IOL explanation

whats the problem?

My vision is not clear at any distance, although just a few days ago I was told I had 20/20 vision. The letters, although readable, were not clear. Google - "PanOptix shadows around text" -

Shadows are likely caused by the fact that you have 3 different distances shown to your eyeball at the same time. IOL optics are fixed so this is a feature of a multifocal lens, any multifocal not just panoptix. So you have the "optimal" vision in focus, and then the suboptimal versions are shown around the best focus version and appear as ghosting. Either your brain learns how to filter these out or not.

Yes, i always had the impression to see all three focus of each letter simultaniously, just at marginally different positions, with my trifocal Panoptix. Like, one letter and two ghosts besides it. Especially with white letters on black background when using computer or phone.

It made small text unreadable, as letters were overlapping each other in a mess, when small letters are close to each other to begin with. I doubt to ever have gotten used to this, so i went for explantation after over 10 month since surgery.

Everybody tells you to wait if you get used to it, while at the same time the window for explantation is slowly closing more and more. A tricky situation, which eventually requires a tough decission into either direction.

How have you been since your lens change?

And what type did you exchange to?

is it easier if you dont wait too long?

MY vision is "great" and "20/20" but EXACTLY same here readable letters but not clear, shadows around text over a month after Vivity implant. Also halos around lights and a little duplicate shadow around like lines in road.

Who did your exchange?

A widely respected ophthalmic surgeon in Vienna, Austria.

Not cheap, but lots of experience with complicated cases.

I just signed up to this forum recently, so i don´t know if i´m allowed to post links here. I´ll send you a PM.

Was is Dr Oliver Findl?

can you please PM me the doctor name?

also what is floaterectomy?

and why did you get ND with panoptix but not with vivity?

Yes, Dr Oliver Findl. Look up his website, it´s in german and english.

I liked how he was not promising unrealistic expectations, but then delivering maximum professional work.

He is expensive, but i would rather choose to be broke, than compromising on my eyesight for the rest of my life.

About "ND":

My first surgery in an other country with Panoptix was done in the regular fashion, like all cataract surgeries are usually done: lens and haptics inside the capsular bag.

But at the second surgery with Dr. Findl in Austria, he placed the lens just in front of the capsular bag opening, but keeping the haptics inside the bag. This seems to prevent the edge of the lens casting this shadow on the side/back of the eyes, resulting in seeing these typical black arcs on the side of the viewing field.

So it has nothing to do with Panoptix or Vivity (they are similar sized lenses, though some lens-types are more prone to this), but it is just a different, rather simple technique implanting IOLs.

It´s called "Reverse Optic Capture", and i could have done this for the Panoptix easily as well, in a follow up surgery.

For most people ND goes away after some month or even a year, but didn´t for me. So he applied the technique right away, when inserting the new Vivity.

ND has mostly to do with your personal anatomy of your eyes, and surgeons just can´t know prior to the cataract surgery, if it will affect you.

But it can be easily corrected afterwards, by applying ROC in a simple additional surgery, where the surgeon just lifts the edge of the lens to the front of the edge of the bag opening. And it stays there, because the bag-hole is slightly smaller than the diameter of the lens (6mm). The haptics just stay inside the bag.

Well, it resolves ND in most cases.

Btw, what was really, really helpfull for my explantation, was the fact, that i held off doing the YAG-laser follow up, when having the Panoptix. An intakt capsular bag really helps, when doing an explantation, so don´t let your doctor talk you into doing YAG quickly, before you´re absolutely sure to keep your current IOLs ! !

About "Floaterectomy":

It´s a vitrectomy, solely for the removal of huge floaters, when you can´t get rid of them by laser (laser just brakes floaters up into many small fragments, but not removing them).

Vitrectomy was always considered as highly risky in the past, but with new techniques, i.e. microincisions and an experienced surgeon, risks have come down considerably.

BUT it is riskier for young people, who didn´t have natural PVD yet, which increases the risk of retinal tear during vitrectomy surgery. So it is very important to choose a surgeon specialized in retinal repair, just in case he has to do that right away as well, during the surgery.

AND vitrectomy increases the probability of getting natural cataracts afterwards dramatically.

But as i´m older and having had both (PVD and cataract surgery) already, it was quite easy for me. Well, one eye two weeks ago. The second eye coming up in 10 days. Knock on wood.

All in all, it seems that i´m nearing a happy end to my 2 year eye-odyssey. But it feels like, you know, when you are on the road, and a truck nearly misses you by a few centimeters at 150 kmh. Lots of adrenalin, and nearly unable to comprehend how close you were to disaster 😃

I hope to have cleared up most questions about "ND" and "Floaterectomy", which are surely plaguing many of us in similar situations, because what was most nerve wrecking for me, was the uncertainty in my mind about all this.

thanks for sharing that reverse optic capture fixed your ND. do they just remove the floating fragments in floaterectomy and not the vitreous?

also please pm me the surgeon name. thanks!!

"soks", i mentioned the surgeons name in above posts twice.

It´s Prim. Univ. Prof. Dr. Oliver Findl in Vienna, Austria.

Just google him, his website is in german and english language.

About the "floaterectomy":

They remove the central part of the vitreous completely, and since the floaters are swimming in the vitreous, the floaters are then gone with it together.

Then the resulting empty space gets filled up with a simple saline solution, which gets replaced by natural vitreous from your body slowly automatically, in a timeframe of just a month or two, without you noticing this process.

There is no requirement for any awkward head positioning after the floaterectomy. Not much pain, just local anesthesia, the eye will be a little swollen, and you have to apply various drops for a month. Feels just like a regular cataract surgery. IF everything goes well.

B U T, it´s a whole other story, when having complications, like an infection, or a retinal tear, during surgery. If the surgeon has to repair a retinal tear as well, he puts an additional gas bubble into the eye, which then requires positioning your head face down, for the next days or a week, so the bubble presses up to the repaired spot on the retina, until it heals in place.

The gas bubble then dissolves automatically in the coming weeks. Not much fun, when being in that situation.

Thats why i suggested to definitely choose an experienced retinal specialist, just in case, if complications arise during surgery.

A vitrectomy should still NOT be taken lightly, and carefully thought about ! !

As i said, the possible risks depend on your initial eye-situation to begin with.

Complications can still arise even after vitrectomy for a month or so. Thats why i rented an apartment over "airbnb" in beautiful Austria and will stay here for another month, so i won´t end up with complications, when having returned to my home country, being far away from Dr. Findl . . .

Some more information can be found here.

.

APR 04, 2018 Reverse optic capture successfully eliminates negative dysphotopsia By Lisa B Arbisser MD

i dont have ND. it might be a function of small pupil so i have quite the opposite.

Lynda111 how did you know the name.

I just Google searched and made an educated guess. Germany and Austria do have some of the world's leading ophthalmologists.