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Medical Forum / General / Vision / July 2005IOL diplopia cause/cure?
Ahhh, my poor left eye - first it was hyperopic and I disliked contact lenses, so I had a Staar ICL put in ... which had zero vault and the eye got a cataract. (Same thing on the right eye, but haven't had that treated yet) Doctor removed ICL and crytalline lense, put in normal acrylic IOL. Saw OK, but then developed PCO, had YAG treatment. Now I see a double-image, superimposed slightly up and to the right of the "main" image. Very annoying at night, light objects against dark background are significantly blurred (for instance, I can't read text on a TV screen, or a street sign) I can make the double image go away from the central field by looking through a pinhole or blocking the lower edge of my field of view. In the remaining "viewport" the image is quite sharp. I'm wondering, what might cause this? What might be treatments for this? I'm getting ready to go back and have the right eye ICL/cataract removed, wondering if there's anything I can do to prevent or minimize this problem in that eye. Thanks in advance, Wayne > Ahhh, my poor left eye - first it was hyperopic and I disliked contact > lenses, so I had a Staar ICL put in ... which had zero vault and the eye > got a cataract. From what follows, I suspect you're in the presbyopic age group. I cannot understand why a surgeon would put a ICL in when refractive lens exchange is the obvious and best solution. (Same thing on the right eye, but haven't had that > treated yet) Doctor removed ICL and crytalline lense, put in normal > acrylic IOL. Saw OK, but then developed PCO, had YAG treatment. Now I > see a double-image, superimposed slightly up and to the right of the > "main" image. Very annoying at night, light objects against dark > background are significantly blurred (for instance, I can't read text on > a TV screen, or a street sign) Sorry to hear that. Have a careful refraction done and hope for an optical solution (glasses). > I can make the double image go away from the central field by looking > through a pinhole or blocking the lower edge of my field of view. In the > remaining "viewport" the image is quite sharp. The idea of the above refraction advice is the hope that a best VA refraction would maximize the stong image, while minimizing the weaker, ghost image. During the refraction process, try to pay more attention to the good image, and try to ignore the ghost. Time also will no doubt help. > I'm wondering, what might cause this? What might be treatments for this? I call it "double refraction" meaning that there are now 2 pathways for incoming light, probably due to irregular shaped holes in the posterior capsule from the YAG. For treatment see above, and as a last resort, if all else fails, consider gas perm lenses with a clear pupil inside an opaque (artificial) iris. > I'm getting ready to go back and have the right eye ICL/cataract > removed, wondering if there's anything I can do to prevent or minimize > this problem in that eye. Go to a better surgeon, one who is comfortable doing sutureless clear cornea incisions, and who does a lot of them (>300 per year). If you are anywhere near the west coast or don't mind traveling for the best, go to http://www.changcataract.com w.stacy, o.d. >> Ahhh, my poor left eye - first it was hyperopic and I disliked contact >> lenses, so I had a Staar ICL put in ... which had zero vault and the >> eye got a cataract. > > From what follows, I suspect you're in the presbyopic age group. 50 now, I was about 45 when the adventure began :) I > cannot understand why a surgeon would put a ICL in when refractive lens > exchange is the obvious and best solution. The hope was that I would get my hyperopia adjusted-for whilst retaining some accomodation (since I was just at the early stage of presbyopia); sounded feasible to me, so I enrolled in the study > (Same thing on the right eye, but haven't had that > [quoted text clipped - 7 lines] > Sorry to hear that. Have a careful refraction done and hope for an > optical solution (glasses). That *does* seem like the safest response now! >> I can make the double image go away from the central field by looking >> through a pinhole or blocking the lower edge of my field of view. In [quoted text clipped - 11 lines] > incoming light, probably due to irregular shaped holes in the posterior > capsule from the YAG. That would explain the sudden onset, then. And nothing much to be done about that, would there be... For treatment see above, and as a last resort, if > all else fails, consider gas perm lenses with a clear pupil inside an > opaque (artificial) iris. I'll keep thatoption in mind ... but my point in *starting* this mess was that I found contact lenses to be a tremendous hassle :( >> I'm getting ready to go back and have the right eye ICL/cataract >> removed, wondering if there's anything I can do to prevent or minimize [quoted text clipped - 4 lines] > anywhere near the west coast or don't mind traveling for the best, go to > http://www.changcataract.com I live in Santa Cruz, so Los Altos is close ... thanks for the guidance! Wayne > w.stacy, o.d. > That would explain the sudden onset, then. And nothing much to be done > about that, would there be... Not really, IF my diagnosis is correct. There is always a chance that it is also a bad IOL or a tilted one, so I also wouldn't rule out completely the idea of a lens exchange later. But first, get that other eye done correctly and see what you end up with. BTW I know that as part of studies he's doing Dr. Chang has implanted some newer focusing lenses that you, being the adventurous type, might be interested in. I wasn't, and opted for the Tecnis prolate silicone lenses in January. IMO they give the crispest vision possible at this point in time, and are relatively immune from the PCO problem. w.stacy, o.d. I wonder if there is a Dr. Chang equivalent in the NYC area. Anyone know ? > I wonder if there is a Dr. Chang equivalent in the NYC area. Anyone > know ? Probably, but none I know about. The day of one of my surgeries a thoracic surgeon from NYC was out here having his done. We both stayed at the Holiday Inn Express that has a free shuttle to the surgery center and to Chang's office, along with a discount rate he's arranged there... w.stacy, o.d. >> That would explain the sudden onset, then. And nothing much to be done >> about that, would there be... [quoted text clipped - 3 lines] > completely the idea of a lens exchange later. But first, get that other > eye done correctly and see what you end up with. Yeah, I'll do that. > BTW I know that as part of studies he's doing Dr. Chang has implanted > some newer focusing lenses that you, being the adventurous type, might > be interested in. I *was* interested in the accomodative IOLs, but I want to train to be a private pilot (being adventurous!) and the FAA won't let you have any accommodative lens implant. I asked specifically about the Eyeonics lens and they said 'no' I wasn't, and opted for the Tecnis prolate silicone > lenses in January. IMO they give the crispest vision possible at this > point in time, and are relatively immune from the PCO problem. I have read about those and the theory sounds very very good. The only worrisome part I an across was that (if I understood what I read) they are somewhat finicky to implant properly, and if tilted or something are susceptible to 'coma' aberration ... so finding a really really good surgeon is (as always) critical. Wayne > I have read about those and the theory sounds very very good. The only > worrisome part I an across was that (if I understood what I read) they > are somewhat finicky to implant properly, and if tilted or something are > susceptible to 'coma' aberration ... Haven't seen that; where did you see it? I read that decentration of the Tecnis iol is significantly less problematic than with standard iols. so finding a really really good > surgeon is (as always) critical. For sure. w.stacy, o.d. |
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