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3 weeks post op question

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Larksparrow
Larksparrow

Three weeks since my Eyhance implantation in one eye (right). Everything has been wonderful for the most part. Happy with my healing and vision in the medical sense. I am 20/20 at distance now. However, I am experiencing an anomaly that I have decided to reach out to my surgeon before my 5 week follow-up.

My issue is blurred/warped light in my peripheral vision. It's particularly noticeable when I am turning my head or moving. It looks similar to the edge of circular piece of cut glass, the way the light refracts at the side edge, a crescent of blurred or stretched light just past the 2 o'clock and the 10 o'clock positions. It isn't flickering, just a constant crescent (not a dark crescent or shadow, it is just as bright as whatever object is in my peripheral view).

ANy thoughts? I wonder if it's just still something needing to heal, or is there possibly something to be concerned about. Like I said, I have reached out to my surgeon, I last saw him 2 weeks ago in my 8 day follow-up where this was not something I mentioned thinking it was still too soon to tell. It is not horrible, but definitely distracting at times.

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  • RonAKA
    RonAKA Larksparrow

    Edited

    What you describe sounds a lot like positive dysphotopsia. There are different variations of it, but one of the more common causes are reflections from the edge of the IOL optical portion of the lens. The majority of the lenses have evolved from having rounded edges to having square edges with sharper corners. The purpose is to try and prevent or at least slow down posterior capsule opacification (PCO) which can cause cloudy vision. However these sharp edges can cause reflections that we see similar to what you describe. One method taken to try and reduce the effect is to frost the edges of the lens. The Eyhance lens has this feature based on what they say in the literature. Whether we see it or not seems to be partly based on chance and how far forward or back the lens sits in the capsule. Over time as the lens "grows into" the capsule this effect can be reduced or go away.

    .

    My personal experience was that I did not have any issues at all in my first eye, but then all of a sudden at about 10 months I started to see an arc like flash of light in my right eye when there was a bright point light source on my left side. Driving down a dark street with street lights on the left side of the road would cause it to occur as I went past each street light. I also see it if I am walking around the hall ways of a dark house and pass by a room with the lights on. It can be a little surprising when I am not expecting it, and a tiny bit of an annoyance, but it really does not interfere significantly with my vision. This flash is very sharp and not fuzzy at all. It is kind of like a quick shooting star and is arc shaped. This eye has an AcrySof IQ Aspheric lens which has square edges. I kind of think something changed with the position of the lens in my eye. It did not however have any impact on my prescription so the change must be pretty slight. My second eye is a Clareon and one of the claims made for it is that the edges are sharper and it is more resistant to PCO. I am at about 13 months now and I have not seen anything like this.

    .

    So I think you should ask about it. If it is the edge effect, the problem is that they can't do much about it, and they can't see it in your eye. All they can do is check to see if the lens position is good, and ask you to describe what you can see.

    • Larksparrow
      Larksparrow RonAKA

      Posted

      thanks for the reply, i also notice it when driving past street lamps. It'll be a pinpoint light until it gets to my 10 or 2 oclock and then flares out like a cone just before it moves out of my view. Interesting that you say its a reflection since I get the abberation on the same side as the source and not the opposite. I'll see what the Dr says, but i suspect you are correct, it's what I suspected as well. Light hitting the edge of the IOL.

    • RonAKA
      RonAKA Larksparrow

      Posted

      That does not sound like the same thing as what I am getting. I see it only with my right eye, and it appears as a quick sharp arc of light in my right peripheral vision when the light source is on my left. When I drive by a street light on my left I only get a single flash of light as I go by when the light angle is just right, when I am almost even with the street light.

      .

      What you have may be just part of the healing process of the eye. I would ask if the lens is properly centered in the eye and not tilted.

    • Larksparrow
      Larksparrow RonAKA

      Posted

      it is only the one eye, but happening on both sides of that one eye's field of vision, not as noticable in the right eye's left peripheral as the right side bc my nose bridge blocks some of it. waiting on Dr response.

    • Guest
      Guest RonAKA

      Posted

      I wonder how they can tell if an IOL is tilted or off centre? I would think some kind of high tech imaging would be required to measure small deviations (half a millimetre or a few degrees)? I don't think it's possible with a slit light, unless the IOL is WAY off kilter. I assume that even when dilated, unless your pupils are HUGE, they likely can't see the edges of the IOL. A cornea specialist actually told me once it's not really possible to judge centration with a slit light.

    • RonAKA
      RonAKA Guest

      Edited

      Yes, it is possible that an ophthalmologist may have the instruments to measure it more accurately. I think that is mainly what they are looking for in the 24 hour post surgery check, and if I recall correctly the surgeon I had only use a slit lamp. Perhaps they are only checking to see if they can see the edge of the IOL compared to the pupil.

