Have Not Heard of This After Cataract Surgery - Help Please

Thanks for the info. I am in Canada and you have to be referred to an Ophthalmologist and usually have to wait a year or more for the first visit. A lot of Ophthalmologists do the follows up with their patients after cataract surgery, however, I was referred to a very busy one and he has an optometrist who does the follow up unless there is a problem.

I have been doing a lot of reading and I think I will go see my own optometrist and see if he can give me some answers.

I am in Canada and with my first eye, the surgeon did the preop, the surgery, and the 24 hour check up himself. The 3 week and 6 week check were done by my regular optometrist. On the second eye, the surgeon had opened his own clinic, and was using another clinic for the surgery. He did the preop at his clinic, the other private clinic for the surgery, and the 24 hour check in his clinic, and also the 3 week check in his clinic. The 6 week was back with my regular optometrist.

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I kind of think the change was that he is now trying to do more in his own clinic to pay the expenses. He has an office and staff to pay with the new business model.

When my husband had cataract surgery 5 years ago, his doctor did everything too. My doctor has 2 surgical rooms at his office and does the majority of his surgeries there. I got to see him for 1 pre op appt and then the surgery. He will also be the one doing the YAG if I decide to go with it. He is very good, but very busy.

Thanks for always taking the time to answer my questions. You have given me a lot of valuable information and made the decisions I had to make about which lens to get easier because of all the information I had. Without this forum I would have never known about plano and the first minus or defocus curves.

I think, but it is just a guess, that your issue may be caused by the haptics which are the bent legs that stick out from the lens causing a wrinkle in the capsule. I would think the surgeon would do what they can to wiggle the lens around in the capsule and ensure the legs are relaxed and the lens is well centered at the end of surgery and the capsule is stretched without wrinkles. Perhaps in some cases this is not possible.

I read that sometimes the posterior capsule is smaller than the lens being put in, so that can cause these folds. When I had my right eye done, my eye wasn't as frozen as the left eye. Near the end of the surgery I could feel an instrument going around and around in my eye. I assume it was the doctor cleaning the posterior capsule and perhaps smoothing it out. My surgeon is apparently one of the best in my province, so really hoping this outcome wasn't preventable. Since I have it in both eyes I am thinking it might be the size of the posterior capsule. I can't see anything on my IOL Calculation sheet that tells me the size of the posterior capsule.

I am not sure capsule size is measured during the preop. I think the theory is that the haptics allow for a wide range of sizes. However, there are different styles of haptics, and perhaps one type may have an advantage over the other with a smaller capsule.

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My family doctor was told that a "quick" way into seeing a specialist such as an ophthalmologist, was to go into the emergency ward at a hospital where one was on call at, and then you would get fast tracked into seeing them. She did this when the retina in one of my eyes tried to detach while I lived in Toronto, and I actually did get a follow up appointment with him only two weeks after he saw me in the emerg department.

I have been doing a lot of reading on how this can happen. Apparently there are 2 kinds of PCO, pearl and fibrous. Fibrous is the folds or wrinkles, which is what I have. People can have a combination of both apparently. If I am understanding what I am reading correctly, in some people their healing cells go haywire and "undergo metaplasia and conversion into myofibroblasts" which can lead to fibrous tissue or scar tissue. This haywire approach would also include contracting of the posterior capsule faster than normal, which would add to the wrinkling or folding. Apparently this can start to happen as early as the day of surgery. I have put this together from many different articles, so I hope I am understanding it correctly. It makes sense if you look at it that some people scar easier than others.

I know the optometrist said I was a fast healer when I saw her 4 days after surgery. A person thinks being a fast healer is a positive, but I guess not in this case.

Did you get toric lenses? I have forgotten. With toric lenses the surgeon has less flexibility in how the lens is put in the eye. They have to exactly line up the toric correction in the lens to the required angular position in the eye. In a non toric they can rotate the lens as required to make the lens fit as best as possible without regard for angular position. They could use the haptics to stretch out any folds in the capsule that they can see.

I don't have a toric. I don't think it has anything to do with the haptics, I think it all has to do with how my body heals. From all the reading I have done my cells go into overdrive to heal and create lots of fibrous tissue and cause the posterior capsule to shrink and contract faster than normal which causes the folds or wrinkles. I am just hoping it hasn't caused the IOL to shift.

