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Medical Forum / General / Vision / November 2008Just had cataract surgery - original problem seems worse
Hi everyone I knew I was developing cataracts and when my optometrist told me he could not do anything more with glasses to correct my deteriorating vision, I had the surgery. Just had it on my right eye; left eye is scheduled for a few weeks from now. I had the Clariflex monofical IOL done yesterday. Today I had the bandage removed. I did not notice any improvement, in fact felt that my vision is now worse. Doing an A-B comparison with my "new" eye and the old one, the halos and starbursts from bright lights seem much worse. Also, I know see flickering in my visual field in bright light. I am disappointed and quite upset. Does anyone have experience/advice to share? Thanks. In article <225fba84-3d84-46ac-9ff1-5f5680ff5446@s9g2000prg.googlegroups.com>, > I knew I was developing cataracts and when my optometrist told me he > could not do anything more with glasses to correct my deteriorating [quoted text clipped - 10 lines] > I am disappointed and quite upset. Does anyone have experience/advice > to share? The next day is too soon to assess very much. Did you see your doctor today, and did the doctor mention any problems? Did the doctor seem happy with the surgery results? Did the doctor do anything to improve your vision? I had halos and starbursts after the second cataract surgery. I don't remember them from the first, but they were five years apart. The halos and starbursts either went away or I stopped noticing them (it's been several years). If you aren't feeling comfortable with your vision on Monday, I would suggest calling your doctor. Although I've had cataract surgery in both eyes, I am not a vision professional.  SignatureDan Abel Petaluma, California USA dabel@sonic.net As Dan said, it is way too early to come to any conclusion about your outcome. Discuss your concerns with your surgeon and please, report back here for others to learn more. On Nov 15, 8:37 pm, Glenn Hagele - USAEyes.org <glenn.hageleSTOPS...@USAEyes.org> wrote: > As Dan said, it is way too early to come to any conclusion about your > outcome. Discuss your concerns with your surgeon and please, report > back here for others to learn more. Many thanks, Glenn and Dan. The flickering has abated somewhat, and I am encouraged by your advice. Will definitely post the results of follow ups. Dear Robru, Subject: Variable results from cataract surgery. I regret your results -- but it usually takes a week before the replacement lens "settles out". I had a check on day after surgery, and then took "drops" for a week. After a week, I was about 20/30 to 20/25. This was far better than the naked eye vision I had of about 20/600 when my eyes had a negative refractive STATE. So -- give it some time. Your results might not be that good, but there are some very good results from cataract surgery. From me, there was not choice -- other than the surgery. Best, On Nov 16, 12:46 pm, roberu...@gmail.com wrote: > On Nov 15, 8:37 pm, Glenn Hagele - USAEyes.org > [quoted text clipped - 6 lines] > am encouraged by your advice. Will definitely post the results of > follow ups. On Nov 16, 12:09 pm, otisbr...@embarqmail.com wrote: > Dear Robru, > [quoted text clipped - 28 lines] > > am encouraged by your advice. Will definitely post the results of > > follow ups. I went to see my surgeon today, because I also developed a new problem. Here is a list of all of them: 1. Glare is worse. Lights now show beams or rays going through them. 2. I experience a periodic flutter in my visual field, like a camera being jiggled. 3. I can see a dark arc in the corner of my eye on the right side. 4. I am getting "ghost", slightly double images. The surgeon told me everything looks fine. The IOL is perfectly centered and my eye is healing nicely. He explained all of the above by saying that the lens envelope needs to shrink around the new lens, which is much smaller than one's natural lens. He said this could take up to three months. That is what is causing every one of the above described "special effects". I want to believe him, but if all of this is true, why was I not told about it up front? I can't help but think he made some kind of mistake during the procedure. I am currently scheduled to have the other eye done on the 5th and am inclined to postpone that and get a second opinion. I now wish I had not had this surgery done at all, as my vision is markedly worse. On Nov 17, 4:45 pm, roberu...@gmail.com wrote: > On Nov 16, 12:09 pm, otisbr...