advice please - have just been told I'll 'neuro-adapt' to my halo and glare problems

[scheeler]

Hi

I'm 59 years old and live in the UK. Last month I had cataract surgery, and Tecnis monofocal IOLs placed in both eyes (Tecnis silicone Z9002). Since then I've been having terrible problems that I've already posted about (thread with the title "huge shimmery structures after monofocal iol implant"). Briefly, whenever a light source is near the edge of my vision I get a huge curved band right across my visual field, with rays leading from it, a bit like half of a huge glowing dandelion clock.

When I saw my surgeon for the four week follow-up exam and told him of my problems, he was totally up-beat, and said he'd never known a patient have this problem at my stage of recovery and not had it disappear 'in six, twelve, or eighteen months'.

Things haven't improved, and I'm posting again because I've just read a copy of a routine letter the surgeon has sent to my own doctor. It's very short, so I'll quote it in full:

"Mr *******'s cataract surgery has gone very well and he continues to settle. He has some halos and glare problems at the present time but both eyes are seeing well unaided at 6/6 in the right eye and 6/4 in the left eye.

I am sure as he neuro-adapts and settles that all of his symptoms will resolve satisfactorily but I have asked him to come back and see me should he have any on-going worries".

This letter has me really depressed, because it suggests he's pinning all his faith on my 'neuro-adapting' , which as a layman, I'm guessing means that my brain will 'learn to edit out' these halos, and I just can't imagine that in a thousand years my brain could 'edit out' such prominent visual features as these  - it's like saying "your brain will learn to 'edit out' that 100-foot tree that's straight in front of you". An eye-surgeon told me the same thing about my floaters, and that never happened, hence my vitrectomies in both eyes.

I'd hoped that once the capsular bags had shrunk down, this problem would be solved, so my surgeon's talk about neuro-adaptation is very depressing indeed, because I just know 'it ain't gonna happen'. And I just can't imagine living the rest of my life like this.

I'm hoping Dr Hagan might be able to give some advice, but I'd also be very grateful for any opinions or experiences from people here who've had the Tecnis silicone Z9002 implanted in their eyes.

After all, this is supposed to be an advanced design, with an edge specially shaped to minimise glare problems - surely it should perform better than this?

[scheeler]

I don't wear glasses now, as the cataract surgery brought my eyes down to plano in the left eye and +0.25 in the right.

As for my psychological problems, I'm already having them treated: I was diagnosed with clinical depression in 1999 and I've been taking antidepressants ever since. And as for 'the more you think about it the worse it will be and the longer it will take', it's sound advice, but not very helpful: I think about the problem every time I walk under a light and see a huge glowing crescent stretching right across my field of view.

And it comes back to the same question: how on earth can the brain learn not to notice something that is that intrusive - a band of light right across your vision? If it were there constantly, I could imagine the brain being able to ignore it eventually, but this is something that only happens under certain circumstances: how can the brain learn to ignore something that happens suddenly?

The following isn't aimed at you, Dr Hagan - you've been very helpful - it's just a general observation.

I feel I've done all I can to ensure a good outcome to this. As a UK resident I could have had cataract surgery done free by our national health service, but instead I spent just about all my savings in order to be able to choose my surgeon. I did my research, and chose a surgeon who seemed to have an impressive track record. I deliberately chose monofocals even though I hated the thought of losing my last bit of accommodation, just so that I could avoid halo and glare issues.

I really thought that after all that careful choice and all that expense, I'd have a trouble-free outcome once things had settled down. Now I feel I'm at the beginning of a life sentence.

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

The more you think about it the worse it will be and the longer it will take. If you have underlying psychological problems such as anxiety, depression, hypochondriasis or obsessvie-conpulsive disorder you should have them treated and see a professional for those problems also.

A really exact refraction in the glasses you wear helps most.

JCH MD

[scheeler]

I hope you don't mind if I ask one thing more in this thread, Dr Hagan (you've been very patient with me!)

What's the best way of encouraging this neuro-adaptation to take place? What I mean is, will it ONLY occur if you repeatedly present the brain with the phenomenon you want to get rid of?

I'm asking this because, as a person who has had depression and anxiety for a number of years, and also suffers from obsessive compulsive disorder, I tend to try to avoid experiences that will cause me to obsess and become more depressed.

In this case, whereas I always used to love going for walks after dark, since I discovered this problem, I've deliberately avoided doing so, because I know how I'll feel when I see these 'dandelions' - and because I know I'll feel depressed for quite a long time after the walk itself. But if neuro-adaptation can only occur by repeatedly presenting the brain with the 'noxious stimulus', then my best strategy would be to take as many evening walks under as many street-lights as I can, regardless of how it makes me feel.

The thought of all the anxiety I have ahead of me if I do this really daunts me, but if this is the only way my brain can reprogram itself, I'm willing to 'bite the bullet'.

This is why I need to know a little more about the mechanism of neuro-adaptation. Thanks.

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

There is no agreement among eye surgeons on the cause of this unwanted light reflexes (dysphotopsia) and in fact there are probably multimple causes.

JCH MD

[scheeler]

Thanks for that advice, Dr Hagan. There's one thing I forgot to point out, though.

These arcs and rays aren't completely smooth - the thick arc itself has a 'fibrous' quality, while the rays leading from it - the spokes in the wheel, as it were - are a bit like what you'd see if you look at a light through crumpled cellophane.

I know these arcs are caused by light bouncing about inside the IOL (though I'd have thought the Tecnis 'Opti Edge' design would prevent this). However, if they were just caused by the IOL, I wouldn't expect any of this 'fibrous' quality - and it's this that is making the arcs really noticeable.

I've been wondering (more like 'hoping'), therefore, that most of this visual disturbance might be due to the capsular bags not having shrunk down to be flush with the IOLs yet, and was hoping that when this finally happened, most of this problem will disappear.

I had both ops done in mid to late May - is it possible that the capsular bags haven't shrunk yet, and that this could be the main problem?

[scheeler]

Thanks for those words of encouragement, jaysta - I do try not to worry about this, but it isn't easy.

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

neuro-adaptation is real and often eliminates these symptoms over 6-12 months. If you feel more comfortable you can get a second opihnion from someone other than the surgeron i.e. a different IOL surgueon.

Wave front glasses the most sophisticated glasses grinding system in the world often helps this while you're waiting for the brain to adapt.

JCH MD

[jaysta36]

Hi this problem will always be there in one shape or another,but it will improve alot better,and you will learn to adapt to it I have,yep it will take 18months,but It will settle,if the visions good,and this problem only accrues in certain lights i.e spot lights in a dull room ,or car light on in the dark,DONT UPSET THE BOAT..and get on with your life and forget about it,you will forget its there in time..