Black rim at corner of eye after cataract surgury

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I had my right eye operated for cataract a month ago, ever since I took the patch off the next day after the operation, there has been this  thin back rim at the far end corner of my eye. The doctor who operated me assured me the surgery went well and he saw nothing wrong, and if there is, there is nothing he can do. Went to another doctor, she said it may be due to the small pupils I have and how my retinal is, says I will notice it less eventually. Went to to a  third doctor, he said it happens when the IOLs are acrylic, but will not do anything about it since my vision is 20/20 after the operation, He said he can operate my other eye and use a PMMA iol instead, he also added that PMMA lens are not foldable as acrylic lens, therefore he will need to make a bigger incision. I don't know what to believe and I am scared to have my other eye operated. I hope someone in this board can shed some insight on my case. Thank you.

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  • Posted

    I am sorry to learn that you have "a thin back rim at the far end corner of your eye." Will appreciate it if you can describe it a little more for me to completely understand your symptom.

    However, the blank recommendation by the third surgeon to use a PMMA lens surprises me. At least in USA, the opthamologists hardly ever use PMMA lens: practically all of them use lenses made of Silicone, Hydrophobic Acrylic, or Hydrophylic Acrylic with their corresponding advantages and disadvantages (Staar IOL lens is of another proprietary material). The PMMA lens does cause less cases of Posterior Capsule Opaqueness, PCO (which is easily treated by YAG laser), but causes much more eye astigmatism due to the large requied eye incision.

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    • Posted

      Thinking some more about your vision issue, it may be Negative Dysphotopsia, which is essentially a shadow cast on the retina by the lens in the eye (tends to be worst for the acylic lenses with square edges).  Silicone lenses with rounded edges seem to have less of that issue. Smaller diameter lenses will also tend to have more of this issue.

      You can find a good article by Caceres on the subject by searching for "Treating Negative Dysphotopsia Caceres 2014". Most of the patients with this problem find that the problem gets less severe or they just get used to it. If the problem is really bad, the doctors will sometimes replace the square-edged acrylic lens with a rounded-edge silicon lens.

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    • Posted

      Missed the word edge in my statement, "...which is essentially a shadow cast on the retina by the lens in the eye...".

      It should have read:

      "...which is essentially a shadow cast on the retina by the lens EDGE in the eye...:

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    • Posted

      Thank you indeed for your response, I so appreciate it. The thin black rim, right, it is  a thin black, not straight line located permanently at the far end corner inside my right eye, it does not obstruct my center vision, it feels real, so real that I even try to push it away with my hand (it would be so great if only it works, sigh). When I shfit my eyesight to my left, the line moves more a bit more inward to the left, too, but it does not come to the center. When I shift my eysight to the extreme right, it disappears. I am afraid of PMMA lens too as I looked it up in youtube, the operation looks complicated, I think of how  the surgeon tries to position the lens manually, I get wearied,  now that you told me about astigmatism, a possibility he didn't mention at all, I am definitely not going back to him. The replacement lens my surgeon used on me is a Alcon, acrySofIQ mod.SN60WF, I can't tell if it is hydrophylic acrylic or acrylic, but I presume it is not silicone. I hope he made the right choice. The thing that upsets me most that he did not even entertain the fact that I have this side effects, I can accept that no body replacement parts can match exactly the same as the originals, and eyes are so sentive, if only he would share my discomforts, tell me the reason. It is of great comfort to me to be able to reach out to good people, professionals or otherwise in this forum, to share, to learn and to be guided. Again, thank you., 

       

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    • Posted

      As a matter of fact, I did read about (and a lot, too) negative dysphotopsia when I was looking for answers to this black curved rim I feel to have in my eye after  the surgery.  

      I also tried to bring this subject to my surgeon, I actually had my tablet with this topic on to show him (exactly the papers by Vanessa Caceres), he totally dismissed me as if I was talking nonsense.

      I am not experiencing a severe problem, fortunately it is  a thin black rim at the far end corner of my eye. I can't tell if the IOL I have is rounded edge or squared edge, I do have the ID card of my IOL, it is Alcon, AcrySof1Q, model  SN60WF. I presume it is acrylic. From various reading I have come across, some say the cause of ND is tiny pupils, others say tiny pupils would lessen the chance of ND, so I am lost. I do know I have tiny pupls, every time they dilate my pupls they complain how small they are.