@embarqmail.com wrote: > [quoted text clipped - 57 lines] > > - Show quoted text - Some of your symptoms are typical to retinal tears or detachment, especially the "arch". I suggest that you see a retina specialist ASAP. I am sorry to say that many cataract surgeons are butchers, and they certainly are not equiped for a thorough examination of the retina. Retinal detachment is a medical emergency -- that is if you want to save your vision. Don't delay! In article <d5ee1e66-4858-4829-9923-339c5af567c4@s9g2000prg.googlegroups.com>, > I went to see my surgeon today, because I also developed a new > problem. Here is a list of all of them: > > 1. Glare is worse. Lights now show beams or rays going through them. > 2. I experience a periodic flutter in my visual field, like a camera > being jiggled. When I hear "visual field", I immediately think of "visual field test", which is a test of just the peripheral vision. Is this what you mean, or is there fluttering everywhere in the vision of that eye? > 3. I can see a dark arc in the corner of my eye on the right side. > 4. I am getting "ghost", slightly double images. > > The surgeon told me everything looks fine. The IOL is perfectly > centered and my eye is healing nicely. I don't know what to say here. I had some of #1 with my second cataract surgery. > He explained all of the above by saying that the lens envelope needs > to shrink around the new lens, which is much smaller than one's > natural lens. I know that there is a lot of healing and growing happening in there. > He said this could take up to three months. That is > what is causing every one of the above described "special effects". That's long time. I know I had to wait 4-6 weeks to be tested for corrective lenses, in order for healing to take place, but my vision was pretty decent. > I want to believe him, but if all of this is true, why was I not told > about it up front? I can't help but think he made some kind of > mistake during the procedure. I would want to believe him also. > I am currently scheduled to have the other eye done on the 5th and am > inclined to postpone that and get a second opinion. Sounds good to me. I have always thought it was strange to have both eyes done at once, although many people do this. If your vision is so poor that you can't see anyway, maybe it makes sense. But if you aren't comfortable with the vision in your operated eye, it would make sense, to me at least, to wait until you have acceptable vision in your operated eye before having the other one done. A second opinion sounds good, also. > I now wish I had > not had this surgery done at all, as my vision is markedly worse. One of the reasons this surgery isn't often done until the vision has noticeably deteriorated, is just so that there will be a noticeable improvement after the surgery. My vision was much better, even a day later, other than the starbursts and halos. Since I have always disliked driving at night, this was not much of a problem. SignatureDan Abel Petaluma, California USA dabel@sonic.net Dear Rob, How bad was your vision -- before your surgery. Even "corrected", I was close to not being able to pass the State DMV test. I could see this myself. There was no question as to the necessity of it. Because of the induced "paralysis" drug for testing, I saw some of the effects you described. Under certain circumstances (sun, and glint) I could see the lens "move" and its effect. Typically the will wait about six weeks betwen the first and second surgery. You should request this delay. It is always a difficult "call" to say when surgery is necessary. That is a matter of you received information about the risks of the operation. I was provided with them: 1. Risks of a failure. 2. Risks of a detached retina. 3. Blindness. 4. Etc. But after reviewing this with friends, and the 'track record" of this particular ophthalmogist - I knew he was the best. Hope this helps. Otis On Nov 17, 6:45 pm, roberu...@gmail.com wrote: > On Nov 16, 12:09 pm, otisbr...@embarqmail.com wrote: > [quoted text clipped - 57 lines] > > - Show quoted text - On Nov 17, 5:42 pm, otisbr...@embarqmail.com wrote: > Dear Rob, > [quoted text clipped - 101 lines] > > > - Show quoted text - Thanks for your responses, everyone. In answer to Otis's question, my vision was not that bad. I was having trouble reading and driving at night so I went to my optometrist. He told me that he could not correct my vision any longer with glasses and I needed cataract surgery. I went to the surgeon he recommended. I really should have gotten another opinion, but I had known people who had this surgery and they were so enthusiastic about it and I had read that it is so safe, that I did not think of doing that. I'm going to get one now -- and will postpone the other operation. Thanks again, everyone, for your input. Rob On Nov 17, 5:45 pm, roberu...