Drawings of my positive dysphotopsia with Tecnis ZKB00

I so feel for your situation and so sorry your surgeon advised clear lens exchange (basically cataract surgery) as an alternative to glasses. people who are young have much better vision than someone of normal age for cataract surgery. some of your issues sound like your pupils are dilating beyond the IOL and reason you see the rim. Despite that you should be able to see better than you do. Was the power calculation accurate. How is your distance vision?

I would ask more questions of your surgeon and if not getting answers seek a 2nd opinion

Hi

Thanks for your reply 😉

I was wearing multi-focal glasses pre-op and elected to get the Multifocal IOL obviously after a consult.

Sitting now in normal light my pupil size is about 5mm which i think is average for me? The lateral rim is really annoying and was actually one of the things i disliked about wearing glasses...In fact I'd often remove my specs in order to not see them at the side and give me a rest kind of thing.

The IOL "rim" is terrible as the closer i go to something to look at it, I can actually see the lenses moving in from the sides to ?focus - Like being in a pair of binoculars!

Re power calculation - no idea (terrible with numbers but I have been wondering) and my distance vision is bad - Mid and far to infinity is just blurred - lacking definition and detail in any light.

This really angers me. I am so sorry that your doctor talked you into getting a lens exchange when it was not needed. As someone who has gone through cataract surgery, I would never suggest this to someone. Anytime I read it online, I tell them not to do it. There are just so many risks to having cataract surgery, especially with multifocals (I have one in my right eye and got a monofocal in my left due to the negative side effects). All of those amazing things you read about cataract surgery in the waiting room pamphlets, online etc... most of it's not true. It's all hyped up to get you to choose their IOL.

I feel your frustration with going into follow up appointments and they tell you it went perfectly. If you've experienced the negative side effects of these lenses, then you know how hard it is to deal with. You look out of your eyes every waking minute. It's hard to just ignore it. But keep in mind its also been 2.5 months. Your eyes are definitely still healing and they will be get better in some regards. It doesn't make sense that your range of vision is that bad though. It sounds like they got the IOL wrong. What has the doctor said about that?

Hi

Thanks for your reply 😉

My ops were in mid December 2020. I was told my vision would improve significantly so to have these issues given my expectations is a nightmare. My mid and far distance vision is definitely not what i was expecting and I've read everywhere that your distance vision always improves first - I'm wondering why that's not applying to me as my distance vision is the same now as it was days after the ops. Re the IOL sizes or calculations being wrong I will ask them next time I attend but I get the impression they won't like that!

One other thing in case it's significant - If i "squint" or make my eyes go "c**k-eyed", my vision is perfect near and distance, the clarity, definition, detail and colour change is instant????

If you are concerned about angering the surgeon (and after the fee you paid they really should be be bending over backwards to ensure you are pleased with outcome) you can go to tour regular optometrist for simple refraction test. Usually healing is 6 weeks after cataract surgeon if all went well and no complications. Given surgeon says all is well how come it isn't? Yes small changes dan occur over 6 months but sounds as if there are bigger issues. See what your optometrist says and then see your surgeon and if necessary get another surgeon's opinion.

Again I am sorry this has been a terrible experience and I wish surgeons didn't suggest this where glasses are adequate.

Hi... Just and update.

So I attended the hospital today and was told again they're happy with my eyes.

I conveyed my concerns and was told that all my issues are due to the IOL's and that the lenses are the correct power and sited properly.

I basically have three options - Wait longer in order to adapt, Get glasses again for mid and far distance or (least favourable option) have lenses removed and exchanged for monofocals. Doing this would take me back to square one but with a total dependency on spectacles and a stronger prescription. The surgeon stressed for several reasons of practicality, safety and eye health lens exchange was not a good option. 😦

Up to you. If i were in your shoes I would get a second opinion from a different surgeon. Maybe an interim step would be to see your optometrist. If an optometrist can correct your vision with glasses then that would indicate something isn't quite right with the power of your IOLs.

Unless your eyes haven't healed and there is swelling or another eye issue going on enough time has passed where you should be seeing better than you are in my opinion.

It's odd you say if an optometrist can correct my vision with glasses may show something isn't right with the IOL power... I might get an appointment with the optician. It was actually the surgeon who suggested spectacles as a possible means of correction for some of my issues but made it very clear that ALL my issues were due to the IOL's and that I was one of the few patients that may take longer to heal etc. Thanks again 😉

IOL power calculations are not always bang on. The healing process too even if the calculation was accurate could alter vision by .25 diopter either way due to healing process. The IOL is much thinner than one's natural lens so as the eye heals from surgery the IOL shifts shifts back and forth till it heals (about 6 weeks) and why surgeons recommend you wait that length of time to visit your optician if you need glasses. Cataract surgery can also

induce astigmatism so that may need to be corrected with glasses as well.

Due to these elements no surgeon should promise glasses free as that may not end up being the case.

