Lost distance vision

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I had a Symfony toric lens implanted in my left eye. Right after surgery I could see perfectly at all distances. Something I could not do before surgery and right eye is still like that until next surgery. My concern is that after 4 days my distance vision deteriorated to the point where I cannot read street signs, etc. Doc didn't seem concerned, said eye was dry. Wondering if this had happened to anyone else and if you got your distance back. I'm mostly concerned because it was so clear for the first 4 days. This is day 10. I'm super happy with near and intermediate, but really want to be able to read street signs.

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6 Replies

  • Posted

    If near and intermediate are clear, but distance isn't good, that suggests that you are now nearsighted, but its very puzzling that the doctor instead referred to dry eye. Usually something like dry eye would impact vision at all distances, though it can change the refraction so in theory its a possibility. Dry eye can happen after cataract surgery, though its usually only temporary until the nerves that were cut heal, and usually would appear right away. Since the nerves tell the eye its dry and so it doesn't lubricate itself enough, people also  may not be consciously aware their eye is dry. It can also be a side effect. Sometimes swelling can happen after surgery and lead to a temporary change in refraction.

    After surgery the IOL needs to heal into position during the first couple of months and although usually there isn't much change, it is possible for the lens to shift position and move either further forward or backward in the eye, which would seem one of the two most likely  issues. That changes the effective power of the lens since its a different distance from the retina, though the change is usually minor. I'd confirm what your refraction is, your prescription, to see whether you are now myopic.  The other likely explanation would be  that the toric lens rotated,  which also changes the refraction  If that is it, then the lens can often be rotated back into place.

    If you are left nearsighted after surgery, or with residual astigmatism, they can correct that via laser enhancement after your vision has stabilized after healing has finished the first couple of months or so.

    • Posted

      Thanks for your reply. I feel like my astigmatism is corrected since I see so clearly near and intermediate. If my loss of distance is due to just rotation or wrong power can a LASIK touch-up correct that? Can the doc tell if the lens has rotated just by visual inspection? How about if it's moved forward or backward. My doc seems happy with my results, but I'm not since up to day 4 I had good distance and now I don't. Thanks!

    • Posted

      If a toric lens is rotated, the doctor can see that, though as you say if the other distances are ok that seems less likely. If you have good vision for some range, but not for far distance, that suggests the lens power is off (whether due to lens movement, or the lens power calculations being off, the reason is academic, but since it changed then lens movement seems likely).  If the lens power is off then you can be corrected using any method that corrects that: glasses, contacts, or LASIK or PRK, etc. They wait until they are sure your vision is stable before doing a permanent laser correction.

       The main issue is to find out what your refractive error is, the prescription they'd give you to correct it with glasses/contacts. 

  • Posted

    If the whole problem were due to the dry eye, you probably would not have good vision at any distance.

    You definitely have nearsightedness and may also have astigmatism. Rather than trying to make a guess about it, it is easy for the doctor to check the prescription required to get you the best vision at the distance. Once you have that prescription, it will be easier to figure out the best way forward.

    The eye examination should also tell you the best vision you can have with prescrlption glasses (or other options such as LASIK).

    If you have significant astigmatism, the doctor should definitely look into your eye to check the current position of the lens. For example, in my own experience with the Symfony Toric lens, it had rotated from the installed position by almost 13 degrees causing significant astigmatism. Not only that, the prescription for the toric lens was slightly off. Once all the information is there, the doctor can figure out whether just rotating the lens back to the desired position will fix the distance vision (in my case, it was not) or one should pursue a different option such as LASIK enhancement. In my case, fortunately the LASIK enhancement was a no-cost benefit added to the basic cost of the Symfony lens. So, I had the LASIK enhancement done, which helped improve my distance vision to 20/15.

    • Posted

      How soon after surgery did your lens rotate? Was it a sudden loss of vision? I feel like my great result went away after 4 days pretty suddenly. How does the doc know if it's rotated?

    • Posted

      In my case, I don't think that it was a sudden rotation (probably gradual), but the doctor noticed it when he examined my eye about 11 days after the surgery (instead of the usual 7 days due to weather). I did notice some derioration in my eye sightover the first 10 dyas, but nothing very sudden.

      The Symfony Toric lens (probably like all toric lenses) has a line marking the axis with the cylinderical correction, which an opthamologist can easily see (he uses the same line when putting in the lens in the eye at the time of the surgery). So, it is easy for the opthamologist to see if the lens is at the same angle on the cornea where he/she installed it or if it has moved.

      There was not much additional lens rotation over the next 3 weeks. So, he felt comfortable that the lens had stopped rotating before he did the LASIK enhancement about 6 weeks after the initial cataract surgery.

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