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Vision is significantly worse after cataract surgery and not improving after 6 weeks

After complaining about vision reduction that glasses didn't help much (I am 47) , the doctor recommended cataract surgery.  I had the new Vivity lenses implanted about 5 and 6 weeks ago.  My vision is still significantly worse than before the surgery: blurry, distorted, flickering, and cloudy with starbursts even in the daytime. After improving slightly after about 3 weeks, it is deteriorating again.  The doctor says there is nothing wrong because I can make out the letters at about 20/40 level given enough time, but functionally I am unable to read efficiently and my work (I do software) has told me that I need to find a new job because of that.  Also I can no longer drive at night. So far they have told me:
1) There was significant swelling and it should clear after a few days or couple of weeks (only slight improvement)
2)  My mind needs time to adjust and type A personalities take longer (first time ever called type A)
3) I have dry eye condition (which I never had before) and need to use more artificial tears (I do all the time and doesn't help)
4) Try different types of tears (doesn't matter much)
5)  Will need YAG and touchups but have to wait for 3 months, what's the big deal everything else looks good
5) I am making it up because other people don't seem to have these problems

I am desperate because I did this to improve my vision and now I am going to lose my job and it will be very difficult to find a new one but the problem is short of disability.  Does anyone have any ideas of what I can do?
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233488 tn?1310693103
MEDICAL PROFESSIONAL
Your experience is very atypical and alarming. I have spent most of this week listening to how happy and pleased out cataract surgery patients are. Those having the first eye done wanted the second eye done ASAP. My strong suggestion would be to get an independent second opinion as quickly as possible. NOTE: you are type A you will need to do some research to find out in your area who specializes in 2nd opinions and is willing to deal with another surgeons post op problems. Most surgeons want nothing to do with post operative problems done by another surgeon.  Exceptions are departments of ophthalmology in medical schools and every mid/large city has several surgeons that are willing and experienced with post op problems.  I would get this goes ASAP.  It seems rediculous to tell you to find another career.
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l'm 48 and told l need cataract surgery in a year, my optomerist said to go with the standard mono focus lens set for distance and wear glasses for close up, he said most people are happy with that and the more fancy premium and mulitfocal lens can have problems and side effects
Avatar universal
I am sorry to hear of your experience with Vivity lens.  I did not have the expected outcome with a  Vivity lens implanted in my LE about 8 weeks ago.
I have blurry distance vision starting  at about 6 feet, excellent intermediate and reading vision.  I have positive dysphotopsia from this lens. Concentric rings around every light source.   I would not be able to drive at night if I had this vision in both eyes.    My surgeon was willing to do a lens exchange for a monofocal.   I did not want to risk 2nd surgery. I decided the good near range is a trade off for the halos/glare in LE.  I  have (tentatively) decided to have RE surgery with an older monofocol silicone lens next month set for distance.   My biggest concern, of course, is will I have glare/light problems with this lens too? My surgeon tells me there is less than 1% incidence.    But if I fall into the 1%, my life after dusk will be completely changed and it's depressing to think about.
I hope you find another surgeon who can help you with a lens exchange or another solution.  You deserve better treatment.
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9 Comments
Cam5151:  from your description of your problem in the LE the first thing that needs to be done if to have a very careful glasses test (refraction) and get glasses, with anti-glare and your distance RX in it to try for night driving. That might take care of the problem. Positive dysphotopsia is more likely to go away than negative dysphotopsia. However a trial of waiting to see if positive dysphotopsia clears would be at least 6 months.  If you are not rushed and function okay with 'driving glasses' you might want to wait a while before you rush into surgery on the RE.  I always tell people to hold off surgery on 2nd eye if you are unhappy and having trouble with the first eye. Over the years the most unhappy and miserable people are people that rushed ahead and have bad or unacceptable results in BOTH eyes.  That being said a high quality  aspheric monofocal IOL if far less likely to cause dysphotopsia than ANY MULTIFOCAL IOL.  Several years ago another eye surgeon and I conducted a survey of unhappy posters on this website. The number of unhappy campers was many times more common in multifocal so called 'premium" IOLS than plain vanilla monofocal IOLs.
Thank you Dr Hagen for  your detailed response.  Yes,  my doctor gave me a new Rx for  driving/watching tv glasses  about 6 wks after cataract surgery in my LE.  
My distance vision in my Vivity lens eye is corrected w/ glasses, however the positive dysphotopsia remains and isn't improved at all by the eyeglasses.  
I have yet to try "amber" night driving glasses that fit over your regular glasses- I have a pair from Amazon coming today.  And I am also hopeful the halos may diminish with time.
  I appreciate your recommendation of a "high quality aspheric monofoal IOL" to minimize the risks for light aberrations in possible upcoming second eye surgery.
What specific lens would you recommend to fit this definition?  Is there any specific lenses you can recommend (ie, brand and name)?
(My surgeon mentioned the "acrylic" material of the Vivity may be causing the light aberrations and recommended a silicone lens.)  

