Hydrophobic acrylic iol glare?

I think acrylic IOLs can cause flickering more than silicone IOLs (my IOL is square silicone). Here's an article to read that says the flickering is from reflections - Cataract Surgery Aug 2012 IOL Exchange: Principles and Practice by Stephen S. Lane MD

Also, I read if the doctor isn't able to clean out the capsule well enough during surgery you are going to get PCO no matter what shape the IOL is.

Was also just reading it can havebtondonwith pupil dilation.  Some IOLs are smaller in diameter.  So if you pupil dilated beyond iol you’ll

Get more glare - more of a night issue.

Thank sou, Sue.An! ?

My lens has squared edges, both side, true. The edges are frosted but it doesn't look this reduces much the edge glare. I don't think it reduces it at all ... The lens is made of hydrophobic acrylic, no water-based then, and a relatively high index of reflection (1.47). 

Yes, light flickering is ONLY from the side, everywhere around the eye. It's basically glare, but in some circumstances it causes these two very annoying phenomena:

1) light shining from the side in a relatively dark environment = very visible SIDE flickering

2) strong, side light in a quite bright environment, like sunlight from home windows, shop reflectors = reflections like a strobe-effect in the whole eye.

The curious thing is this glare is present in both pupil conditions: during the night and in daylight. At first I didn't believe it was due to the edge, since it happens even during the day when the pupil is very small, but a doctor told me that the light hits the edge no matter how small or wide the pupil is. 

The flickering sensation is due to the small eye-movements. Practically the flickering you can see is your eye movements "reflected" by the light. Probably some eyes absorb more light than others (especially light-colored eyes). 

For the second eye I don't want a totally different material. This hydrophobic acrylic looks like more problematic than hydrophilic. What about staar's collamer? 

* I DO want a totally different material.

Yes I totally think the flickering  you are experiencing is due to IOL edge glare and get that it is really annoying.  This may subside with time as your brain adjusts and may ignore it just like it does with floaters.  As you experience this with pupil dilated and not I don’t think it has to do with IOL size.

I have not heard of staar's collamer lenses - perhaps they aren’t available in Canada?  But you should research to find another type of lens.  Have you discussed this with your opthamologist?  Perhaps he could suggest a lens that would complement the one you have and not produce edge glare.

At night I can see a partial thin light circle around the lights–that's probably caused by the edge too? After the operation, when there pupil was very large, I could see the entire circle. This is how I see:

http://web.ncf.ca/aa456/misc/cataracts/edgeIllumination.jpg

I'm sure it won't subside with time because it's deeply annoying, it's practically there everyday, all the time, in different forms in day and night. My doctor says she doesn't understand what's the problem since other patients are happy with that lens. She uses mostly acrysof and tecnis, which are both hydrophobic acrylic and on many forums you can read about flickering in this specific material.

Has it been long since this lens was implanted?  If only a matter of weeks your eye is still healing.  I had string glare first 5 weeks after implant and have seen that reduce quite a bit.  They say I will see improvement in that too as months go by.

If it has been months and no improvement and you feel you really cannot live with the flickering you can consider a lens exchange.  Just don’t have a YAG procedure as that makes a lens exchange difficult.

Several months already ... I don't think it won't change anymore.

The problems is what lens to use ... My surgeons says that she won't use silicone because it's "old-fashioned" material and it could cause problems. Do you think water content of the lens has some impact on dyspotopsia? Because hydrophobic lens don't have any water and they are labelled as the most problematic for glare and halos. My surgeon says the flickering has nothing to do with the edge design ... but I suspect it does and she simply doesn't want to admit she put me an unsuitable lens.

You may be right surgeon doesn’t want to acknowledge but I suspect it is edge glare you are experiencing.

Unfortunately I don’t know much about which lenses have more or less of this issue.  Nina234 who responded to you earlier had I believe B&L silicone lenses.  

Perhaps someone else will weigh in on lenses you should consider.  

Positive dysphotopsia is a very wide term to describe a lot of disturbance caused by many, different factors: lens thickness, lens edge, lens curvature, lens refractive index, lens density (collamer core is more dense than silicone, for ex.), distance of the lens from the iris, corneal abnormalities, disturbances in wide or small pupils ... Sometimes doctors don't know (or don't dare) to acknowledge the problem because they don't know why is the reasons of that, what is the main factor or factors.

At the start I didn't think it was caused by the edge but observing VERY well all symptoms, the annoyances are caused by the light shining from sides, from top, below, left or right, in the eye. So that must be one factor causing that. My doctor never checked my eye to discover what was that factor causing glare, I don't know, trying to shine inside my eye with some light from different angulation and seeing what part of the lens is reflected, or some other method, she just said that she doesn't know anyone complaining with these lenses and goodbye. Now I must discovering what's the problem, it's very frustrating. 

 

Silicone lens with squared edge. Probably the whole problem is caused by the squared edge.

My lenses have a square edge but I don’t get that flickering.  Square edges help prevent PCO.  

Interesting.  Did you get a monofocal or multifocal.  I have a Symfony Lens which believe it or not gives me about 8 or 10 circles around certain lights outside at night.  Don’t see them on insid lights.  They are faint like a spider web and I do know it is lens design.  I knew prior to the surgery about that.  The circles in the lens is what gives me good vision at all distances during the day.  I haven’t worn glasses since the surgery.   I can see through the circles easily enough and have adapted.

What diameter is your IOL?   I am wondering if your pupil dialated beyond the IOL.   It really does look like you see the edge all around the IOL in that photo.   

Have you seen another specialist to discuss this?  Doesn’t sound like your own one wants to discuss.  And perhaps she doesn’t do explants.  

I have seen many complaints about it .  Especially on another forum I was on prior to surgery when thinking about my own choice of IOLs.  I will see if I can find it.  Perhaps there you can see what most decided to do.  Thinking it was lens exchange but cannot recall.

It also may be where IOL ends up in the eye.  As it adheres it shifts back and forth a bit.  Your natural lens is 4mm thick whereas the IOL is just 1mm thick.

Hello Sue.An, I have the same problem: light glare/flickering only when the light is directed from the side into the eye. But this happens even during sunny days, when the pupil hole is pretty small. How is possible the light does hit the edge then? Thank you for your reply.

This happens more with square edge IOLs bs round edge.  However square edge IOLs help prevent PCO more than round edge ones.   There really is no lens that is perfect and no two eyes the same.

Has it been long since your surgery?   Some of these annoying side affects dissipate with time as the brain adjusts and tunes them out.

It's been nearly one year and still there, it won't go away. Hydrophobic acrylic with square edges. How about silicone with rounded edges? Will help change the lens material too?

The silicon with round edges is theoretically supposed to have less edge glare.  The brain is supposed to adjust but after a year that should have happened.

Have you consulted (with another expert to see if anything can be done).  If you haven’t had a laser procedures maybe a lens exchange is possible).  Your best bet is to find a specialist that can give you options and willing to discuss those.

Other than edge glare are you able to see well?

Ingrid have you done much research on the net?  I found a few interesting articles but unfortunately can’t post links here.  If you google the following there are some interesting articles.  If you can’t find them I think I can include links if I message you.  But try googling this:

Shedding Light on Pseudophakic Dysphotopsia

Silicone IOL’s have a lower refractive index and they are supposed to reduce positive dysphotopsia.  I am considering doing another exchange for a silicone.