Hi

😕 There's just so much that I appear not to have been told about and regards wearing glasses post-op that was only mentioned for very small print. Although the surgeon disagreed i wasn't advised of anything apart from halos and reduced contrast. With the contrast reduction I think you could adapt to that easier.

I'm really worried about my job now as i reckon it would be impossible for me to drive safely anywhere at night - Ive got halos, starbursts and glare - constantly and that's not improved at all since surgery. Regrettably, i can't see much in the way of help with that e.g. special night glasses and the like. The discussion about halos was short like everything else and only the other day was it mentioned my eyes would have changed shape post-op which i believe is astigmatism!? May i ask, are you clinical?

I may have missed your post/ thread. How long ago was your surgery and which IOL lenses did you choose?

First off do you see well during day time and your issue is with nigh vision with glare halos and starbursts at night?unfortunately there isn't a fix with glasses to help with night time glare etc that i am aware. i tried glasses off amazon (yellow) but didnt find they helped at all. I have the edof symfony lenses (both eyes). 3 years later i still see huge concentric circles around lights but oddly enough those no longer trouble me - they are faint especially the outer rings and i have to look intently to see them. First 6 months or so i had to plan my routes driving at night - it was easier to drive on streets with overhead lighting than no street lights. What helped a little was driving with my car's interior dome light on. the glare starbursts and halos did subside. Now I really dont think twice about night driving. inside lights do not bother me - not even concentric circles as those lights have to be a certain distance to see them.

Do you drive for a living? That would be difficult and your surgeon should have considered that when recommending a premium lens and steered you away from them. Regrettably many just think of the money as the premium lenses cost so much more and usually not covered by insurance.

If you are not seeing clearly (daytime) there are other issues going on and you should follow up with the surgeon and if you get know where may get a refraction test from your optometrist.

The powers have to be off. That's the whole reason you got a PanOptix. Now you wont have perfect vision at all ranges but you nothing should really be very blurry. I have a Symfony IOL in my right eye and my distance prescription is -.50. I can see intermediate and distance without glasses with no issues. I rarely wear glasses. As Sue said, it would be a good idea to go to an optometrist to get a prescription check. I would be very interested to see what your numbers are. Has your surgeon mentioned a Lasik touch up?

Hi

I had dual AcrySof IQ PanOptix Tri-focal IOL’s (Model TFNT00) placed in mid December last year.

Other than a short discussion regards monofocals versus multifocals, there was no options given for which trifocals I would receive - I was

told several times the lenses were the best.

By day i see better but by no means near perfect - Basically my near vision to about 6/8 ft is OK but with "artifacts" and beyond that is just blurred and out of focus - I can generally see things but without definition. For instance, some days I can read a reg plate from 20 meters with some difficulty and some days I can't. I also can't recognise people from certain distances as well.

At night, as light decreases, so does my vision and the Halos, starbursts and glare are present everywhere with any light source both day and night, just far worse at night.

I tend to walk now looking at the pavement as it's weird looking forward and my head gets sore. The pictures in my post above are exactly what i see as i edited the pics to show that although I do also see a starburst with the halo but that's not in the pic.

The size of these light issues depend on the type of light and distance from it - sometimes they're huge!

I've looked into the driving glasses on the web and to my concern found nothing.

The driving is a huge issue because I'm in the emergency services and do drive at work. This is now and again but is sometimes dependant on my role or partner.

The halos etc will cause other issues at work that I hadn't even thought of, but I'll take note of your advice if I get to drive my own car again.

The surgeon did say that multifocals "may" cause halos and "could" affect driving from a work perspective and I did say I don't always drive at work and he accepted that. He did not mention anything about it affecting me when driving in general such as my own car, so i just thought it was about blue lights or something!

I also had no idea that it would be so bad as even looking at pics on the net don't look as bad as what i see, not to mention nothing was said about dealing with these issues during the day as well.

I also said to him about my headaches and eye aches and he just passed it off as stress due to my eyes adapting, being off work and being in lockdown - I wasn't very happy about that tbh and subtly disagreed.

I've had a refraction test every time I've been at the hospital and they just run over the fact I've blurred vision etc just saying it's the effects of the lenses and I'm adapting! With the tests from the optometrist, I've always described what i'm seeing when doing the letter on the wall tests. She's heard it so many times now that when testing, she just says "it doesn't matter if it's blurred just tell me what you can read"!

I am going to make an appointment for an assessment from my local optician though.

Thanks again for your input and support with this 😃

kevin77191

Hi kevin and thanks for your support 😉

I asked the surgeon on the last visit if my lenses were the correct power and in the correct position and he said categorically yes and

again said the both procedures went without issue - Which i don't agree with but hey what do i know?!

He actually showed me some hand written notes (no idea as i couldn't raed them from the distance ) and said the numbers showed my

vision was or was close to 20/20?