@gmail.com wrote: > On Nov 16, 12:09 pm, otisbr...@embarqmail.com wrote: > [quoted text clipped - 55 lines] > inclined to postpone that and get a second opinion. I now wish I had > not had this surgery done at all, as my vision is markedly worse. Roberu, try googling "dysphotopsia", which is the term for your symptoms. (The article by Randall Olson in "Review of Ophthalmology" is particularly good.) In most cases, these symptoms diminish with time due to neuroadaptation; however, sometimes the IOL needs to be explanted. I've read that the problem is caused by a poor fit between the IOL and the recipient's physiology. (You would not want to get the same brand of IOL implanted in your other eye.) It would probably be very wise to wait until you're satisfied with the vision in your first eye before having a second surgery. In your place, I'd definitely cancel the second surgery for now, and I'd get for an independent second opinion. > On Nov 17, 5:45 pm, roberu...@gmail.com wrote: > [quoted text clipped - 69 lines] > definitely cancel the second surgery for now, and I'd get for an > independent second opinion. Thank you, Jane. You're right -- all of my symptoms are a type of dysphotopsia. And in Googling the term as you recommended I found one source that says it affects up to 10% of cataract patients. I'll bet also that these patients -- like me -- do not have very "ripe" cataracts. If I had been nearly blind with cataract disease, the artifacts I am now experiencing would probably not be noticed as much or bother me as much, given the radically improved vision. Perhaps the surgeon's three-month interval is to allow for neuroadaptation, which also appears to take care of these problems for many people. I do find it odd that among the many complications listed in the consent form, you will not find "dysphotopsia". Interesting. Thanks again. Rob On 11/17/08 3:45 PM, in article d5ee1e66-4858-4829-9923-339c5af567c4@s9g2000prg.googlegroups.com, > On Nov 16, 12:09 pm, otisbr...@embarqmail.com wrote: >> Dear Robru, [quoted text clipped - 54 lines] > inclined to postpone that and get a second opinion. I now wish I had > not had this surgery done at all, as my vision is markedly worse. You seem to probably have photosias related to the IOL. The jiggle is the IOL vibration in the eye. The dark arc is a known, but less common, ivusal effect, less commonly seen than a bright arc due to light reflecting internally in the lens. The ghosting may be uncorrected refractive error - you still need to get tested for glasses, for example, for residual astigmatism, which may causes ghosting. The glare and beams may be faint wrinkes in the empty lens capsule, which does need to shrink to make it smoother and tighter. If wrinkles stay there and bother, the capsule is lasered to make a clear opening. None of these are necessarily due to a surgical problem, just part of the usual. These visual phenomena are not usually discussed beforehand, as most people are not that sensitive to them. If you describe them all beforehand, everyone will be looking for them and see most of them. Might you be an engineer, perhaps? > On 11/17/08 3:45 PM, in article > d5ee1e66-4858-4829-9923-339c5af56...@s9g2000prg.googlegroups.com, [quoted text clipped - 75 lines] > > Might you be an engineer, perhaps? Thanks, Dr. Robins. I am in computer science. I do tend to notice things that other's don't, but these artifacts are very noticeable. I now know that they are relatively common and also that many people neuroadapt to them. Your explanation of why they are not described beforehand makes sense. On the other hand, if one expects them, there might be less of an emotional reaction and feeling that "something went wrong", which might make it easier to adapt or habituate to them. I think the second opinion will help reassure me about the current situation. I appreciate your comments. Rob On Nov 17, 6:45 pm, roberu...@gmail.com wrote: > On Nov 16, 12:09 pm, otisbr...@embarqmail.com wrote: > [quoted text clipped - 57 lines] > > - Show quoted text - You are about 3 days post op!!!!!! The eye needs to heal. Have you ever had a bruise heal in three days? There is inflammation in the eye and you cannot expect it to be cleared up until after you have finished with your post operative drops, about 4-6 weeks from now. If concerned, postpone the Dec 5 procedure. A second opinion doesn't make sense unless you still have problems 6 weeks from now. > On Nov 17, 6:45 pm, roberu...