Flickering light after cataract surgery

I think you are right steve24102.  Most of these types of issues result from over correction or under correction and not the lenses themselves ( monofocals and premium).

Do you think flickering is related more to some corneal abnormality (high order aberrations) than intraocular lens?

I'm almost certain the flickering was from the IOL. As I mentioned in this thread, having a piggyback lens installed just about eliminated the flickering, but at the "expense" of making nighttime halos, rays, starbursts etc even worse.

Hi peter, thanks for your precious contribution! This is what happens to my eye: I have two different iol: acrylic in one eye, silicone in the other eye, both bloody squared, sharp edges: one has the edge frosted, the one does not, so during the night I can see matt glare/circles/arcs in one eye (the frosted acrylic edge) and shiny in the other (not frosted silicone edge).

Night dysphotopsia are perceived from different angles, for example, one eye sees arcs and circles at some specific angle while the other does not. Left eye has a strong glare with the light from below, the right one from above left. So for each eye the dysphotopsia angle is different, but both always from the side! Frontal light does not cause that specific dysphotopsia. Frontal photic phenomena are halos around light and starburst (and I do believe they are connected with corneal issues, because I had them even before with my natural lens).

THE FLICKERING MATTER: when a strong straylight hits my eye from the side (shop ceiling reflectors, strong daily light coming from the window in dark room etc), some part (the edge?) of the iol gets illuminated and eye movement makes that light flickering. It's not the light itself that flickers but the eye movement (called 'saccades') causes the light to "flicker". If the light is VERY STRONG, I can perceive the strobe-effect just inside the eye and it's very annoying, when the light is less strong, I can see only the light flickering around the light source.

I have iridodonesis too (wobbling of the iris) but I'm not sure if this is the cause of the flickering.

Sorry if I wrote s much but I had to explain well the problem, because even doctors don't understand what this phenomena is. Making the pupil small does not help, because some light still enters the eye and makes that "part of the iol" shining. Wearing sunglasses reduces the light entering and makes the flickering disappears. So it's OBVIOUSLY something that shines on the lens.

One question, Peter: when you have a very strong light around you, do you see the flickering or it's completely gone?

Second question: do you have a Sulcoflex lens implanted as piggyback?

"Making the pupil small does not help, because some light still enters the eye and makes that "part of the iol" shining."

I tried pupil restricting drops and they did markedly reduce the rays, halos and starbursts etc, but they also (not surprisingly) reduced my night vision. And since they only help at night, I decided not to bother with them. However, the fact that they worked (for me) seems to confirm the theory that the halos etc, are caused by the IOL being too small a diameter, so that when the pupil is wide open, light hits the edges of the lens (maybe goes around and behind the lens?) causing the problems.

"One question, Peter: when you have a very strong light around you, do you see the flickering or it's completely gone?"

It's almost completely gone and I would say is no longer a significant issue.

"Second question: do you have a Sulcoflex lens implanted as piggyback?"

Sorry (and I feel like I slipped up here), but I can't find any record of the type of lens used for the piggyback. I don't recall their being various options the way they were available for the original IOL.

Thanks! How old are you peter? And what is the first lens used in your eye, do you know?

I'm 76. Had the surgery done on my left eye 4 years ago using a Trulign IOL. Been holding off ever since on doing the right eye in view of what happened with the left. Afraid I may have to bite the bullet and have the right done in 2019 and will most likely have them use a monofocal lens.

Am 40. At 76 years your pupil should be smaller than mine. When I use brimonidine (alphagan), which reduces pupil only 1 millimeter (from 5 to 4, for ex.), I have a very visible reduction of halos and starburst and I don't see arcs and circles anymore. They all occurs only with very low lighting. The flickering though remains the same and it's the most bothersome just in bright lighting (outside, during the night I don't see flickering at all or very mild). So this bloody flickering is not a "typical" dysphotopsia, but it occurs only with side lighting so it's still a dysphotopsia. A surgeon suggested that it's a sort of negative dysphotopsia ... It could be, but I don't see and have never seen any dark crescent or anything like this ever.

I'm really wondering what causes this flickering, if it's really a sort of edge-glare+eye-moment or it's something different. And why a piggyback lens would reduce the flickering? What do you think?

Few months ago I had implanted a piggyback dark lens in the sulcus and the flicker indeed stopped but I had it removed after a while because the very dark sensation in the eye (almost impossible to see at night outside). If you type "xtrafocus iol" on google you will see what it's about. This is another proof that a piggyback iol in the sulcus stops the flickering but in this case is was a normal lens but a totally black one, so am not sure the flickering stopped because 1) reduced corneal aberration 2) less light went in the eye 3) the iol masked my wobbling iris 4) piggyback rounded edge absorbed aberrant side rays 5) the piggyback filled the space between the iris and the iol

Could you find out what lens was used for you as piggyback? is that possible?

Check on google, there is a pdf with the title "Management of positive dysphotopsia

in a patient with prior refractive surgery" (sorry, if I copy the link here they will remove my post).

It's about a woman who had laser surgery years before the cataract and after the cataract operation she had this light steaks and flickering from the side. The doctor put a piggyback iol in the sulcus and the flickering stopped.

I am 43 and I experience flickering occasionally in low light conditions but not as bad as you are experiencing. For me it almost feels like light traveling across the lens.

But Alphagan or even Lumify takes it out completely along with the edge glare. Also I feel that Alphagan reduces the pupil by 3mm as my pupils become tiny dots.

The halos and concentric circles remain but they don't hinder nighttime vision. I am going to start using Alphagan Z which is 0.1% Brominidine Tartrate and without the BAK instead of Lumify which is only 0.025%.

As far as I can determine nobody knows what causes the flickering. And don't think anyone knows why the piggyback helps. The doctor that did my piggyback was not very optimistic that the piggyback would stop the flickering, thought it more likely it would help the halos, starbursts etc. So what happened, it really helped with the flickering, but made the other stuff worse.

The piggyback that was used on me as far as I know was clear and had no prescription.

I've moved 1200 miles away from the doctor that did the operation, but will attempt to find out the specifics of the lens he used.

Side light rays that enter this lens, are directed more anteriorly by the piggyback iol, and so they miss the functioning nasal retina.

peter, may I know a bit more about your light flickering, now solved? in what light condition did happen? when was stronger and weaker? please describe a bit. I wish to know if it's the same one I experience with my two iols. thanks

It was most noticeable in relatively dim conditions when there was a bright light source from the side, like a window.

If you not already done so, I suggest you look at this now very long thread from its beginning to get my input, then in "real time", as well as the input from others with the problem.

adlibi that would not be uncommon for someone who had prior lasik surgery. most people I know say they experience much more glare and halo at night after having laser vision correcting surgery but they were pleased to be rid if their glasses. one of the reasons I believe that surgery is done on both eyes so that patient doesn't have time to compare vision between their eyes. That procedure also makes power calculation difficult when it comes to cataract surgery. It is very hard for surgeons to predict who will experience ND. A lot with time see that diminish.

Thanks Peter! I have the worst flickering on the side and above: most of lighting is that angles, the windows and the ceiling lighting. Did you see flickering with ceiling reflectors too?

As someone said, it's not the light flickering, it's the eye movements that makes the light flickering.