Need advise on glistening and reflections
Posted , 7 users are following.
I am in my fourties, live in Europe and had cataract surgery 3 years ago with acrysof monofoncal toriq lenses set for nearvision. The doctor only focused on nearvision since I was minus 7 in both eyes. He did not belive in monovision. I have been very uhappy since surgeries because of the limited range of vision, and because I cant adjust to progressive glasses. I now use three pair of glasses . One for prolonged reading, computer and longer distances . I can also wear contacts monovision for a couple of hours before eyes get tired/ dry. Unfortunately I noticed bothersome reflections after surgery. After the surgeries I was told that could not happen with monfoncal lenses, so it was only in my head. So I have tried my best to live with subtle rainbows, color distortions and some sort of half doubble vision and difficulities with driving at night. In addition I have this unnatural look to my eyes. I was hoping no one else would notice but unfortunately many do, and it makes me very uncomfortable to the point that it impacts quality of life. Last week i saw a new doctor who told me that if I had adressed the issues a couple of months after surgery she would have considered an iol exchange. She was very understanding of all the issues but stated that an exchange after so long time might tear the bag and I would be worse off. But she would reconsider if I was very serious about it. She also said that internal reflections from monfoncals are rear but heard of . She said cosmetic reflections are due to the iol type I have, and that some may be bothered. I had also developed glistening in one eye but that the effect of this is controversial, but may impact vision as glistening in these lenses for sure will increase over time. Wish I had known about this in the first place! She informed me about add on lenses and laser to improve refraction but stated that it would not help with the visible reflections. Anyone with similar experiences or advice?
0 likes, 13 replies
soks Sorry.eyes
Posted
sorry you are going through this. have you had YAG yet? if not you could exchange with a specialist.
Sorry.eyes soks
Posted
Thank you Soaks! I have low grade PCO in both eyes , no YAG yet so doctor said an iol exchange must happen before YAG. She said the public health care have experienced doctors but they would only offer exchanges in more serious cases, and anyway these surgeries are very uncommon and something they want to avoid. If anyone know of experienced surgeons in Europe or even in the united states I would consider making an appointment, due to my failure to adopt to the situation.
soks Sorry.eyes
Posted
i will exchange. they can tear my capsule. i am also in 40s so will need vitrectomy anyway to clear YAG remnants at some point. my surgery was october 2018. dont know anyone in Europe. i have high grade PCO.
Sorry.eyes soks
Posted
I really hope it works out for you! Are you considering having it done soon? Have you found a doctor? My last doctor mentioned that if bag tears it was possible with sulcus lens but that they are not so stable.
rwbil Sorry.eyes
Posted
I am sorry for what has happened to you. This is a tough one. I am bothered by a doctor recommending setting both IOL to close vision. There have been people that do that but it is rare. In my opinion most of life happens at distance.
The longer you wait the more risky explant can become and definitely don't go YAG.
I don't know if there are other eye issues you have that have lead to the decision made, so my best advice is do research and find a top doctor in your area. One that does clinical trials and writes research papers. And get more opinions from Top Doctors. Unfortunately I don't know anything about European doctors.
Maybe you could contact a Dr. like Dr. Shannon Wong who does lens explants. He has always answered my emails. This is your eyes and this might be something worth taking a trip to the US for.
Sorry.eyes rwbil
Posted
Thank you rwbil! I was naive and trusted the doctors advice, without doing research myself. I just did not know of the options. Thank you for advice on the doctor in USA. This gives me a little bit of hope.
RonAKA Sorry.eyes
Posted
Sorry to hear you are having these kind of issues. I have an AcrySof IQ Aspheric monofocal in one eye set for distance vision. I am still waiting for surgery in my second eye. My wife has more recently gotten both eyes done with AcrySof IQ Toric lenses set for distance. We were fully aware of the claimed issues with glistenings, and discussed it with the surgeon. He does thousands of surgeries and said that he has seen glistenings in the lenses of patients but none have ever caused any issues with vision. Alcon has made significant improvements in their quality control and while this issue used to be more common, if your eyes were done three years ago the quality control improvements should have been made by that time. We certainly see no issues with them in our eyes. With respect to the reflections you mention we do not see them in our eyes either, nor have we seen them in the eyes of anybody else that has had cataract surgery. I never even heard about it until I read about it in this forum. The surgeon certainly never mentioned it.
