that you should live with it a while and see if you can adapt since any potential treatment might not help or in some cases might make things worse.
Certain sorts of issues like halos are more common with multifocals, and if you can't adapt to them after several months then a lens exchange is commonly suggested as a possibility. However other issues like jiggling text and flickering light may or may not be related to the particular lens you have. Its important to try to determine the likely cause before considering what if anything to do about it. If it were definitively the choice of lens then a lens exchange would be something to consider, but given issues that match what you've described can happen with other lenses as well, its best to try as much as possible to pin down the cause before considering a lens exchange.
Certain sorts of issues like halos are more common with multifocals, and if you can't adapt to them after several months then a lens exchange is commonly suggested as a possibility. However other issues like jiggling text and flickering light may or may not be related to the particular lens you have. Its important to try to determine the likely cause before considering what if anything to do about it. If it were definitively the choice of lens then a lens exchange would be something to consider, but given issues that match what you've described can happen with other lenses as well, its best to try as much as possible to pin down the cause before considering a lens exchange.
I actually do have a sensation of flashing heights at the outside portion of my eyes. I am fairly pleased with the vision usually but the times when I feel like my eyes or the text moving are very disconcerting. It is worse on a computer screen or with Florecent lighting.
1 Comments
This free ebook from a surgeon mentions a common issue during the first few weeks after surgery:
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."
The issue is that your eye makes many small movements when trying to read, saccades, and if the lens is loose then inertia will cause the lens to keep moving longer after the eye stops and confuse your visual system.
Usually that healing finishes within the first 6-8 weeks, though perhaps it is taking longer in your case or there is something wrong. A doctor should check to see if your IOL is moving, what they call pseudophacodonesis (with a few minor spelling variations like k instead of c, and a "-" after pseudo). Another potential cause of the IOL moving is loose zonules (tike ligaments), they hold the capsular bag in place and if they are loose the bag containing the IOL can move.
You might wish the doctor to know about the issue before the appointment, because sometimes the staff dilates eyes before a doctor sees you for a followup. The usual drops they use to dilate the eyes are also cycloplegic, they paralyze the accommodation muscles and tighten the zonules which makes the bag less likely to jiggle and may hide the problem. A surgeon might wish to try to see in before the dilation, or use different dilating drops which aren't cycloplegic.
If it isn't pseudophacodonesis then it may be hard to get a doctor to diagnose such a rare issue unfortunately, it often gets lumped into the general category of a "dysphotopsia", an unwanted visual artifact. It seems important for them to try to be sure what the cause is if possible so they can determine if it would help to do a lens exchange, or risk making things worse due to more trauma to the eye loosening zonules further for instance. It may be that the type of lens you have has nothing to do with the dysphotopsia.
In my case with a different lens when I tried to read initially the text looked like it was moving around, combined with a sense of the light flickering. After a few months the text stopped seeming to move around, but the flickering continued. Its reduced quite a bit, but very slowly over the 14 months postop and isn't quite gone. The issue I have is rare, and there is a good chance it isn't related to what you are experiencing (you don't mention flickering). In my case it seems the most likely explanation is iridodonesis, my iris jiggling during eye movements. Usually iridodonesis doesn't cause visual artifacts so surgeons don't even look for it. In some cases after cataract surgery, usually with people who were highly myopic and had larger eye structures, replacing a large natural lens with a smaller artificial one reduces support for the iris which can then move. It seems in some rare cases, mostly those with light eye colors like my blue eyes, that can cause visual artifacts. Often even light eyes have striations in the iris of black amidst the lighter color and so the stray light entering the iris can vary as it jiggles (and perhaps get reflected off the lens in addition).
It isn't something others would notice easily. I managed, with some difficulty, to capture it with my phone's camera and surgeons commented on the quite marked iridodonesis the videos show (though one noted that may also mean the capsule is jiggling as well even though the surgeon didn't spot that in the postop), and suggested that the best thing to do is give it more time to see if I adapt to it.
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."
The issue is that your eye makes many small movements when trying to read, saccades, and if the lens is loose then inertia will cause the lens to keep moving longer after the eye stops and confuse your visual system.
Usually that healing finishes within the first 6-8 weeks, though perhaps it is taking longer in your case or there is something wrong. A doctor should check to see if your IOL is moving, what they call pseudophacodonesis (with a few minor spelling variations like k instead of c, and a "-" after pseudo). Another potential cause of the IOL moving is loose zonules (tike ligaments), they hold the capsular bag in place and if they are loose the bag containing the IOL can move.
You might wish the doctor to know about the issue before the appointment, because sometimes the staff dilates eyes before a doctor sees you for a followup. The usual drops they use to dilate the eyes are also cycloplegic, they paralyze the accommodation muscles and tighten the zonules which makes the bag less likely to jiggle and may hide the problem. A surgeon might wish to try to see in before the dilation, or use different dilating drops which aren't cycloplegic.
If it isn't pseudophacodonesis then it may be hard to get a doctor to diagnose such a rare issue unfortunately, it often gets lumped into the general category of a "dysphotopsia", an unwanted visual artifact. It seems important for them to try to be sure what the cause is if possible so they can determine if it would help to do a lens exchange, or risk making things worse due to more trauma to the eye loosening zonules further for instance. It may be that the type of lens you have has nothing to do with the dysphotopsia.
In my case with a different lens when I tried to read initially the text looked like it was moving around, combined with a sense of the light flickering. After a few months the text stopped seeming to move around, but the flickering continued. Its reduced quite a bit, but very slowly over the 14 months postop and isn't quite gone. The issue I have is rare, and there is a good chance it isn't related to what you are experiencing (you don't mention flickering). In my case it seems the most likely explanation is iridodonesis, my iris jiggling during eye movements. Usually iridodonesis doesn't cause visual artifacts so surgeons don't even look for it. In some cases after cataract surgery, usually with people who were highly myopic and had larger eye structures, replacing a large natural lens with a smaller artificial one reduces support for the iris which can then move. It seems in some rare cases, mostly those with light eye colors like my blue eyes, that can cause visual artifacts. Often even light eyes have striations in the iris of black amidst the lighter color and so the stray light entering the iris can vary as it jiggles (and perhaps get reflected off the lens in addition).
It isn't something others would notice easily. I managed, with some difficulty, to capture it with my phone's camera and surgeons commented on the quite marked iridodonesis the videos show (though one noted that may also mean the capsule is jiggling as well even though the surgeon didn't spot that in the postop), and suggested that the best thing to do is give it more time to see if I adapt to it.
1 Comments
Use the search feature on this page and archives and seek out the many discussions of the ReStor intraocular lens. You will find them informative.
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