Interesting. Is there any way to try to mitigate this I wonder? I got CME (also kind of an overreaction) and also a small wrinkle from my first surgery. I wonder if maybe starting steroid drops BEFORE surgery would help my second eye heal better.

I couldn't find anything, other than how the surgery is done, that would help prevent this. I did find an article or 2 that indicated sometimes wrinkles can be caused by the size of your posterior capsule being smaller than the IOL, not by this fibrous tissue. You say you have a small wrinkle, so I wonder if this is what caused your wrinkle and not PCO. Not sure if they can tell by just looking at it. Not sure if using the steroid drops prior to surgery would make a difference. Good question for your surgeon.

I did come across some articles that said this fibrous tissue can cause your IOL to shift or tilt and because I have numerous folds and wrinkles in my right eye according to the doctor I am a bit concerned about that. I also read the lower the setting they use on the YAG the better and from what I understand this fibrous tissue can just get thicker with time. I would assume the thicker the PCO the stronger the setting would have to be on the YAG.

I came across one study that called it striae (not sure if that is the same as folds) and the study found that for people who only have one or 2 striae it usually goes away on its own by about 5 months. That doesn't appear to be the same for people who have 3 or more (Postoperative posterior capsular striae and the posterior capsular opacification in patients implanted with two types of intraocular lens material).

I am going to make an appointment with my own optometrist and see if he can give me answers. I will see if he can scan my eyes so I can see these folds.

I think that is a good idea to get another independent opinion.

I was told that a YAG treatment was also suggested (and preferred) when the cornea of the person was too thin to take the risk of using a regular laser treatment. Highly myopic people usually have thin corneas which is why if your prescription is higher than something like -5.0, they won't take the risk of trying to correct your vision using a laser. From what I have read, it is usually safer than a regular laser treatment.

Went to my optometrist today to get his opinion on this PCO I have. He confirmed I definitely have it and said he would normally send a person to see an ophthalmologist if they had that much. He gave me a quick eye test and said I was 20/40 in both eyes. I was 20/20 a week after surgery in both eyes. He said he could give me prescription glasses to give me 20/20 vision. This has me trying to figure out if my vision will go back to 20/20 after the YAG or stay at 20/40. I thought with PCO your vision couldn't be corrected with prescription glasses. I know when a person is developing cataracts, changing your prescription glasses can help give you clearer vision until the cataracts have developed to a certain stage. I am wondering if this is the same with PCO.

In your original post you wrote: "I had Tecnis 1 in both eyes, LE -0.1 and RE -0.55." Did your optometrist give you your current refraction values to see how much they have changed? I didn't think PCO changes the refraction. It is supposed to look like a cataract with fuzzy vision, and I would not expect a change in prescription to change that as the fuzzy vision is coming from the capsule, not the lens.

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I saw my optometrist for an annual check a couple of weeks ago and he tells me that I have PCO developing in my left eye, but I don't see anything. Interestingly this is my second lens which has been in my eye about 14 months now. He says my other eye which was done about 2.5 years ago is fine. And, this second lens is a Clareon which is supposed to have more resistance to PCO. I guess you never know. I have to think something was not done as well on the second lens. Cleaning or polishing is one of the things they should do during the cataract surgery to prevent PCO.

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In any case I said I would discuss it with an ophthalmologist that I have an appointment with in October. He is a laser specialist and hopefully will give me a good second opinion. Since I am having no optical issues, I am hesitant to rush into it.

You are correct, those were the targets for my LE and RE. I was very surprised at the 20/40. It just didn't make sense to me. I have read a couple of studies about the lens shifting because of these fibrosis folds and one said "fibrotic changes may also have a mechanical effect on intraocular lens (IOL) position such as axial shift, decentration, tilt and capsule striae". I am wondering if this has happened to me. The studies seemed to indicate once YAG is performed the lens does shift back, perhaps not completely, but it does shift again.

I forgot to ask for the prescription because I was thinking I wasn't going to get glasses right now. I forgot it would help me figure out what the refraction was. I will call them tomorrow and go and get it. Can you explain to me how I figure out what target the surgeon hit using the prescription please.

My husband had the Alcon Acrysof in both eyes 5 years ago and so far he has had no PCO problems.

