regression following catarct surgery

[jaycat]

I had cataract surgery on right eye 8 weeks ago, monofocal lens (I'm in the UK, NHS) which corrected my shortsightedness in that eye.  Vision was very good 2-3 weeks after surgery, insignificant residual short sightedness & insignificant astigmatism.  I saw the consultant again 10 days ago because I'm having pretty bad problems with ghosting & seeing multiple lights in dim light & darkness, which optician told me was due to my pupil size when dilated.  My consultant said that my vision had regressed over the last 3 weeks, I am measurably more short sighted again than I was 2 weeks after surgery which he says is due to the astigmatism in my eye changing & worsening, & that it is still changing.
How usual is it for astigmatism to worsen & "regression" to take place, 8 weeks after surgery, when my vision acuity was very good initially?  and how bed might it get/when might it stop changing?  I'm very worried about this ongoing deterioration, & I'm now due to have 2nd eye done in 3 weeks time.

[jaycat]

Many thanks Dr Hagan, that's been very helpful.  

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

This is my last comment:   In our practice we do not generally operate on the second eye till the person is happy with the first eye. It's your corrected vision that is important. In other words if with a lens like -0.75 + 0.75 axis 90 you vision corrects to 20/20 plus its been a good operation and what you need are glasses to give you good vision.

On the other hand if they do the glasses test and your vision is not clear or if with the glasses you are having problems with dysphotopsia then that is a problem.

Consider a "time out".  See what happens over the next couple of weeks. If you're still unhappy get a second opinion.

JCH MD

[jaycat]

Many thanks for taking the time to respond again Dr Hagan.
I asked for best corrected distance vision. Had an eye test by my optometrist 4 weeks after surgery & my results were -0.75, +0.25 astigmatism - great visual acuity but I had & still have significant problems with ghosting & seeing multiple lights in subdued daylight & darkness.  Saw my consultant again 2 weeks later ie 6 weeks post-surgery, and my visual acuity on basis of an informal eyetest had measurably deteriorated (I don't have a prescription for this test).  He puts this (& the other problems) down to my astigmatism increasing - he said it was "something like 0.75" going on the basis of him doing quick checks with lenses in front of my eyes.
What worries me is that my visual acuity & astigmatism have measurably deteriorated in the space of that 2 weeks, & my impression is that in the 2 weeks since then (now 8 weeks post surgery) they have deteriorated further.  I have another optometrist appointment in 1 week.
My distance vision in the OPERATED EYE ONLY, without glasses, other eye covered, is tolerable, but now less sharp than in UNOPERATED EYE ONLY, WITH glasses, but with cataract & out of date prescription.
Apparently my eye has healed well & is physically fine.
I'm concerned about going ahead with 2nd surgery while I still have these deteriorations going on, but don't know if my eyes being so out of balance might be contributing to the changing astigmatism?
Any opinion you have would be most welcome.
Many thanks.

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

With you being so myopic and with surgeons not wanting to leave you needing such thick glasses it is inevitable that you would have trouble with the eyes working together and I also would have told you that you would need surgery on the second eye about 6 weeks after the first eye PROVIDED the first eye healed well. We also discuss what you want your vision corrected for after surgery. some myopes want to be able to read without glasses and use computer without glasses. In that case we might shoot for -2.50 and -1.25   Others would want distance clearer without glasses then might go 0.00 and -1.25  and there are many other combinations. You need to discuss this with your surgeon.   If the vision in your operated eye is relatively clear at distance or near without glasses AND THE UNOPERATED EYE SHUT its likelly your surgery is doing well.
JCH MD

[jaycat]

Many thanks for your thorough response Dr Hagan, much appreciated.
When I had the 1st surgery & requested a lens that would correct my short sightedness I was told that in that case the 2nd surgery would have to go ahead, soon, because my eyes would be left very out of balance.  The hospital team are still telling me this, which I understand, & apparently my vision in the 2nd (left) eye has now deteriorated significantly; I can tell just from the difficulty I am beginning to experience in day to day life that the vision in both eyes is changing, and not good, so everything is becoming a bit of a struggle.  In that respect, it seems to me to be a good idea to go ahead with the 2nd surgery sooner rather than later, in the hope that when my eyes are 'balanced' that will help - but I am also very worried that I encounter the same problems with the 2nd eye.
I suppose I'm wondering whether the difference between the 2 eyes is contributing to my difficulties (didn't ask the consultant that exact question).
My vision in the right eye prior to surgery was -9.25, having previously been -7.25 prior to the cataract developing.  My vision in the left eye was -6.75, (with the beginings of a cataract) but is now apparently -9.00, presumably due to cataract having developed further.
I'm still considering your suggestion of a 2nd opinion, just it's not too easy to organise in UK, & not in time I have available.

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

Often there is swelling of the cornea immediately after surgery, which can change the shape of the cornea and therefor the glasses RX as well. As the swelling clears in the first week after surgery things can change, for the better ie better vision without glasses or worse, worse vision without glasses. We tell our patients that things may change for a week. However it is unusual for major changes to occur after 7-10 days after surgery. Thus I can't tell you where you will end up.

You might consider postponing surgery on the second eye till things stablize on the first eye or get a second opinioin.

JCHMD

[taurus1203]

Hi Jaycat,
May I know do you have astigmatism before ? Did you use LRI to correct the astigmatism ?
What IOL do you use ?

Thanks