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How does an optometrist distinguish between PCO or tilt with blurry vision?

Posted , 6 users are following.

hilary13182
hilary13182

Hi. In my left eye, I had a J&J toric IOL lens inserted 5 months ago. The surgery has been a nightmare from day 1. Very high IOP 2x's, awful pain from the incision(s) at 9-11 o'clock. In follow-up appointments, the surgeon's post-op optometrist said it was just "dry eyes", however I could feel deep pain only at the incision spot. Both conditions have gotten better, but I still have some residual discomfort.

Btw, the right eye was operated on a month ago, and is feeling fine- I opted for a near/mid viewing range because I'm an artist. But now wish I could change it to a solid mid-range, but that is another discussion.

I have developed pretty dense PCO in the nightmare eye and a very light amount in the right, and have a slight amount of residual astigmatism. The eyesight in my left eye is very blurry.

Have any of you had experience with an IOL tilting/shifting? What happens to your eyesight then?

Can optometrists always spot this, or do they need special equipment? I want to make sure this is not the case, before even thinking of doing a YAG.

Does the PCO get worse over time? I'm terrified to get the YAG procedure, given that I've had/have so many problems with the left eye- because I don't want to irreversibly hurt it more.

I'm interested in your experience. Thank you so much.

Btw, I live in the USA. But wish I lived in Europe. From what I hear, you guys have more advanced equipment/ methods.

0 likes, 17 replies

17 Replies

  • RonAKA
    RonAKA hilary13182

    Edited

    Some thoughts on your questions:

    .

    1. A small amount of astigmatism is not necessarily bad. It will reduce the sharpness of vision at the distance the monofocal lens is set for, but it will also increase the depth of focus so it may help with reading some.
    2. I have no experience with tilting or shifting of the lens. A toric lens is more difficult because it not only needs to be centered, but the angular position is critical. I would return to the surgeon to have the position checked to see if there is anything wrong. I believe they can reposition it if necessary.
    3. PCO is not uncommon. I believe it can occur rapidly or very slowly. There are risks to a YAG procedure but they are not very high. The surgeon I went to has written a paper on it and estimates the risk of retinal detachment is about 0.5% or 1 in 200. You can google an article about it using this phrase.

      .

      Review of Ophthalmology 10 MAY 2018 PCO: What’s Wrong With Doing a YAG?

      .

      In any case I would suggest you need to go back to the surgeon that did the work for an evaluation.

  • soks
    soks hilary13182

    Edited

    optometrist can easily see a shifted iol. PCO is also easy to detect.

    on PCO, i am as scared as you are. i have fast moving PCO too. my mother got YAG 26 years ago then got retinal detachment. she did not treat it and lost that eye. due to this she never got YAG in her other eye. the vision in that eye is 20/40. she refuses to even get that eye dilated.

    she does not complain of poor vision in that eye. uses bifocal glasses.

    i wish i was in europe too. surprisingly US is worse at availability of latest technology for opthalmology.

    • hilary13182
      hilary13182 soks

      Posted

      Yes, I am very afraid to get a YAG because it is not a wholly benign procedure. I was wondering how an ophthalmologist/optometrist measures tilt of a IOL.

    • soks
      soks hilary13182

      Edited

      tilt matters only if you have a toric lens. those lenses have marking on it. displaced lens can be noticed by comparing the iol centration against the capsularhexis or the iris.

    • hilary13182
      hilary13182 soks

      Posted

      I do have Toric lenses. Can you please explain "centration against the capsularhexis "? How does a doc diagnose tilt from looking on top of the IOL? Wouldn't they have to see the haptics and the IOL from the side, to see the degree of tilt? Thanks...

    • hilary13182
      hilary13182 soks

      Posted

      Hi. I'm not speaking of post-op rotation....

  • rwbil
    rwbil hilary13182

    Edited

    "In follow-up appointments, the surgeon's post-op optometrist said it was just "dry eyes","

    Why are you seeing an Optometrist? When I had my left eye done, I saw the Opthamalogist for my follow up visits.

    You need to see the Opthamalogist and if it was me I might be looking to get a 2nd opinion and looking into seeing a top rated Opthamalogist and maybe a retinal specialist.

    • hilary13182
      hilary13182 rwbil

      Posted

      Yes, I am going to start investigating, looking for a 2nd opinion. Hopefully an Opthamologist specialist somewhere between Seattle, Washington State, USA, and the British Columbia, Canada, border....

    • rwbil
      rwbil hilary13182

      Edited

      I always like to look at the doctors that are doing clinical trials. You can also go to Castel Connolly top Doctors and find ones in your area and then do some research on those doctors to find a good fit for your situation.

    • RonAKA
      RonAKA hilary13182

      Edited

      On a quick look there is a website that appears to be a J&J sponsored site where you can enter your zip code to get a list of possible surgeons. Try googling this:

      .

      beyond cataracts find a doctor

      .

      When the list of surgeons comes up there are icons below their photo which show which J&J services they offer. Perhaps more services means better doctor? Or, just more expensive??

      .

      I agree with @rwbil in that your issues are probably beyond that of a optometrist. But your optometrist may be able to help you find or narrow down choices for a surgeon to give a second opinion.

  • ad12345
    ad12345 hilary13182

    Edited

    What kind of more advanced equipment/ methods do we have in Europe? I haven't heard of any.

    • soks
      soks ad12345

      Edited

      they have iols we dont have in US like zeiss, synergy. otherday i also came across an european clinic that simulated dysphotopsia. they also have virtiol which is iol simulator. europe is advanced

    • hilary13182
      hilary13182 ad12345

      Posted

      Hi. Even my ophthalmologist told me that IOL's, are more advanced- 10 years ahead, than what can be found in the USA. I've heard this is because scientists from different European countries share information, studies (???)...

    • ad12345
      ad12345 hilary13182

      Edited

      I would not agree with you. There are IOLs not available in the US, however, I don't think it makes Europe more advanced. For example I am looking for a surgon here to have my IOL exchanged and there aren't many options. I also consider flying to America....

  • Sue.An2
    Sue.An2 hilary13182

    Edited

    Sorry Hilary - sounds like you've been through a lot.

    Someone on the forums and posted a lot on her experience (Julielyn I believe). Original surgeon missed or would not admit an error and did a yag but it was a haptic outside the capsular bag tilting the lens. She eventually had an exchange done in Florida. Worth reading through her threads.

    • hilary13182
      hilary13182 Sue.An2

      Posted

      Hi Sue Ann, This sounds like it might apply. Do you have any idea what the title of her post was? I'm interested....

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