Did you get refraction done at any point after the surgery? Those would be useful to compare to. The target is not all that useful as a comparison as a target is just that, a target. You need the refraction done to find out where the eye actually landed.

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If you have no astigmatism (cylinder) where you landed is simple. It is just the sphere value in diopters from your prescription. If you have astigmatism then you add 50% of the cylinder diopter to the sphere diopter to get the spherical equivalent (SE). An example:

Sphere: -0.25 D

Cylinder: -0.50 D

SE = -0.25 + (-0.5)/2 = -0.5 D SE

And if there is no cylinder it is just -0.25 D

This is the first refraction I have had since surgery. I got my prescription from yesterday:

RE: Sphere -0.5 Cylinder: -0.5

LE: Sphere +0.25 Cylinder: -0.75

If my math skills are working RE is -0.75 and LE is -0.125. I think that is bang on for what he was targeting. His target was RE -0.55 and LE -0.1. I guess this means the reason my vision has deteriorated is because of the PCO. Not happy about needing a YAG this soon after surgery, but not much I can do about it.

I am so glad I went and got the prescription and figured this out. This makes me feel so much better. Of course I have you to thank for this knowledge. I would not have had a clue you could figure this out if I had not read some of your posts. I am so glad I found this forum and there are so many people like you willing to help other people going through their cataract journey.

Your math skills look good. That is also a very accurate outcome compared to what was predicted. In hindsight your left eye potentially could have benefited from a toric lens. The sphere power would probably go up by 0.5 D with the Cylinder at 1.0 D. However, the Tecnis 1 lenses do not appear to be available with a cylinder power of 1.0 D. The minimum is 1.5 D, and that would have been too much. So within the Tecnis model line the correct lenses were selected if the objective was to get a very mild monovision with the right eye being the close eye. One of the issues with astigmatism is predicting what the impact of the cataract incision will have on how much there will be. The surgeon may have gotten more than expected.

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I also am troubled about whether to do YAG or not, but I've procrastinated to October when I get a second opinion. And it is not really affecting my vision (yet). If it is affecting your vision, and it seems it must as your refraction seems to be what it was intended to be, then it probably makes sense to go ahead with the YAG. I think I would hold off on getting updated eyeglasses until after the YAG, just in case it changes things.

With the PCO in my right eye it is like someone has taken a greasy finger and smeared it across my eye. I am starting to get that in my left eye now too. I get a lot of flashing in both eyes every day, which could be caused from the folds. Some days light really bothers me, especially going into stores with bright lights. I have read that one of the first things a person notices with PCO is they can't see words clearly. Not being able to read street signs anymore was the first thing I noticed. I then noticed I couldn't read words on the tv anymore either. If I wasn't bothered by the PCO, I wouldn't get a YAG done. If it is not bothering you, and you have another appointment in October it was probably a good choice to wait. Unfortunately, they can't tell you how fast these things progress, so that can make the decision of when to get a YAG harder.

I have a hard time seeing the effects of the PCO due to the biggest issue I have now in both eyes which is PVD. PVD is like wearing glasses and having a small bug dashing around on the lens of your eyeglasses. I got it in my first eye (right) about 10 months after cataract surgery which is nearly 2 years ago now. It has faded quite a bit but I can still see it. My second eye is much more recent and it appeared about 13 months after surgery, or about a month ago now. It is quite distinct. This is the eye the optometrist says has the PCO, but I don't really see it. If the PVD was out of the way I might see it.

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With respect to the flashing, it has accompanied both PVD events. I have had theories that the flashing was reflections off the edge of the IOL, but I have abandoned that theory. I think it is the PVD progressing. Apparently when the membrane pulls away it is perceived as light and shows as a flash. Now in particular with the most recent one I can cause the flashes easily. It is much easier to see them when in a dark room at night. I can see them with or without my eyes open. This is what has convinced me that the flashes are not real light reflecting off the lens, but are just perceived as light. All I have to do is move my head left and right or look left and right with my eyes. I think the movement causes the membrane to move or pull away causing the impression of light.

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That may be one way to test your theory that the PCO folds are the source of the flashes. Check to see if you can see the flashes with your eyes closed in a dark room. Also keep in mind that light flashes can be caused by retina separation. That is a much more serious issue than PVD or PCO, and requires immediate attention.