Re lasik no no quite. I said to him that i was upset as i was hoping they would find a problem and he asked why. I said because at least

then they'd have a cause and something to fix. He then looked at some notes again then said something about using laser to clean a little

opacity from the back of my left eye but immediately stressed it would not change anything. The issue was I believe maybe a remnant of the

inflammation that i had previously post-op in my left eye. I had inflammation, some swelling and eye was rather painful and bloodshot.

Hi kevin and thanks for your support 😉

I asked the surgeon on the last visit if my lenses were the correct power and in the correct position and he said categorically yes and again said the both procedures went without issue - Which i don't agree with but hey what do i know?!

He actually showed me some hand written notes (no idea as i couldn't read them from the distance ) and said the numbers showed my vision was or was close to 20/20?

Re Lasik no no quite. I said to him that i was upset as i was hoping they would find a problem and he asked why. I said because at least then they'd have a cause and something to fix. He then looked at some notes again then said something about using laser to clean a little ?something/opacity from the back of my left eye but immediately stressed it would not change anything. The issue was I* believe* maybe a remnant of the inflammation that i had previously post-op in my left eye. I had inflammation, some swelling and eye was rather painful and bloodshot.

How disappointing - Really think it was thoughtless of him to put it down to pandemic lockdown and adjusting. Night vision should have nothing to do with how well you see during the daylight. Things should be sharp and crisp.

Is there another cataract surgeon you could see for an independent opinion. You would not be first person that found a reason from going to another surgeon for a 2nd opinion

Hi

Yeah I could maybe visit another private clinic but in the meantime I've arranged to see my own optician early April.

I've read heaps today both on the forum and the net and watched quite a few of Dr Chong Youtube videos - very educational and eye opening. Also been looking at other lenses e.g. Symfony and Tecnis Synergy but there's not much on the latter.

I'm feeling now that I've made a major mistake because of the night time light and contrast issues and such been searching desperately for a solution. As there's been no change in four months, I'm now thinking there's unlikely to be and such, my career is now on the rocks. With that in mind over the short term and avoiding insanity over the long, it may be the only fix is lens exchange for monofocals with a reliance (again) on spectacles!

Yes so agree with this. Something about surgeon's attitude and dismissal of blurred vision us not right. Refraction test by cataract surgeon not the same. And optometrist will be able to test provide a prescription which should tell you what is going on.

Reliance on glasses not the end of the world compared to what you are experiencing. First things first and find out from your optometrist what your prescription is. Wishing you all the best. Let us know what you find out.

I know what you mean. You want them to find something that it causing your issues that they can fix but the unfortunate part about cataract surgery is that once the IOL is in your eye, anything of the things that can go wrong are not an easy fix because they most likely would have to re-enter your eye again.

When he is talking about a laser to clean a little, he is talking about PCO. It is possible that you have that and he could laser it away. Why would he say that it would not change anything? Why did he mention it then? Makes me wonder if he knows the power of the IOL is wrong and thats whats causing the blurriness, not PCO.

Anyways, good to hear that you have an appointment with your optometrist coming up. Let us know how that goes 😃

At 4 months out to still be so unhappy with the outcome and having issues with visual acuity I would 100% be looking for a surgeon with experience in IOL exchange. I hate to say it but I don't see it getting any better at this point. Healing and adaptation can take time but 4 months is long enough. I personally think you need to get that IOL out of there. Yes it's true that they don't like to do that and it's a little more risky but it IS done all the time. The time to do that would be as soon as possible. The longer the IOL is in there the more it will adhere to the capsular bag which makes it harder to remove.

Please note! If they do the laser for PCO an IOL exchange will be almost impossible. Not completely impossible but significantly more difficult and risky. The number of surgeons that would attempt it would be few and far between. That procedure actually removes a portion of the back of the capsular bag. And I AM NOT a surgeon... I'm just some idiot on the internet... but I doubt the Yagg laser will help. If I were you I'd be pushing for an exchange / looking for another surgeon.

yes I agree, a lens exchange is a good idea. I think it's also important that she gets a prescription check. if it can be corrected with glasses and she's OK with that, she can avoid a lens exchange

and also agree that a YAG should be last resort at this point.

Should have been refracted at 6 weeks really. But if that hasn't been done yes that yes that's the first step. Won't help the dysphotopsias though.

kevin77191

Hi kevin, re the PCO, if i had that in only one eye would that cause the issues i have? When he mentioned the laser surgery it was like a muttered conversation with himself then answered his own question kind of thing!

davi98963

Eye opening comments and thanks for your input. I have two multifocal IOL's placed.

They actually said the healing and adaptation process could take months but they never said any specific time.

It's just like they keep wanting me to wait indefinitely and it was only in the last appointment that the surgeon basically said, listen - your complaints are textbook and caused by the lenses so you just need time to adapt. Given what you've said about the lenses adhering etc I'm wondering why they keep sort of fobbing me off.