    • Guest
      Guest RonAKA

      Edited

      My ophthalmologist said once he sets the lens and closes up it stays put… just as he left it. It doesn't move. Of course we know that it CAN sometimes move slightly but I guess it depends on what he meant by "move". Does he mean shift 0.3 mm or a total dislocation / subluxed haptic? Not sure. Of course the latter is exceedingly rare but the former? Not sure.

      .

      Also apparently there is disagreement on what centred even means. With laser assisted cataract surgery there are a few different options for how to determine the centre of the Capsulorhexis.

      .

      I think the next day check up is mostly to check that things are healing properly. They're very concerned in the early days about the incision opening back up and inflammation.

    • RonAKA
      RonAKA Guest

      Edited

      Using the pupil center to center the lens is common, but there are some that believe the lens needs to be centered on the optical axis, which is not necessarily the pupil center.

    • RonAKA
      RonAKA Guest

      Edited

      Actually I think lens movement is not an insignificant risk, and especially with toric lenses. Some lens materials have a lower risk of movement and rotation.

  • adam06539
    adam06539 Larksparrow

    Edited

    If it's only in the periphery to the left of your left eye, or the right to the right eye, these are abberations from your incisions. It needs some healing. If you see them also in your central vision, that is positive dysphotopsia.

    • karbonbee
      karbonbee adam06539

      Posted

      But would that explain him getting them three weeks after surgery though? I had them for maybe two days after the first eye, then a week after the second eye, but they've resolved themselves now.

    • Spoo
      Spoo karbonbee

      Edited

      It takes a LONG time for eye tissue to heal, seemingly a lot longer than most other tissue. That's why you're not supposed to mess with your eyes for months after surgery.

      When looking at my night lamp, i can with my left eye see that the left side of the straight lamp-shade edge has a bumpy distortion, with my right eye the distortion is on the right side. It's swelling from the incisions. It's easy to notice the distortions when looking at a light source with a straight edge on it.

    • Guest
      Guest Spoo

      Posted

      Spoo… curious if you've brought up this distortion to your doctor and if Cystoid Macular Edema has been ruled out?

    • Spoo
      Spoo Guest

      Edited

      I think I mentioned it to her in my last checkup, but it sorta seems like an obvious feature of being cut from just that specific side of your cornea. On the left eye which is more recent there's a more pronounced "bump" on the left side (where the bigger cut is). On the right eye, which was done 3+ weeks ago, there's a noticeable bump on the right side respectively. Also she checked my eyes on monday using a slit lamp and didn't notice anything. I can still verify this.

    • Guest
      Guest Spoo

      Edited

      I've never heard of the corneal incisions, which are outside your field of vision, causing distinct distortions like that. The cornea will flatten along the axis of the incision but that just induces astigmatism which can cause smearing and ghosting, not distortions. CME does cause distortions. It can be hard to see and very easy to miss in a slit lamp exam. You should ask for an OCT of the Macula. Most doctors will have their own OCT machine in the office and it just takes a second to do the scan. I had zig zag distortions in straight lines for weeks and my doctor dismissed it after doing slit light exams and just told me to use artificial tears and allow time for brain adaptation until it got very bad and I INSISTED something was WRONG and they needed to investigate. They relented and did an OCT and found a very noticeable (in the scan) cyst on my Macula. Treatment was simple (steroids) but I would want that ruled out by OCT if I were you.

    • karbonbee
      karbonbee Spoo

      Edited

      "When looking at my night lamp, i can with my left eye see that the left side of the straight lamp-shade edge has a bumpy distortion, with my right eye the distortion is on the right side."

      .

      I tried this a couple of times with a couple of different lamps and I'm not noticing any bumps or distortions. Both eyes were done three weeks ago. I do have a history of healing really fast, though I've never had any surgeries on my eyes before.

      .

      I wonder if anyone else experienced this, or has it something to do just with what is happening with your eyes? Have you considered a retinal tear?

      .

      Symptoms of retinal detachment can happen suddenly and include:

      • Seeing flashes of light.
      • Seeing a lot of floaters — flecks, threads, dark spots and squiggly lines that drift across your vision. (Seeing a few here and there is normal and not cause for alarm.)
      • Darkening of your peripheral vision (side vision).
      • Darkening or shadow covering part of your vision.
    • Guest
      Guest karbonbee

      Edited

      distortions / warped shapes are usually related to back of the eye issues (retina, macula)… something like cystoid macular edema or epiretinal membrane

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