Karin

If there is any chance it may be retina-related, maybe you should get an appt with a Retina/Vitreous specialist, if you live in USA.

I live in Canada. I have had both of my eyes dilated and am told they are fine. I see the ophthalmologist in a couple of weeks, so I will see what he says.

Flashing can be a sign of retinal detachment. Call you doctor or maybe even go to emergency especially if its combined with shadows across your vision or peripheral vision.

There sure are a lot of different things that can happen to a person's eyes. I hadn't heard of any of them, except cataracts, until I joined this forum. PVD and PCO at the same time would be hard to deal with. I have had this strobing/flashing since day after surgery in both eyes. I have had both eyes dilated since then and am told it is not a retina issue. I will see what the surgeon says when I see him in a couple of weeks.

A slight shimmering effect for a week or two after surgery is normal. Bit it doesn't sound like that.

Considering I have the Tecnis 1 which doesn't usually cause this type of thing, I agree it is odd. I have brought it up with my surgeon's optometrist in his office and my regular optometrist and they both say it will eventually go away. It started day after surgery in both eyes and I have had both of my eyes dilated and checked since surgery. I am wondering if it is caused by the folds in my capsule, although that seems odd because it is in the same place on both eyes.

The shimmering effect happens with all IOLs and always goes away. I don't think that's what it is though. You're talking about flashes of light. The shimmer isn't a flash. It's more like in the periphery vision things look… well… shimmery. It's just the lens making tiny microscopic movements I think before it starts to settle in / heal,

I have been giving this some more thought and if my vision has gone down to 20/40 in both eyes from 20/20 because of the PCO, how accurate would the optometrist's refraction test be?

My first thought is that the refraction is probably still valid. PCO is somewhat like a dirty windshield. It obscures your vision, but does not make it out of focus due to refraction. When your refraction is determined you are picking the best image even though the windshield is still dirty.

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This said I believe there may be some types of PCO that cause enough build up at the back of the capsule that it can shift the IOL forward, and that may actually change the refraction.

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But either way I guess the way to find out, is to do the YAG, let it heal and then do the refraction again. The YAG should fix either cause of the loss of vision.

I asked my doctor about the flashing lights in the periphery since I have that but doesn't really bother me. She said flashing lights like a strong strobe light and very large floaters could be an issue and I should contact her. I have been using that as my guideline since mine are mild and easy to live with.

Yes, mine are flashes also in the periphery but they are very mild and quick and don't really disturb me but they are indeed flashes of light just not pronouced strobe lights.

I got Tecnis 1 also with RE .50 (almost 3 wks. ago) and LE 1.25 (over 6 wks ago) but I ended up with LE strong close in vision to about 16 inches and RE clear most of the day to 65 inches using the digital clock as a measurement. What is strange is that when I wake up in the morning RE is very, very clear to 110 inches and then changes with the activities of the day. Sun with polarized sunglasses always seems to make my vision worse when I return indoors even before with my natural lens. Everything is pretty blurry for a while.

I haven't been tested yet except for one test saying my LE landed at 0-1.75 which was a surprise.

Will be tested at 6 weeks on June 8. I also have had in both eyes quick light flashes which are don't really disturb me and I do forget about them.

I am not that unhappy with the results as I have really good close to high intermediate vision which was very important to me. I can drive as before without glasses also (but do use them for legal reasons). I am still not EVER wearing glasses as before which is fine with me (except as required by law when driving but could easily not need them as my distance is adequate...similar to what I had before).

I have had the flashing/strobing in both eyes since surgery. I wake up with it, but most days it is gone by the afternoon, although some days it lasts until the evening. Some days it is debilitating and makes it hard for me to focus. I have had both eyes dilated and checked, so there is nothing wrong. I seem to be opposite from you in that my eyes improve as the day goes on. It is hard to tell right now what my vision is because of the PCO I have. I am hoping once I get the YAG this flashing will go away and my vision will return to what it was before the PCO started bothering me.

Yes, your flashing does indeed sound different from mine. I wrote down some notes on the type of PCO you have from an earlier discussion so that I can refer to it if I have any of those symptoms. I feel my vision should be sharper but I am assuming that the targets landed .5 off in both eyes not giving me the distance that I targeted originally.

Good luck on the YAG....at least it is fast and easy with a very high success rate! Should be a snap.