      I am going to live with this tiny black rim and hope that it will somehow go unnoticed. I am not comfortable right now to have my other eye operated, because in addition to the black rim, I still feel uncomfortable with my eyelid, I feel as if it is swollen or something is making it heavy, strange to say though,  the eyelid is not drooping or anything, in fact it is lifted up, I don't know why, but if I were to have a  blepharoplasty, it would not be necessary now.

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    • Posted

      It is too bad that the surgeons often choose to not listen to the real issues which people have after a cataract surgery (or other treatments). It should have been easy for your surgeon to try to explain to you that many  patients (about 1 in 5 by one article) tend to have the negative dysphotopsia after the cataract surgery, that the reasons for it are not clearly understood (although the lens design has an effect), and that most probably the problem will be easier to deal with as the time goes by. This would have saved you much of the unnecessary worries. Instead, he just got defensive and decided to pretend that there is nothing wrong with your eyes.

      Any way, I do hope and wish that your symptoms do get better in the coming weeks.

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    • Posted

      Yes, physicians should change their attitude, it would really help the patients, the more they learn about the possible outcome,the better they would be prepared, making an informed choice. My surgeon had me signed a 3 page consent form listing every possible negative health issues a cataract surgery may bring, but nothing like this is in the

       form. 

      Indeed, I do hope the symptomes will go away on tip toes, I am determined not to let them spoil the positive result, paid for so profusely as well from my own pocket... Thank you again,.

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    • Posted

      It was the same with, very depressing, making me feel like it was my fault that I was ungreatfull. Doctors do not tell you about the side effects which they can not correct. Many issues are ignored, psychological effects that patients suffer as well. 

       

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    • Posted

      Hi Peggy, Katherine & Everyone who's contributed such important information about pre & post cataract surgery. My cataract surgery was done on my left eye on 6/25/18 & then on the right eye on 7/10/18.  I'm responding because I also experience the vertical dark line along the outer edge of my left eye.  I read about Dysphotopsia & brought this issue up with my surgeon at my 4 week visit & he dismissed it as the incision healing.  There was never pre or post surgeon discussion with me or my anyone his staff about possible side effects.  I did my best to learn as much as I could online so I could feel somewhat confident asking questions, & hoping to have a meaningful discussion with my surgeon which never happened.  This saddens me because after 60 years of wearing glasses including 30 years with progressive lenses, I felt lost with my vision changes post surgery & worked extremely hard to find ways to provide myself with comfortable glasses where I could see the computer & close up as both eyes were healing.  My right eye post surgery has some cloudiness at the center & horizontal glare when I look at bright lights.  My surgeon says this will likely go away in time as the dark line will disappear in time which he expressed at my 6 week checkup when he wrote a prescription for progressive lenses because I was having trouble with bifocal, the line.  At that same visit, my surgeon also said if the black line along the left outer eyes doesn't disappear, it can be lasered...what another eye procedure!!  I don't think so! Atleast not for a very long time & only if necessary.  Now at 7 weeks our from left and 5 weeks out from right eye cataract surgery, both eyes feel "somewhat artificial,"  a feeling of wanting my own biological lenses back, cataracts & all.  I realize this is a reaction to how I'm seeing through the artificial acrylic lens & like any body replacement part, it will take time for my brain & my eyes to make these changes over time together & sync up..hopefully.  I'm deeply grateful for this site & for all of your responses which help me to feel not so alone with this monumental transition and adjustment. Surgeons and their offices need to become aware of the enormity of change patients experience and provide a way or a place other than a therapist's office, to deal with this very real transition and visual adjustment.

      Thanks for listening.

      From a concerned mental health therapist, in practice for 30+ years.  

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    • Posted

      Hi Marie and others.  I had both eyes done in January 2018 and I have a black crescent on both outer sides of my eyes.  I was told by my doctor my brain will get used to it.  My brain has not.  He also said that my pupils are large that that could be the reason the edge of the lens is what I am seeing, and something to do with the way light enters my pupils.  He could Rx some drops to make my pupils smaller, but NO I don't want drops.  I also now have double vision when looking to the right, so they Rx'd new glasses!  I had the surgery to get rid of glasses and contacts!  I have asked for a second opinion by another doctor.  Not happy about seeing "blinders" in my vision or having double vision.  the only thing I read was that i might have droopy eyelids and I did before, so now they are more so.  However, my vision in general is much better and so that makes driving at night safer.  Just don't like the blinders and double vision.  I will keep you posted after my second opinion.  

