Have Not Heard of This After Cataract Surgery - Help Please
Posted , 8 users are following.
I had cataract surgery done on both eyes recently. Left eye was done 5 weeks ago and right eye was done 4 weeks ago. I had Tecnis 1 in both eyes, LE -0.1 and RE -0.55. I was very happy with the outcome. I only need reading glasses if I am reading a book or magazine. I can see my computer fine and my cell phone I have the font set as large as it will go and can use it without a problem, although reading glasses definitely makes it easier.
About a week and half ago I started noticing a change in my vision in my right eye. I had been able to see crystal clear from 2 feet out to as far as the eye could see. Starting a week and half ago I could only see things clearly from 2 to 3 feet and then things started to get blurry. I also developed a smear over my eye starting at the top outside edge and going down to about the 10:00 position. Went back to the clinic that did my eye surgery and saw the optometrist (once the surgeon has done your surgery, you never get to see them again lol). The optometrist checked my eye (she also dilated my eye and checked the retina) and said I had “folds” in the membrane behind my eye due to scar tissue (when I thought about this later it didn't make sense because shouldn't the scar tissue be in the front of the eye). I had more of them in my right eye, but also had one in my left eye. I do not notice any change in my left eye vision.
She explained to me that once my eye was completely healed the surgeon would go in with the laser and “polish” these folds to remove them. She said he would do both eyes on the same day. When the front desk made me the appointment to get this done the slip they handed me said YAG. Well to the best of my knowledge a YAG does not “polish”, it removes part of the posterior capsule. I have done a bit of research and it seems these “folds” can be caused by a number of things.
Not sure why this optometrist would give me incorrect information. A person cannot make an informed decision about their situation with incorrect information. I am very upset about this because it prevented me from asking follow up questions. Polishing and removing are 2 totally different things with 2 totally different outcomes.
I have decided I am for sure not getting a YAG done on my left eye because I don’t have any vision issues right now. My questions are:
- Has anyone heard of these “folds”?
- I have read all the negative posts on this forum, so does anyone have any positive outcomes from YAG?
- What is the best YAG method, cruciate (X) or the circular?
I was so happy with my vision outcome and just 2 days away from finishing my eye drops and ready to cross the cataract finish line. This has put me into a tail spin and after reading all the negative posts am beyond terrified of making a bad situation worse. Any help/information you can give me would be greatly appreciated. Thanks.
0 likes, 64 replies
neverquit karin08666
Edited
When i had bilateral cataract surgery, i almost immediately had unexplained worse vision in one eye. Refraction was good, but especially when reading letters, they looked very "fuzzy" and "torn", making them hard to read. Also on road signs. At any distance, far and near.
The surgeon attributed that to temporary positive dysphotopsia of my Panoptix, but i couldn´t understand why only one eye was so much worse than the other. Much later, at another ophthalmologist, they showed me high resolution pictures of my capsular bag behind the lens, which was completely "wrinkled". Now, after creating the posterior capsular bag hole, this effect is gone.
So i think, the YAG treatment would solve your problem, not by polishing, but by creating the usual hole in the bag. They probably used the term "polishing" when talking to you, as they always think we are the regular uninformed patient, and polishing sounds nicer, than "shooting a hole" 😃
I was told, the cruciate X method (which most surgeons use) is less risky in respect of possibly creating a floater as a side effect. Floaters can still happen, but won´t for most people.
In any case, i would not hurry to do YAG, until you´re absolutely sure, that every other aspect of your cataract surgery worked out to your satisfaction, as any necessary subsequent surgery gets more complicated after having done YAG. It has no adverse effects on your eye, if you delay YAG, until you deem it really necessary.
karin08666 neverquit
Posted
Good point about "polishing" sounding better than "shooting a hole". Thank you for the laugh out loud moment I had when I read that. We need more of those in our day.
What you had sounds like what I have, right down to the street signs. I noticed mine 2 1/2 weeks after surgery. Did your doctor say why this happens? Because it happens right after the surgery, it makes me think it has something to do with the surgery.
It is good to hear of a positive outcome with YAG. It is good to know the things that can go wrong so you are well informed, but I find I need to balance that information with positive outcomes also.