@gmail.com wrote: > [quoted text clipped - 69 lines] > If concerned, postpone the Dec 5 procedure. A second opinion doesn't > make sense unless you still have problems 6 weeks from now. Thanks for the advice. I hope you are right. I do think that surgeons should warn patients about the potential for dysphotopsia. They warn about everything else, and dysphotopsia is far more frequent than any other kind of complication. I would also advise anyone who has been told by an eye examiner (optometrist, etc.) that he/she requires cataract surgery to get a second opinion. Just because you have cataracts does not mean you require surgery. Rob Dear Rob, Subject: My judgment. I AVOIDED it -- until it was obvious that there was no choice at all. Thus, when it "succeeded" I was indeed impressed. Judy is correct. Give it time. It was at least one week before things "settled out". I am certain your naked eye was far better than mine -- so for me it was a profound success. I know this operation will strike each of use differently -- but for me, I have discarded my minus lenses -- permanently I would hope. Some people "object" to using the "plus" for me. Not me -- I think the engineering "trade off" is perfect. But even here some people will COMPLAIN about there "near vision" and the fact that they use a plus at near. So, you can't please everybody -- so you got to please yourself. (Where did I hear that before?) Best, On Nov 18, 5:13 pm, roberu...@gmail.com wrote: > > On Nov 17, 6:45 pm, roberu...@gmail.com wrote: > [quoted text clipped - 83 lines] > > - Show quoted text - On Nov 18, 9:28 pm, otisbr...@embarqmail.com wrote: > So, you can't please everybody -- so you got to please yourself. Not too often, Dear Boy, or you'll go blind! > (Where did I hear that before?) Best guess? The voices, in your head. > I would also advise anyone who has been told by an eye examiner > (optometrist, etc.) that he/she requires cataract surgery to get a > second opinion. Just because you have cataracts does not mean you > require surgery. OTOH, people choose to have LASIK electively. Complication rates are pretty similar between the two procedures and there are arguments for using cataract surgery as a treatment for refractive error. On cataract surgery the best advice used to be "you need surgery when you can no longer see to do the things you want to do." But it's appropriate to consider surgery at an earlier stage, if there is a big refractive benefit. -MT > <roberu...@gmail.com> wrote > [quoted text clipped - 14 lines] > > -MT Here's an update - two weeks after surgery. The shimmering/giggling problem is gone. What remains are glare problems at night and the negative dysphotopsia. On the glare problems -- which are manifesting themselves as rays coming out of bright lights -- my surgeon echoed what Dr. Robins said earlier in this thread -- that wrinkles in the lens capsule could be the culprit, and these should resolve as the capsule contracts around the iol. I talked to my surgeon about replacing the lens and he recommended strongly against it. The lens is a Clariflex, which has an edge design that is intended to provide the advantages of square-edged iols in minimizing post-cataract lens capsule clouding while also minimizing dysphotopsia. He said that round-edged iols, which I understand from the Medhelp forum and other places have the least chance of causing negative dysphotopisa, are never used anymore due to the lens envelope clouding issue. I am not sure that this is true. However, as the other symptoms are abating I am going to hope that the negative dysphotopsia will as well. Still going for a second opinion. I think part of my problem is that no one prepared me mentally for these after effects, and I did not do any research beforehand. So I'd like to offer thanks to all for your advice and info. On 11/28/08 11:42 AM, in article 63a31fce-7657-4aa6-aafd-57bb90b87a4c@i18g2000prf.googlegroups.com, >> <roberu...@gmail.com> wrote >> [quoted text clipped - 39 lines] > > So I'd like to offer thanks to all for your advice and info. The silicone rubber Clariflex IOL also has less edge problems than the higher index of refraction acrylic IOLs, such as the Alcon Acrysof. The IOL exchange of preference when the Acrysof is a problem is to put in a Clariflex, in an article I read by David Chang, one of the IOL experts. The Clariflex is an update of the older SI-40, a rounder-edged IOL, but unlike the Acrysof that has a 90 degree angle edge,t eh Clariflex is purposely a slightly oblique angle to minimize internal reflections, but is is sharp at its posterior point of contact with the lens capsule, so it purportedly gives the advance of the square-edged IOLs regarding reduced opacification, coupled with fewer dysphotopsias. |
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