Drawings of my positive dysphotopsia with Tecnis ZKB00

Thanks for the update! Sorry I havent been on here much so just noticed it now.

What was your prescription when you went to the optician? Do the glasses help at all?

I have a monofocal that was set for distance, my distance prescription is -.5 (which is nothing and my distance vision is really good), I can see my computer screen without glasses (though I do have a pair for computer if I'm on it for a long time which are +.5) so i'm getting intermediate as well, I need glasses for close up stuff though which is +1.50. So in my example they didnt hit the distance target 100% but it's actually fine with me because I like the benefits of having some intermediate vision. It's a bit odd that hes saying you will need glasses for everything if they put a monofocal in. That should not be true.

Now there are cases where monofocals can give you some issues. With mine, i'm experiencing some glare in my peripheral but I think it might be from my eyelids, but if you read through here you will see there are some people that have negative side effects from monofocals. I'm just saying this because I want you to have realistic expectations. Not to say that you will experience them but they are possible.

Have you tried to book a second opinion from another surgeon?

Hi 😉

Thanks again for replying and thanks to Sueann as well all the others - All of you have been so supportive.

My prescription from the optician was lots of numbers I don't understand:

Vision (R) 6/7.5 (L) 6/7.5-2 and VA R 6/6-1 L 6/6-2

Also (R) 00.50 00.50 055 and 00.50 00.50 055 and

(L) 00.25 00 25 055 with 00.75 00 25055

Wearing the glasses is better and worse!

The positive is that edges are more defined or crisp.

The negative however is that I see reflections in both lenses from light sources and how bad is dependant on light and worse at night.

Wearing them doesn't really change much regards Dysphptopsias except the halo shape. With that, my left eye (glasses on/off) remains the same but with my RIGHT eye, the Halo is more defined at the actual light source i.e. street light.

The halo rings are also more round rather than being slightly "off" round and I noticed that the halos had tiny double crosses "x" diagonally beside them - These were more noticeable in my Right eye.

Definition or crispness from the glasses appears to be light dependant with more light giving better definition (obvious ghosting) but with too much light, the crispness or definition reduces and the ghosting becomes even more apparent.

I still have the "silvery shimmer" on edges and haziness is same - Feels like I'm looking through a window (but with better definition). So basically - distance glasses appear to be out.

I've pretty much decided mow that nothing can be done and I'll need to have the Multi-focals removed and Mono-focals implanted. I'll have to just surrender what reasonable near vision I have gained in order to get rid of all the artifacts and get my distance vision sorted out. I'm assuming he can do the YAG after the Mono-focals go in and get my distance vision better.

I'll need to find out first what lenses he will use as all I know is that they are the Alcon make. I also have these questions too:

Will exchange remove light sensitivity?

Will exchange completely remove Halos, Glare, Ghosting, Rims and Shimmering.

Will I be able to see my PC monitor clearly - 60-70cm distance?

Will I be able to see my TV clearly - 4 metres away?

Will I be able to see detail in scenery - as now with distance glasses

As i said before financially I'm now at a loss so I'm staying with the same surgeon - the optician advised this as well - but in general, I can't really see any other way forward with this... :_(

I haven't had surgery yet but based on my research I would say:

• Light sensitivity is not IOL dependant but rather is a common side effect that goes away over time
• Any IOL can have Halos, Glare, Ghosting but the incidence of these phenomenon with mono-focal IOLs is very low
• Shimmer is again (I believe) not IOL dependant but rather is a common side effect that goes away over time (has to do with the healing process)
• 66cm distance (-1.5D defocus) results will vary. You MAY get usable (or even decent) vision at that distance with a mono-focal but patient result vary greatly based on your own eyes and on how close you hit the targetted refraction. If you end up a little under-corrected that distance may be quite good. If they nail 20/20 distance perfectly it might not be as good. The best bet if you want a very safe lens (i.e. very low risk of visual side-effects like halo and glare) but some amount of intermediate vision would be the J&J Tecnis Eyhance Mono-focal IOL, If they say they are going to use an Alcon IOL I would assume they mean the Acrysof IQ Mono-focal or maybe the new Clareon Mono-focal. With those IOLs they cannot promise you usable vision within 3 feet but again you may get lucky. My Dad has mono-focal IOLs and can read food ingredient labels! But maybe 10% of people that get that good a result with a mono-focal. I'd say with a standard Mono-focal you have maybe a 50/50 chance of not needing glasses for the computer. With Eyhance that might be an 80% chance. With Vivity that might be a 93% chance. Although given the issues you've had I would not recommend Vivity and I'm sure your surgeon's would not either. With an exchange they want to go a risk-free as possible of course! They might be willing to do Eyhance thought as it is classified as a Mono-focal and has virtually the same contrast, distance quality and halo incidence of a standard Mono-focal in clinical trials.
• TV, distance and scenery should all be amazing with a Mono-focal. That's kind of the whole point of a Mono-focal. You give up some quantity of vision (i.e. focus depth) in exchange for the best possible quality of vision (from maybe 3+ feet to infinity assuming you set them for distance)

Hi david and thanks for your great reply.