I think the more I've learned about this topic and it's ups and downs, it's clear to me that i wasn't a suitable candidate for these lenses. My decision to have the lenses implanted was on the back of the excitement of getting better vision, being told i was unsuitable for laser surgery and also surgeon maybe assuming i had researched and as a consequence, failed to discuss other options.

From what I've read there are certain patient types who are physically and mentally unsuitable for these lenses, the latter being for example, the perfectionists, engineers and the like - I fit this category to a T.

My job involves working shifts and very often requires me to work in low light. I also drive both day and night and such, my distance vision requires to also be good. I never expected to be able to see 10 cm from my nose but I did want to be able to read my phone or do paperwork without spectacles. Albeit with several artifacts, I can do this now but i had no idea it would be at the expense of my distance vision ergo, my job, all driving and not being able to enjoy my hobbies. I've tried to read up on the different types of lenses and from what I've found, there are always dysphotopsias with multifocals so it appears I've no option other to have them removed?

You said in your post that i "should have been refracted 6 weeks ago". Can you explain what you meant by that?

I really appreciate your help and support 😉

Should have been refracted = gotten a glasses prescription for any residual refractive error. Glasses might improve your distance acuity. They won't help with the dysphotopsias though.

.

Yes the nature of diffractive lenses is that they cause halos and other visual effects. The intensity may vary from person to person depending on a host of factors (pupil size etc.) but everyone gets them to some degree. The idea is that eventually your brain learns to ignore them. That doesn't mean they go away. It just means that eventually you don't notice them as much. It's sort of like people who live beside a train and it drives them crazy at first but eventually they don't even hear it.

.

The problem is that perfectionist type-A people are not good at ignoring small details. In some cases these kinds of personalities never habituate / neuroadapt. You may still adapt to them if you give it more time. I have Tinnitus and I'm type-A and I thought it was the end of the world for the first 2 years. I was totally miserable! But then it started getting better and now, 25 years later it's like I don't even have it. I do though! If I listen to it it's just as bad as it was on day 1 (probably worse). But I just don't listen to it anymore.

.

That could be you with the halos as well. But on the other hand if you really do want to consider an IOL exchange you'd want to do that fairly soon. Surgeons don't like doing it beyond 6 months or so. And also any cataract surgeon will tell you never to put a multifocal in someone that does a lot of night driving for a living (like truck drivers). So it does sound like you might fit in that category and a monofocal would have been more suitable. And I guess wearing bifocals isn't the end of the world.

It’s tough to say about the PCO. You said you’ve had these issues with blurriness for a while so I’m not sure if it is PCO, and if the doctor said the laser probably wouldn’t change anything, that part is concerning. Leads me to believe that he knows the power of your IOL is off. So when you go get a prescription check, it will be interesting to see what it is.

You are most likely right that choosing a Panoptix was the wrong decision unfortunately based off many of the things you said, especially that you work a lot in low light which is not a strength of a multi-focal. As David mentioned, the artificats will most likely not get better though you may notice them less. With my multi-focal, they drive me nuts, which is why I went with a monofocal in my left eye.

So you really need to think hard if you want to get an IOL exchange. It's not an easy procedure and it will cost you $ to get it done. I don’t see your vision improving much since it’s already been 4 months. Yeah it could get a little bit better the artifacts won’t go away. So don’t wait too long if that’s the road you want to go down. Its also important to get your prescription checked and see if using glasses again could be a solution. And maybe see if you can get another surgeon to give you a second opinion. It’s tough, there’s no right or wrong decision, you know yourself best. Where abouts are you located?

davi98963

Thanks for that and no, there was no discussion until last visit about spectacles and even then that's after i said i was really unhappy again.

Re the halos and other dysphotopsias - I wasn't told about anything other than the "chance" of halos but reassured they would reduce over a short time - 2 months or so. The contrast was discussed as a passing issue but again, it wasn't made clear to what extent it would affect me.

Having said that, I have hoped things would improve but they haven't - not one bit to be honest and I simply can't afford to wait any longer as i no longer have a pay packet coming in and obviously the issue with the capsule adherence that I wasn't aware of is now in play.

I'm in the emergency services and therefore although I don't always drive, I would imagine most people - including surgeons - would have a fair idea that i do drive sometimes but am constantly surrounded by flashing lights and work in the evening in all weathers. I've not been out that much lately but I did see an ambulance passing by around a week ago...Looked like a Christmas tree or UFO on wheels - God only knows what an accident scene in the dark would be like!

I had multifocal glasses for years but always had issues with them at work - logistically a pain in the proverbial. I had considered laser etc for a number of years but with the advent of Covid, wearing glasses with PPE became more and more frustrating and on a few occasions even dangerous. It was barely tolerable during the summer but when moving towards winter it became intolerable and due to constant"steam ups" I thought now is the time to ditch the spectacles and went to see about laser!