        Not sure why this is not addressed in the literature.  I probably would have gone ahead with the surgery anyway, but it would be good to know what might be an adverse outcome. 

       

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    • Posted

      I, too, had a similar experience. I feel as if my lower eyelid is crawling up the middle of my eye. The doctor basically said to wait and it should diminish. It has not and now they want to do a YAG procedure. The problem with that is if it does not work, they cannot ever replace the old lens with a new one.

      Maybe if the doctor had mentioned the "negative dysphotopsia," (defined as the perception of a shadow obscuring the temporal field of vision, while positive dysphotopsia is characterised by halos, arcs or streaks around point light sources), I might have made a different decision about surgery or at least went for a second opinion!!!

      Now what? Live with it or go for another "fix it maybe" surgery.

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    • Posted

      I have had the second opinion and still no real resolution. Another surgery would create more risk. I don't know what a YAG procedure is that you mentioned. I was told I could have a laser procedure for a specific symptoms, but there are risks to that too. I can't really say I have gotten used to the feeling of "blinders" I have but sometimes I don't notice it and other times I do. I'm going to live with this, rather than risk another surgery that may not correct the problem. The double vision I have looking in one direction the doctor said might be dry eyes.... I'm trying lubricating eye drops he recommended. I may pay out of pocket to go to a University hospital where the experts are, but that is not something I will do right away as the cost may be high. Best of luck. Diana in CA.

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    • Posted

      I am having exact problem with both my eye ops and is driving me insane. like a pair of curtains being closed simultaneously. I can see perfectly but this outer thin curve at outer edge of both eyes is upsetting but i am so relieved to hear i am not alone in this. my surgeon says he has only heard of this twice in over six thousand operations and hoping my brain gets used to it. still early days but first op was six months ago and is still there

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    • Posted

      I got a second opinion and now that surgeon said the first will be referring me to a cornea specialist. I am waiting for that appointment. There is a name for the condition but i don't have it handy. i can respond again later with that info. my brain had not gotten used to it and actually seems more pronounced.

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    • Posted

      Not to frighten you Mavis but you might want to see a retina specialist.

      Seeing a curtain-like shadow coming down across your field of vision can be a sign of retinal detachment. These signs can occur gradually as the retina pulls away from the supportive tissue, or they may occur suddenly if the retina detaches immediately.

      Best have this looked at asap.

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    • Posted

      i had my right eye cataract removed and an iol inserted,since then i too see this black arch that blocks some of my periferal vision and at times is annoying with me wiping my head as if my hair was hanging on my eye,but its not.i read that if the iol is misplaced you can see this arch .the operation to correct it involves cutting you eye,removing the fluid within your you so the retina dosent tear and you lose the eye,remove iol then replace an iol correctly ,refilling you eye with another fluid (it didnt mention what type fluid replaced your natural fluid),then your eye is stitched. ive also read cataracts can be removed by lasers but since it is more expensive insurance companies wont cover it.if you have money you can get the best care ,if you dont you get the old and sometimes outdated medical care especially since insurance companies own the doctors now and their decisions are controlled for the sake of money instead of humanity.

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    • Posted

      I am not sure it is 100% due to IOL misplaced. Sometimes it is due to pupil dilating beyond the IOL. IOL is just 6mm in diameter. The younger one is the pupil dilates more in low light / dark conditions.

      You can get drops to temporarily constrict pupils. As one ages this should rectify itself. The brain too learns to adapt and filters it out.

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    • Posted

      hi Sue. the dark arc is actually negative dysphtopsia. constricting the pupil will make it worse. dilating the pupil actually make it better. it is not the edge, it is really a shadow on the retina due to the eye physiology. it may go away on its own or will never go.

      what you mentions helps people like me with positive dysphotopsia where the edge reflection is of the color of the light source.

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    • Posted

      my Kaiser doctor, after two second opinions, has referred me to a specialist who will do surgery in one eye at a time to lift the lens which is believed to help resolve the half circles at the sides of my vision. The surgery is late February. The surgery is late February. I’ll report back.report back.

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