Both my eye ops were in December 2020. I've noticed that my eyes have become a bit more sensitive to light in the last week or so - Whether that's an influence of the glasses I'm not sure but I have a row of white houses across from me and it's like snow blindness when the sun hits!

With respect to the Vivity I found more negatives with that but the Eyhance was the lens I landed on after some research and my decision was ultimately based on opinions of both patients and surgeons themselves.

Unfortunately, my surgeon excluded the Tecnis off the bat because he had a "bad experience" with Symfony and likes the Alcon make better!

To be honest I was really disappointed as I thought if I was happy with that he'd have went for it and with the slight potential of better intermediate it was a no-brainer.

I'm going to call them tomorrow to find out exactly what lenses he'll use so I can look them up.

Although my near vision is good it is far from faultless as I have several things wrong with it. I think I mentioned previously that I misunderstood the difference of Near and intermediate vision.

For me, if I can see my watch, my PC and my Iphone from at least arms length that would be fine. As it stand I can see tiny details with things from a few cm's away but

I don't really need that - That's were I think the surgeon mistook "my" meaning of wanting better "near" vision.

With my job wearing reading glasses will be a pain but before I wore varifocals constantly so best case post op, is glasses but only some of the time. I wear a lot of PPE and often in strenuous scenarios - one of the reasons for the procedures to begin with. Having the luxury of not wearing glasses all the time sounds like heaven now and I'm not always going to be working either and that's were my hobbies come into play. I love Astronomy and Space as well as movies - including UHD and 4k for my projector and screen. I also drive at work too and as said, love scenery, so you can understand why the distance is more important in both the short and long term.

I was hoping the glasses may have helped give me some "mental respite" but for the most part they made things worse and I'm wondering what the surgeon's reasoning was behind getting me to try distance glasses for another month!

UPDATE: I opted for explant of the MIOL's and my experience to date has been terrible with my vision driving me nuts.

I had panoptix iols implanted around 18 months back and and since the explant (and monofocal implant), have had nothing but grief. The explants were done almost a year after the initial implant. Since then, I've had retinal swelling 4 times, constant headaches and my general quality of vision is way short of what it should be. of course, I keep hearing the "numbers are great". I've had YAG and several other laser treatments to remedy the complications of the explants which made some issues worse.

The explant operation apparently was "perfect" until a week after when i started having worse issues. The surgeon then advised me that he had to site a Capsular Tension Ring!!! Another few weeks down the line and after some laser, I was told that the op had a complication in that some jel (vitreous humour?) had leaked from my eye and a thread of it was adhering to the lense.

I was told I had two options - further laser to dissolve it or surgery to cut it.

The main issue this seemed to cause was a sort of double vision with ghosting - worse at night but slightly visible during the day e.g. I see a street light then another fragmented image beside it.

I opted for laser and after 3 sessions it was looking good, however post session four, The issue was far worse - I now had a sort of triple vision with the light scatter far worse. My reading acuity is not as good either. I didn't notice right away, but my pupil is oddly shaped and not round now. The surgeon said that my iris was damaged in the operation which was something they also failed to advise me of. Further and to my anger, even although we BOTH agreed and after I specifically asked the surgeon to favour distance vision monofocals for my exchange he went an implanted my right side with a close vision one. The result is now that I have a permanent "haze" in my right vision which is REALLY annoying.

As usual, I went through the routine, drops for this and that for four weeks and nothing has changed. My last conversation with the surgeon revealed he was refusing to do anymore surgery, had no idea what was causing the transient swelling and that in his opinion, the last laser had no complications and he saw no reason why this could cause additional vision issues.

So despite being told my vision is 20/20 and I have no issues with my eyes (except of course the vitreous thread adhering to the lens), now I'm on drops to reduce the size of the pupil at night.

I've noted that when I take the drops, my affected pupil doesn't constrict fully as it should and to date, 2/7 in, there's not much noticeable difference. I'm back in a few weeks but the surgeons general attitude now is there's nothing he can do and I'm stuck with it.

So I still have light sensitivity - My affected eye is very "white" tinge and my right is more warmer white tinge. I have "unequal vision" due to the monovision, I have transient floaters, Head(eye)aches are less but transient, ghosting with text and objects at night, starbursts and light scatter in both eyes but worse in right (affected eye). It's kind of like having the MIOL's in but not quite as bad in some ways and worse in others.

Any opinions would be great 😃

sorry you are having to go through this. why did vitreous leak if your capsule was intact at explant?

how old are you? does the pupil constriction not help with dysphotopsia?

Hi...late 50's and surgery was elective - wore glasses since late twenties.

Ironically, my pupil doesn't fully constrict as the iris was damaged during the second surgery (explant) so even with drops it makes little difference to dysphotopsia. In respect of the vitreous leak that happened also at the second surgery. That surgery was about 9 months after initial implant.

A capsular tension ring was also implanted at the same time. The surgeon said the vitreous thread was adhering to my lens causing tension and increasing the dysphotopsia and such used several laser treatments to reduce/rectify it. The first 3 helped a little and the last one made it a lot worse!