Thank you for any insight!
"Insight" good choice of words.  There are many excellent IOLs and for a variety of reasons including legal and the rules of MedHelp I cannot give specific recommendations.  Both silicone and acrylic give excellent results in modern aspheric monofocal IOLs.  The debate silicone vs acrylic has been around for many decades. Silicone cannot be used in diabetics or patients at high risk of RD since silicone oil used in RD surgery may damage the lens. The main problem is not the material so much as mono- vs mult- focal.   The other thing you might want to discuss with your surgeon is a trial of using Alphagan-P  (not the generic bromonidine) brand name drops for a trial of using at night for driving. These drops keep the pupil from dilating widely at night. Has been used on LASIK patients with glare at night with some success.  
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Thank you for the recommendation of drops.  I did try Alphagan-P %.1 at night and unfortunately  halos did not diminish in my Vivity lens eye (LE).  I have been reading many of your posts the last few days, they are very enlightening and straightforward for a non medical person to understand.    
You made a suggestion to obtain new glasses for distance/night driving to help with halos.   I read another post where it mentioned that "post op" glasses should correct your distance vision in operated eye to match distance vision in non operated eye.

As previously mentioned, I did obtain "distance" glasses about 6 weeks post op:
_The halos do not go away in my  Vivity lens eye (LE) w/ the glasses.  Outdoor Christmas decorations are large round colors of light.
_Distance vision is definitely *not* as crisp in operated eye (LE) as non operated cataract eye (RE) w/ glasses .   However, I can drive  and see the TV with the glasses, and I assume my non-operated eye (RE) is doing all the "heavy lifting" for night driving/distance.  
My questions:
1) If the distance Rx  for my operated eye was made stronger, do you know if there might be any effect on the halos?
2) Would providing my before and after Rx's help with your answer?
I am also asking this question in the event I have my RE implanted with silicone monofocal set for distance and I experience the *same* problem with halos/poor night vision -I'd like to know my options before I take that step .  
Thank you.
What do you think of Extended depth of vision lens? do they give you better near vision then mono distance lens and not have the risks and side effects of multi focal lens
Thank you for the recommendation of drops.  I did try Alphagan-P %.1 at night and unfortunately  halos did not diminish in my Vivity lens eye (LE).  I have been reading many of your posts the last few days, they are very enlightening and straightforward for a non medical person to understand.    
You made a suggestion to obtain new glasses for distance/night driving to help with halos.   I read another post where it mentioned that "post op" glasses should correct your distance vision in operated eye to match distance vision in non operated eye.

As previously mentioned, I did obtain "distance" glasses about 6 weeks post op:
_The halos do not go away in my  Vivity lens eye (LE) w/ the glasses.  Outdoor Christmas decorations are large round colors of light.
_Distance vision is definitely *not* as crisp in operated eye (LE) as non operated cataract eye (RE) w/ glasses .   However, I can drive  and see the TV with the glasses, and I assume my non-operated eye (RE) is doing all the "heavy lifting" for night driving/distance.  
My questions:
1) If the distance Rx  for my operated eye was made stronger, do you know if there might be any effect on the halos?
2) Would providing my before and after Rx's help with your answer?
I am also asking this question in the event I have my RE implanted with silicone monofocal set for distance and I experience the *same* problem with halos/poor night vision -I'd like to know my options before I take that step .  
Thank you.
Unfortunately the proper eye glasses prescription cannot be made 'stronger' to help a person see better.  The glasses test produces the best possible glasses at that time for that eye.  The problem is the eye/IOL not the glasses.  I would suggest you get the best possible second opinion on the area you live in.  Every large community usually has one or more ophthalmologist that specializes in post operative eye problems. Most surgeons don't want to deal with another surgeon's problems.  You do need a macular OCT to be sure you do not have disease of the central part of the eye which gives us our visual acuity. It is very concerning that the  operated eye with best glasses RX is not as good as unoperated eye.  
Avatar universal
Thank you  for your responses and advice, Dr Hagan. I have made an appointment for a second opinion before proceeding with a second eye surgery.  
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Best of luck and if you find something definitive consider reposting for others following this discussion
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