Don't know what to do.

Posted , 6 users are following.

Hi,

I used to be active here on this forum a couple years ago. I live in Europe and had a cataract surgery about 5 years ago (I'm 30 now); Tecnis 1-piece monofocal.

Since then I've been suffering from Positive Dysphotopsia. My overall visual acuity used to be very good, like 25/20 uncorrected, but that's not the case any more due to severe PCO.

My Dysphotopsia is edge-related as my pupil dillates far more than IOL's optic. I've visted lots of MDs, including those abroad, however, most of them tried to discouraged me from IOL exchange. I considered switching to Aspira aXA, but finally got scared of additional surgery.

I'd like to ask those who have a real-life experience with YAG capsulotomy and/or IOL exchange.

Do you think there's any point in doing a small YAG opening in order to have some kind of pinhole effect? Do you think I can get into troubles not only because of IOL's edge but YAG edge as well? Is there any chance that my capsule would overlap the edge of IOL and mask it a little bit giving some relief? P.S. I know that YAG itself doesn't help dysphotopsia, but am looking for some tips what to do if I finally give up with IOL exchange.

0 likes, 11 replies

11 Replies

  • Posted

    Did any of the doctors mention Pilocarpine eye drops? What does the dysphotopsia look like? The Tecnics 1 has a 6mm optic but there are some IOLs that have a 7mm optic. An exchange years later isn't completely unheard of but it's riskier than doing it a few months after surgery so it might be difficult to find a surgeon that would do it for anything less than a vision-threatening issue or a dislocated IOL. And they may have to use a 3 piece IOL with sutures rather than an "in the bag" placement… which would limit your IOL choices.

  • Posted

    hows was you near vision with the monofocal? 7mm aspira is a good lens but dint know who is exoert at iol exchange outside US. aspira is not available in US. in US, Safran will recommend sofport. i am in similar sutuation as you. alphagan helps me and so does lumify. and i am now used to the horrible arcs. i have severe pco too. i have pictures of it too. good luck.

  • Edited

    the problem with tecnis is that it is 4.9mm optical zone. clareon monofocal, sofport and clareon vivity are 6mm optical zone. at 30 that may still be a problem.

    • Posted

      it's not so easy. In case of Tecnis it varies with IOL power. For Sofport it's not full 6 mm neither. Take a look at EnVista - the same. There are certain powers for which it looks like Tecnis...

    • Posted

      Likely your pupils will get smaller with age, I'm not sure any IOL will fix that issue since they tend to be generally 6mm optics. So you'll risk messing with your eyes and yet not get relief for that problem.

    • Edited

      Thanks, but according to pupil size vs. age charts I gonna get some relief in 2045/50...

    • Posted

      Yeah this is the case, but i just wanted to highlight that you may not get any relief with any IOL until your pupil naturally constricts to a smaller size, so the risk of a lens exchange is high while the gains maybe 0.

    • Posted

      adam i saw a surgeon today. pm me if you want to know who. he told me with big pupils i will struggle with the tecnis lenses as their diffractive diameter is 4.9mm. he also said he thought sofport is refractive for all 6mm.

      he said panoptix and sofport was better option for me than eyhance.

  • Posted

    There is a piggyback lens option which may help. Raynor Sulcoflex is an example. Google the article below for a bit more information. Potentially the location of this lens would get around the large pupil size issue. I would be skeptical of the benefits of a reduced size YAG hole.

    Piggybacking With the Sulcoflex BY MOHAMMAD I. KHAN, MRCOPHTH; AND MOHAMMED MUHTASEB, FRCOPHTH

    • Posted

      Thanks. Piggyback improved Negative Dysphotpsia, not PD.

      A small YAG was advised by some.

    • Posted

      Most negative and positive dysphotopsia issues are edge of lens effects which can be aggravated by the IOL position in the eye combined with a large pupil. I have not investigated it to any extent, but if a piggyback lens can reduce the diameter of the light shaft coming into the eye and to the standard IOL, the issues MAY be reduced.

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