Neuroadaptation, halos and multifocal IOLs: What's your experience?
Posted , 4 users are following.
Like many others I'm suffering from huge concentric rings/spiderwebs after implantation of two trifocal so-called premium lenses with diffractive optics. I was told that these vision issues will dissipate but they didn't within the last nine months. Neuroadaptation worked perfectly with several multifocal contact lenses in the past. For example big halos vanished within minutes when I put in new contacts for the first time. And now I'm stuck with these lenses that severely impaire my night driving ability. It's extremly exhausting, dangerous and depressing.
My question: What's your long-time experience? Have you experienced neuroadaptation even 6-12 months after the surgery? Maybe 1-2 years later-on? Any tips or tricks to trigger it?
Every surgeon refers to neuroadaptation but until now nobody is able to explain how it really works. The only solution to get rid of the rings/spiderwebs is explantation including many risks which can even worsen your eyesight. There is no dry-eye or decentration involved. Residual astigmatism treated with glasses. These factors are ruled out. It's "only" neuroadaptation. And the patient is called to be a failure.
0 likes, 6 replies
Sue.An2 assia99778
Posted
What type of IOLs do you have? I have Synfony EDOF lenses and do see huge concentric circles around certain lights at night. I still see those circles 4 years later. However I don't find it frightening to drive at night. The rings are very distinct and outer ones are fainter than inner ones. Early on (first 6 months) saw lots of flare from light sources - so much so it hid the concentric circles. That was harder to deal with at night - used to plan my routes where there was overhead street lighting. I have read these visual disturbances are worse if the refraction is off. I do have great daytime vision so would never consider an exchange.
Some people never adapt and only you can judge how much this disrupts your life and is bothersome. Explantation is a riskier surgery than cataract surgery. More important to find a skilled surgeon who does a lot of these surgeries. Don't get your cataract surgeon to do it - even if they offer it for free.
assia99778 Sue.An2
Posted
It's the ZEISS LISA, which is similiar to PanOptix and has 12 diffractive rings. Both IOL are off-axis. That's the reason why I have to use glasses to correct residual astigmatism. There was the suggestion to try rerotation but after such a long time the capsule has already shrinked and the chances for successful surgery are not very good. Never read in this forum or elsewhere that someone had successful rerotation several months after the surgery. The question is if this off-axis-issue exacerbates the perception of rings/spiderwebs. Every point light source is surrounded with these rings. A front light from bicycles has a diameter of 1,5 m. This means you can't see the person on the bicycle because of those huge and many rings. I had neuroadaptation regarding ghosting (white letters on black surfaces, e.g. subtitles in movies, that were surrounded by a white shadows). That's gone.
We don't have explantation specialists like in the U.S. where they do 10-15 explantations a week. It's rather 10-15 during a year, at the most. Yes, I went to a reputable and experienced eye surgeon.
Wearing several glasses (for computer work I have to wear two glasses at a time, one over the other, because varifocals don't work with trifocal implants and intermediate is blurry) is not what I have paid for and I never wore glasses since my childhood - but it's manageable. The severe dysphotopsia unfortunately not. I fully depend on this neuroadaptation process.
Thank you for everybody to join this discussion with her/his long-time experience! I although appreciate further knowledge/studies about neuroadaptation and multifocal dysphotopsia. If someone had IOL-exchange due to this problem: What was the outcome and how long was the IOL in place?
Meuwth assia99778
Edited
I have a panoptix in my left eye, and all the visual disturbances I've had since day1 post-op are still with me 2 years later today. It did improve, but it's not because it was fixed by itself, by any means. I would attribute this improvement to fibrosis of the capsular rim. As the fibrosis gets more dense, less light is able to pass through to cause the halos, but your vision is also dimmer as a result. Then, one simply gets "used to" the visual disturbances. It's not that it's gone, but you simpy get used to having it there. If you asked a man who lost a limb "how did you get over your loss of limb", he would probably tell you he didn't, but life goes on. From the doctor's perspective, it's never been about being perfect, but if they could restore some semblance of normal life for their patient, it's considered a "win".
assia99778 Meuwth
Posted
I've seen you started a thread asking for explantation specialists in the U.S.: Why do you want to explant the PanOptix despite getting used to the dysphotopsia? IOL-exchange of acrylic hydrophobic lenses becomes very difficult after 2 years of the original surgery. They tend to stick to the membrane. Hydrophilic lenses are easier to be explanted even 2-4 years of implantation.
Meuwth assia99778
Posted
Aside from the dysphotopsia, the vision is not sharp. If I recall correctly, PanOptix has a total light pass through rate of ~88%, and from that 88%, the light is split between three focal points. In contrast with a monofocal where light is concentrated to one point, the PanOptix just doesn't deliver a good image quality. If you're trying to thread a needle, you will probably do a poor job of it. I am who really cares about detail and fine work, so I am seriously contemplating the exchange.
assia99778 Meuwth
Posted
Yes, you are right. It's the same with the trifocal ZEISS IOL: Not usable at all for close working. And this is nothing you can adapt to. It just doesn't work as you mentioned above.