I'ts clear the halo/starburst and glare issues I have, mean the multifocals need to be taken out but i'm hoping that I may be able to get some monofocals that will have no halos etc, give me ok (not perfect) arms length vision, and improve my distance significantly enough that I can drive safely at work....Or am I asking for too much?

kevin77191

Hi kevin, you said "With my multi-focal, they drive me nuts, which is why I went with a monofocal in my left eye"...Are you saying you "had" multifocals and bad halos etc in both eyes but are less now due to having a single lens exchange rather than both- Are you still seeing halos and starbursts etc - Did it help much?

I'm in the UK and the surgeon is NHS but with his own private clinic so i am a private patient. I paid for the ops from savings but I recall reading somewhere on the net, that they must allow you two years to resolve issues without paying extra. He did offer me a refund indirectly but I was told that accepting isn't a great idea because that absolves them of responsibility so it's a double edged sword as far as surgeons and second opinions go - Hence the visit to the optician. I guess I would have a claim for various reasons but I just want it fixed so i can get my life back...It's all a mess!

Good analogy with tinnitus. I developed that 2 years ago - drives me buts some days. Especially when it is quiet.

True with time you learn to live with it.

going down a legal route could be very long and pricey. Not always worth that (know from personal issue - not a medical one). Doctors and lawyers have deep pickets. If offered a refund maybe consider it and use that money for another surgeon to do an exchange.

Ed...,

I have a friend that has PanOptix and is less than pleased with them. She must be coming up to about 2 years with them and her biggest complaints about them have not improved -- halos at night making driving unsafe, and less than crisp closer vision in dim light. Her solution is not to drive at night, and she uses +1.75 readers for smaller text reading (even in brighter light). She is not frustrated to the point of having them removed though.

.

You asked about monofocal lenses as a solution.

"I'ts clear the halo/starburst and glare issues I have, mean the multifocals need to be taken out but i'm hoping that I may be able to get some monofocals that will have no halos etc, give me ok (not perfect) arms length vision, and improve my distance significantly enough that I can drive safely at work....Or am I asking for too much?"

.

I think one of the misunderstandings (including myself) about monofocals is that they only let you see at distance. I have one, and the overall range is actually from distance (infinity) down to about 1/2 meter. It is easy to read the dash instruments in a vehicle for example. It does jam out when you get closer than a half meter, and working on a computer screen and paperwork at the same time would be very difficult if not impossible. You are in that category of "my vision is perfect, but my arms are too short!". I have AcrySof from Alcon with a material similar to the PanOptix, and vision at distance is excellent. I have better than 20/20. No halos or flare issues with lights or at night. The standard approach with them in both eyes is reading glasses or progressives.

.

I have only had one eye done but will need the second eye done in the next couple of years. I am heading down the road of monovision as a solution to be essentially eyeglass free. That is when a monofocal is used in the second eye, but under corrected from about -0.75 D to as much as -2.0 D. The more common range however is -1.0 D to -1.5 D. Based on simulating that with a contact now, I probably will ask for -1.25 to 1.5 D. You are never going to get it exact.

.

Monovision does not give you perfect vision, but it is good useable vision with virtually no side issues. Reading glasses are needed for very small print especially in dimmer light, but that is about it. I have progressive glasses, but almost never wear them unless my contact eye gets irritated from the contact.

.

Monovision is an option that is not often considered, and those offering "premium" lenses are not really motivated to promote it as there is no premium price involved. It just uses bread and butter standard lenses with no extra cost. The only adjustment is the power used.

Hi RonAKA 😉

I'm sorry your friend is having difficulty and after two years 😦

Regrettably I need to be able to drive and all the other issues are driving me nuts but I'll certainly look into the monovision option more as having read a little about it, it appears to be more accepted by patients and has less fall-out after the implants.

Regards reading distance - My best near vision reading small text e.g. a letter, is between 6 and 20 inches - under and over that becomes increasingly out of focus. Beyond 4 ft is when the focus drops and life becomes hazy with less definition.

Am i correct in saying you have a multifocal in one eye with no halos or flare at al and

you're waiting to get a monofocal in the other?

Interesting to hear you comment that monovision is under considered as I've read that a few times today in literature from surgeons. Hopefully the optician will help me find a definite path to go down - I'm still trying to decide whether to go with this or another surgeon.

One other thing that popped up on the net was the use of eye drops (as and when required) to constrict your pupils to help nuero-adapt quicker. Although that sounds good, I've still got the other issues and now the clock's ticking as well! Thanks and I really appreciate your input 😉

Am i correct in saying you have a multifocal in one eye with no halos or flare at al and you're waiting to get a monofocal in the other?

.

Actually I have a Alcon AcrySof IQ monofocal lens set for distance in one eye, and the other is still waiting for cataract surgery. I am using a contact in that eye to simulate what it would be like if I get the power set for mini-monovision. I have considered using a Vivity EDOF in the second eye, but have cooled off on that idea, and am most likely now to go with another AcrySof IQ monofocal lens.

.

I have heard of some using drops to address some of the issues with IOLs. However it may be more effective in controlling the effects of dysphotopsia caused by a larger pupil size. Most older cataract patients have smaller than average pupils due to their age.