Thanks for responding and giving me very helpful information. The people on this forum have always been helpful and informative and have made the decisions I have had to make easier.
neverquit karin08666
Edited
Well, my own case is neither a good or a bad YAG-outcome, because i simply did no YAG.
In the end, i had to have vitrectomy/floaterectomy done for other reasons anyway, so my bag hole was made during the vitrectomy by hand from inside, from behind the lens capsule. No laser.
It´s a very elegant method, which guarantees that any particles go out together with the vitreous, during the vitrectomy. The result is the same, no more PCO or any "folds/wrinkles".
Nevertheless, a vitrectomy has its own specific set of risks, but thankfully nowadays much less than 10 or 15 years ago. And beeing not too young and having had PVD already, certainly helped in my case.
So i´m happy again, even with a "hole" in my eye now 😃
Guest karin08666
Posted
These capsular folds are common. As for polish vs. YAG I assume your optometrist (not being an ophthalmologist) is just confusing her terminology. She has the right idea but is using the wrong words. You are right that the fix is to make a hole with YAG not "polish". That refers to something some surgeons do during the initial surgery (just making sure they get all the cells out of the capsule).
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I assume the "smear" is a maddox rod effect (streak) from point light sources at night, so you only really see it a night. If that's the case, it would probably be best to wait until / if you develop PCO before doing YAG. That will fix the PCO and take care of the streaks at the same time. I'm not sure your surgeon would recommend YAG only for the light streaks. I also got these… since day one. The fold that causes the streaks isn't caused by scar tissue, it's just from the haptics pushing out on the bag.
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As for the hyperopic shift, unfortunately that is also common. I'm 8 months out from my first surgery and I experienced the same thing. Near vision was AMAZING at first! I was thrilled. And now it's not so great. The vision can continue to shift for awhile. Most people say it's stable after 6 weeks but that hasn't been my experience at all. My shift to more far sightedness has been gradual over the past 6+ months.
karin08666 Guest
Posted
I have the streak during the day too. When light is coming in through the windows it is like someone has taken a greasy thumb and smeared it over my eye. It is not just one thin light streak, it is one wide smear across the majority of my vision. It's like looking through a greasy smudge. My distance vision has changed. I can see things clearly from 2 to 3 feet and then they start getting blurry, like before I had cataracts and took my prescription glasses off. I can no longer see the numbers on the house across the street with my right eye, but it had been crystal clear prior to these folds. I can't read street signs with my right eye anymore either. From some of the things I have read on this subject my ability to see words could continue to decrease. I apparently have many folds on my right posterior capsule. The things doctors don't warn you about before the surgery amazes me. I guess most people would have information overload and not want to go through with it, but I like to know so I am prepared.
When I had my right eye done, my eye wasn't as frozen as the left eye. At one point during 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. I also read you could get these folds if the posterior capsule is smaller than the lens they are putting in, which makes sense.
Thanks for the information. I like getting all the information I can so I can make an informed decision.
Guest karin08666
Edited
If it is impacting your vision that much (and they are pretty sure that that is the cause) then I'm sure they"d go ahead with the YAG. Really hope that if that is how it ends up going that it solves the issues.
RonAKA karin08666
Edited
If you have not found it already you may want to have a look at this article.
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CRSToday MAY 2021 When To YAG and When Not To
karin08666 RonAKA
Posted
Thanks. I have read it before. Every article I read seems to give me a little bit more information.
Guest karin08666
Edited
I did some research after reading this thread and found an interesting YouTube video "YAG Posterior Capsulotomy: The final hurdle to a Premium Visual Outcome" as well as a few other good articles. In short what I learned is:
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karin08666 Guest
Edited
Thanks for letting me know about this video. I found it very interesting. It makes a person hope their eye surgeon knows about these things to prevent further complications. Neither the circular nor cruciform method seem to be good options, but unfortunately they are the only options.
I would really like to wait to get it done, but considering in 2 1/2 weeks after cataract surgery I had numerous fibrous tissue on my posterior capsule that was already causing me vision problems, how long before it gets so bad it makes the procedure harder. The thicker the fibrous tissue, the more power they have to use on the YAG, which can cause pitting of the IOL. They seemed to want to get it done as soon as my eye is healed (mid May), so that also makes me think I should.