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I would say that my lens has been perfect, and it was up until about 10 months after surgery when I got posterior vitreous detachment (PVD). This has been dismissed as an ageing thing independent from my cataract surgery. However, exactly coincidental with this PVD I started noticing flashes of light in the periphery of my vision. It only happens at night with my eyes open when there are bright lights in my peripheral vision. I suspect somehow these flashes are not directly associated with the PVD but may have resulted from some coincidental movement of the lens position. I will be seeing my surgeon next week and will be asking about it, but I suspect this is positive dysphotopsia. These typically happen when the pupil is wide open in low light. It is also more of an issue with younger people like you as they have larger pupils. So, probably not much comfort but these issues can reduce as you age.
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As far as "subtle rainbows, color distortions and some sort of half doubble vision and difficulities with driving at night" I don't have anything like that.
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I am curious about your vision not being correctable with glasses. What is your most recent prescription for progressive lenses? I am wondering what is making your eyes hard to correct. Normally monofocal lenses are easily correctable with eyeglasses.
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IOL exchange is a difficult procedure and should be approached with caution. I believe @soks is in Europe so may be able to make some suggestions on who may specialize in this.
Sorry.eyes RonAKA
Posted
Thank you RonAKA!
I hope you get answers to your concerns next week! Both of my doctors acknowledge my cosmetic issues but the first one does not take external reflections into consideration because he only uses Alcon lenses and his only goal is to get rid of cataracts. The other doctor has another approach. Recently I found an article on line - Impact of intracular lens design on anterior surface reflections. I dont know if this is relevant to my case but it seems that high index of refraction iol has more of cosmetic issues. As for my internal reflections, I am just a very rear case, but it happens. As you say glistenings may not impact vision but I am concerned. The issues with progressive glasses is that I get headaches and feel dizzy. Have tried over long period of time. Ordinary glasses work fine but just for either near, medium or far.
RonAKA Sorry.eyes
Edited
Alcon has now developed a new material which is said to eliminate the glistening potential. It uses exactly the same refractive index as the AcrySoft material, so it seems that Alcon does not seem to be concerned about the refractive index causing reflections. The other common choice at least in North America are the J&J lenses like the Tecnis. They have a slightly lower refractive index and have not had the glistenings issue. However, the AcrySof material has been shown to have better outcomes with respect to PCO and stability in the eye. Stability in the eye against rotation is important especially with Toric lenses. In any case if you google this article below you can find more about the Clareon material which is just becoming available in different parts of the world. Other manufacturers are Carl Zeiss (Germany) and Hoya (Japan), but they are not so popular in North America and I am not familiar with them. You may have more availability of them in Europe.
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The Open Ophthalmology Journal Comparison of Visual Outcomes and Patient Satisfaction Following Cataract Surgery with Two Monofocal Intraocular Lenses: Clareon® vs AcrySof® IQ Monofocal
Sorry.eyes RonAKA
Posted
Thanks for the information! I will google the articles and lenses.
RonAKA Sorry.eyes
Posted
I did a quick search for "iol exchange specialists in Europe" and came up with this name. You may do better if you search with google in your own country and language.
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Marie-José Tassignon
Past Chief and Chair of The Department of Ophthalmology of The Antwerp University Hospital, Antwerp, Belgium
ad12345 RonAKA
Posted
She implants only her BIL IOL. I don't say it's bad but she claims it's the only good IOL in the World (designed by her).
RonAKA ad12345
Posted
I knew there was something unique about what she is doing, but I didn't dig deep enough to figure out what it was. I just noticed that she did 18 exchanges in a study.