Hi

I'm 52 with no previous eye disease - Just needed multifocal spectacles for general vision deterioration. I actually remember my last visit to opticians maybe a year or so ago, that my eyes were actually quite good for my age...how ironic!

My average pupil size is between 4 or 5 mm so probably rules me out for drops then? Also if i may, was there any specific reason you chose the Alcon AcrySof IQ and why have you went off the Vivity?

5 mm is on the larger size for pupils as far as I know. 3 mm is on the smaller side. There are others here that have used drops, and they could speak to how helpful they are more than I could.

.

The AcrySof IQ has blue light filtering to simulate the natural lens. The Tecnis does not. But, all considered there is not much difference between the AcrySof and Tecnis.

.

The Vivity has some issues with contrast sensitivity especially in dimmer light. In a monovision configuration I concluded that the standard monofocal would likely give me better overall results. The Tecnis Eyhance is similar to the Vivity and seems to have less of an issue with contrast sensitivity.

ed, have you had your eyes dilated during an exam? i went for a second opinion following my first multifocal iol mishap. during the regular exam, nothing abnormal was really found, yag /lasik was suggested. i was expecting my original surgeon to double check the healing process by dilating the eye but he never did. the 2nd opinion dr discovered my lens was inserted incorrectly only after dilating my eyes. the lens was at a tilt (multifocals need to be spot on) with the haptic free floated out of the bag!!! an exchange was absolutely necessary

Hi julielyn

Thanks for your reply;)

I've had the dilation drops in only twice post-op and that includes my last visit.

Hopefully my optician - not the surgeon - will afford some guidance on how to go

forward with this. To be honest I'm rather nervous now about a second op and with luck i can avoid that and I'm also considering whether i should go for another surgeon/clinic as well! Because they've kept me hanging on for so long - to heal and adapt - I'm not far off from 4-5 months down the line now.

Re your eyes - Where you having the same issues; Why couldn't they just reposition the lens; and what was the remedy for your issues at the end up?

i ended up having the 3rd opinion do exchanges to a different lens alcon restor 3.0 multifocal one eye also received a toric. the original lens was not what i asked for, and the first surgeon wasnt experienced enough to perform an exchange correctly, he also gave me the same bs responses you are getting...oh give it 4 months--yea excuse me, im bumping into things here!!he tried to exchange to a different power and it was extremely painful with worse results( he couldnt get the iol back in the bag and never admitted to it, said surgery was a success HA!!) my exchange surgeon actually made the tool many drs use during exchange, so i know i was in good hands. dr shatz from sight trust in sawgrass fl, near ft lauderdale has an outstanding reputation and only uses the restor lens ( at least he did 2.5 years ago ) .

i believe you received the wrong lens for your desired outcome, or it is sitting at a tilt in your eye causing many problems.

are you using over the counter eye drops for dry eyes? i find that if i use the drops daily still, my vision does improve

** CAN MODS EXPLAIN WHY MY POST WAS DELETED PLEASE**

Hi Julielyn

As i said in my last post, it must have been terrible having to go through all that but I'm glad (i'm presuming) it worked out OK now?

Although told otherwise, I feel the op on my left eye was definitely problematic as i recall the procedure being longer and very uncomfortable. After that op i had a lot of eye ache and some bleeding in my eye - Lasted about a week and they said I had an infection. I had black marks in my vision and couldn't see letters and pictures properly. You mentioned my lens may be tilted - How would they check for that - Would an optician be able to see that or would that finding require more detailed testing? I tried eye drops now and again but as you've suggested it i'm putting them in am and pm daily so we'll see. I did mention a lad on yo tube that gave an account of 1-11 months post op multifocals. I added the link (maybe reason why post deleted?) but it was very helpful as it was a patients perspective.

Nice to hear from you Julelyn - hope all is still going well for you. after all you've been through sure hope so.

SueAn

For some reason links are not allowed here. You have to post a description of the article or youtube video name so that others can search for it with Google.

sounds like your left eye was a problem. were your cataracts highly developed? did you have previous eye surgery? also sounds like a retina tear if you were seeing black lines, or like a curtain.

i still see the edge of the iol, especially in my right eye, but this is usually in the morning while my eyes are still waking up. im sure my pupil is beyond the 6mm lens i have installed. this will go away as i age. my pupil will not expand as much

as for finding out if your iol is properly placed, you will need to be fully dilated. as i mentioned before, my 2nd opinion dr was all ready to perform YAG to "clear up" my vision, because i was complaining of the shadow effect, and everything being blurry. once i was fully dilated he did the "hmmm well, we cant do YAG, "and brought in a student/assistant to verify the problem. This was the first time he had seen a haptic free floating and occasionally rubbing against the iris. and also noted the tilt. in actuality, the lens was about 1/2 way out of the bag. this problem was not seen in the slit light, during a routine examination. this 2nd opinion dr wanted to wait 4 more months before performing an exchange. i was not thrilled with the lack of follow through, so sought out a 3rd opinion, who stated, lets get that out now before it causes more damage, and explained the exchange procedure thoroughly. and dr shatz said he has unfortunately seen and done several of these type of exchanges. my exchange took @ 20-25 minutes and i provided them with a thumb drive to record the procedure.