Also making this decision harder, my son is getting married at the end of August and I would really like to be able to "see him clearly" through the ceremony. Not to mention my eye surgeon is on holidays from mid July into September, so the window is fast closing to deal with this and any further complications like floaters or a bigger hole needing to be done. I see my regular optometrist in 2 weeks, so hopefully he can help me decide. I know my eye surgeon is very good, so I guess eventually I just have to have faith and take the leap.
Lynda111 karin08666
Posted
This 2019 study, the latest I could find, says the circular pattern is better.
"Two different patterns and outcome of neodymium YAG"
Lynda111
Edited
But I think the surgeon's skill in doing YAGs is more important than the pattern that they use.
karin08666 Lynda111
Posted
I can see how the circular pattern would be the better option. Dealing with a pitted IOL would not be a good outcome. Having a skilled surgeon always gives you the best odds of a good outcome though.
amy99928 karin08666
Edited
Yes I have- after my surgery I just had the YAG 2 months later. Two drs said the capsule behind was also cloudy. One comment was the rear wall of the capsule containing the lens is "trying to form a cataract too" and I assume it was already like that but it could have been in response to the surgery? Anyway yes they call it polishing and I corrected them because it's actually drilling a hole with a laser. I asked why the laser doesn't drill a hole through the new lens and she said it's the nature of the laser. I do think it damages the photoreceptors behind and I read there is an increased chance of optic nerve damage later. Furthermore, once we have had YAG we can not upgrade our IOL when there are great advancements in the future because the risk of retinal detachment is too high. The YAG laser hole lets in too much light and the glare and glint is worse now (also weirdly I have to hold things further away to read) so for me it was maybe a mistake but the YAG is quick and easy and you probably will benefit? I am young and I expected perfect 20/15 vision like I had before cataracts so this Vivity is a disappointment.
karin08666 amy99928
Posted
Thank you for all the information. I was quite disappointed when I found out I needed a YAG so soon after my cataract surgery. I have read it could also be the type of cataract you have that attaches to the capsule and the surgeon can't get it off without putting a hole in the capsule. I have a monofocal lens and can't see me wanting to change it at this point in my life, so that is not a concern for me. Other than the worse glare and glint, the YAG turned out ok for you? No big floaters blocking your vision? For some reason that is one of my major concerns and that my lens will get pitted from the laser, which can happen. My surgeon is really good, so I just have to put my fears aside and have complete faith in him. He did an amazing job on my cataract surgery and I was very happy with the outcome, until I got this PCO, which is no fault of his.
amy99928 karin08666
Edited
there is a room with three yag laser machines and i sat in one of them and she selected a disc to put in probably narrowing the size of beam i don't know and she turned out the lights and told me to sit at the machine and she pushed a button a few times making the light come on and it was done. I have no floaters or detached retina or anything. I expressed concern as she was selecting the slide about possible risks and she said no those almost never happen and she's been doing it 35 years. She told me to look at her ear but then i did not realize it would be so fast and i looked down and i don't think the beam went in the right place but she said no it's fine bc she had my eye going straight with the machine's face mount and one other bracing frame. I don't trust her though so be sure to look straight ahead so the laser hits the back and you won't wonder if it pierced the right place like i am.
amy99928
Posted
fyi i'm 49 and my friend at church in late 70s did it and "loves it"
karin08666 amy99928
Posted
Thanks for the information. Looking down during the procedure or moving would be something I would do and then like you worry about. I am sorry you have to deal with the worse glare and glint after the YAG. That would be hard to deal with every day. For some people their brain starts to ignore it and hopefully this will happen with you.
Thanks for the information, it was very helpful.
RonAKA amy99928
Edited
Not sure about the YAG lasers, but the ones used for Lasik track your eye movements and compensate for them if you move your eye during the time the laser is on.
Guest RonAKA
Posted
Also the "disk" is a contact lens… like a big lens they hold with their index and thumb (not the kind you buy for vision correction) but they stick it right on your eye. That gives them a more focused beam but it also helps minimize eye movement.
amy99928 RonAKA
Posted
okay good. Today she looked at the eye again and I asked if she saw the hole and she said yes and affirmed it was centered... (but if it were not I don't think she'd say so).