also, i can no longer use prednizone eye drops. and dr shatz team only used durozol as the steroid .

over the counter eye drops are my best friend. i do have surface floaters, and i know inhave some wrinkles and creases where the capsule has come in contact with the iol. i actually have a bubble in my right eye field of vision about the size of a pen head. its really only noticable when looking at an all white back drop

life is good, vision is good, i cant complain 😃

yes suean, my vision as best it can be. i dont know about you, but i can sometimes see the cells that have started to grow on my iol or capsule. i can see these when i have a droplet of water on my eyelashes and im out in the sunlight ( usually when floating around in the pool) i can see a halo effect of the concentric circles, and see floaters, or cells. i find it absolutely fascinating!! there are only a few, so it seems YAG will be a ways away 😃

That sounds very positive. I do not see signs of cell growth yet but do have an issue with my left eye. Thought it was pco but optometrist says it is epiretinal membrane. I see fine with both eyes open but with right eye closed lines appear curvy (windows, door frames. central vision not great - hard to read. She says unrelated to cataract surgery but I have read it can cause it but mine developed over a year after my surgeries. Need to see a specialist and I do have a referral but with covid things are slower than usual to see one. It appears surgery only solution and not done unless severe case of it. Wait and see I guess.

Glad to hear you are doing well.

Sue.An

Hi

No previous eye surgery and I didn't have cataracts. I wore multifocal glasses and as an emergency services worker I was having extreme difficulty wearing PPE whilst working with Covid patients etc. Ironically despite needing glasses for near/intermediate, my distance vision wasn't too bad and I was told at last check up about a year back my eyes were good for my age.

I see the IOL pretty much all the time - especially in the morning - I don't know if the optician will do the dilation but i can ask.

When I had the infection/inflammation post op it looked like dark smudges especially visible on light backgrounds and surfaces - Like small paw prints!

Also when looking at words was weird and the best analogy is the Everlast boxing logo - The letter sizes went from large to small then large again.

Did you have to pay for all your consults as I'm now well out of pocket as not working and paid for my ops with savings?

I think it sounds like you've been really lucky but only because you were persistent - I'm really glad it's worked out and your sight is safe.

My decision really boils down to a trade off between work and my life in the long term - Either glasses for near with monofocals to correct my intermediate and distance or keep the multifocals and have glasses to correct the blurry distance - The problem that backs me firmly into a corner is the Halos and Glare. Those affect my driving so significantly I wouldn't be able to do my job. From what I've read Halos etc may never go away and if they do it's usually in certain types of people and over the long term - up to two years with some. I think in the back of my mind maybe the decision is already made i.e. ?monofocals but I'm quite nervous about any prospect of having more surgery as it's obviously not without it's risks and I've lost some faith in the surgeon!

yes, everything became out of pocket well over $10k total, but so worth it in the end. at the time i had good health insurance, so seeing the specialists was a copay, but even an office visit would have been worth it. today i am self pay so theres that

can you see a retina specialist? , thats a but concerning to have contorted vision , perhaps your eye pressure was up, causing pressure on the iol itself

as for the floaters, they increase with dry eye. much like windshield wipers that have run out of fluid. my OTC drops are a lifeline and considering buying in bulk or investing stock !! ha 😃 during recovery immediately following surgery, dr shatz's team had me using drops every 2 hrs while awake

For what it is worth I did a bit of research into eye drops. Hylo seems to be the optometrist recommended product and quite expensive. It has 1 mg/ml of Sodium Hyaluronate, which seems to be the "blessed" active ingredient. That is 0.1%. I found another product available at our Costco in Canada at a more reasonable price. It is Hydrasense Advanced and contains 0.15% Sodium Hyaluronate, or 50% more. I use it occasionally for both my IOL eye, and also for the non operated eye in which I wear a contact. Seems to work well when I need it, but that is not very often. My wife goes through it much faster and has used up 3 vials while I have not even used up a half of one.

So I thought I'd post an update.

Visited optician who advised my eye and lens health is good. I got a tiny prescription for spectacles that gives a tiny bit more focus to help with the intermediate and distance haziness or as I've found out - the "vaseline" eye!

Another visit to the surgeon also showed the same results with my eye tests and he wants me to try the spectacles over next 2-3- weeks. He said he wants to try everything before deciding to replace the multifocals with monofocals.

He advised YAG could come later if required but only after firm decisions are made on retaining or removing the lenses. I told him I wanted the multifocals replaced and he has reluctantly accepted that. I also said that even though the glasses may help my distance a little, they would not alter the fact that I have halos, glare, ghosting issues etc and he advised the spectacles might reduce some of that, making them tolerable.

There was a brief discussion about Monovision, The surgeon said that as this would be a second operation, monovision was not an option and when asked about lens makes e.g. Tecnis Eyhance, he confirmed he only works with Alcon type lenses.

I asked if the monofocals would remove my issues with halos etc and he basically said yes mostly but when i asked him about improvement with distance, he said just now i am four lines above driving standard and with monofocals, i will be significantly worse off. He did say he could give me great distance vision later with YAG but stressed I would need spectacles permanently for anything other than distance.

I questioned this and he said as he has already operated, he has no way of knowing what the outcome of a second op would be and such, couldn't promise anything and said he would get me to sign a form accepting i might have to wear glasses for "everything" after the monofocals go in! Opinions..?

Seems strange that they would say they can't do monovision because it is an explant and second operation. Monovision is quite simple. The eye intended for nearer vision just gets a standard monofocal lens but with the power selected to leave you somewhat under corrected (-1.25 D or so) for distance. That eye will not be sharp at distance, but the other eye which is not under corrected should be sharp at distance.

.

I have progressive glasses and with both eyes corrected for distance near and for astigmatism my vision is the best. However, with no eyeglasses and my near eye under corrected by 01.25 I have quite useable vision at all distances. My brain is switching eyes to see the best image to do it of course.

.

Perhaps because you have had issues with the PanOptix they are thinking you are just not a candidate for monovision. And, also with those lenses in it may not be possible to simulate it with a contact before it is done.

.

Explants are not that simple and there are specialists that do it. You may be well advised to find one that is experienced. It would seem best to do the distance dominant eye first fully corrected for distance, then wait 6 weeks or so before considering the second eye. If the first eye goes well and you vision is sharp at distance then I can't see why they couldn't do the same for the other eye but select the suitable power for monovision.

Hi RonAKA

I think the reluctance to try Monovision is based on me as an unhappy patient. Further to that, it is true what you say about not being able to do a trial contact as before doing any implant, the surgeon said he would normally trial with contacts first in order to assess adaptation - He's simply not willing to try in case of a poor outcome or I don't like them and was very to the point about that .

The doctor is a NHS surgeon who also runs his own private clinic. He advised that he had extracted several lenses but from other peoples patients and not his and appears confident in his capability. Following my trial of spectacles for distance, a further discussion will be held regards how to go forward and how the operation should be handled e.g., general or local anaesthetic etc. Nothing more has been discussed yet.

I have pretty much rationalized my plan to go with monovision based on having a backup plan B. Because I have simulated it with a contact I am pretty confident what I will get and am prepared for it. I know that it is not perfect vision. While my IOL distance eye is essentially perfect, I will not have that kind of vision with my second eye for distance. It will be compromised in that I will not have binocular perfect distance vision. My backup plan is to wear progressive glasses. With a plain monofocal lens in my nearer eye it will only be off perfect distance vision by -1.25 D. That is quite a minor distance correction in a progressive lens. I have never had progressive eyeglasses so thin and light as I have now as one eye has zero correction for distance. With monovision the other eye lens will be even thinner and lighter.

.

This said based on my monovision simulation I expect to be eyeglass free nearly all the time.

Everyone wants good near and distance vision (and I'm no different) but compared to when I wore varifocals compared to my vision now I feel as I've lost out. I actually feel kind of trapped in these lenses and the penance I paid for good near vision was too great. I believe that my definition of near vision and that of the surgeon's was very different - To me "near" vision was looking at a phone or using a PC whereas I realise now that is actually "intermediate" vision - another thing not explained to me! In reality, I never actually wanted "near" vision - just glasses free intermediate and distance vision and I would have been happy just to need glasses for near.

Edo0812 I cannot help but think surgeries done on NHS are for most part cataract surgeries under UK medical care exclusively monofocal lenses. Although they may do the occasional explant for patients that got premium lenses privately and unhappy with them NHS would not do many of them.

Is there not a consult you could get with a specialist who does mainly complicated surgeries and exchanges? I would really recommend you see one of those surgeons before making the decision.

Hi Sue.An2 😉

The only resource I cam access is other private clinics - maybe a free consultation but beyond that (and financially) I've have few other options.

What you said is exactly true in that the surgeon said he has explanted patients from "other" practices but not his - I don't know how many though. If I did speak to someone else what would I say...With my issues wouldn't they just say yeah they need replaced or are you worried he's not qualified enough?

Yes I would have concerns about how many of these exchanges he or she does in a year. This surgery requires more skill than cataract surgery. I know from my family in UK NHS does cataract surgeries that are covered under their medical care and they only do monofocal lenses.

If for no other reason than to get information can you research surgeons that specialize in IOL exchanges and get a consult even if to get another expert opinion on whether there is an issues with your current lenses and their recommendation on what's to be done?

If the NHS surgeon only does a few of these surgeries a year I would have concerns.