Panoptix - YAG decision

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I'm a 42 year old male who had a wonderful cataract operation about 2 months ago. Eye is all healed. I'm seeing that eye can be dry most days in the night when I wake up. The doctor has checked this and ruled out dry eye syndrome.

The eye doctor has chosen the right power with very small variation (-.5) in power. I chose PanOptix lens.

My vision was very good right after cataract surgery - I was able to read the last line letters during the eye exam.

Here are my challenges

  1. I have PCO right in the visual axis in both eyes- assuming glare and cloudiness are directly linked to it. I can't read the last 2-3 lines during the visual exam now. I see a decrease in clarity and eye sight.
  2. I see Halos - manageable so far
  3. starburst - manageable so far
  4. Flickering - I see flicking on my eye under bright lights, especially when the light enters from the side
  5. I'm seeing that eye can be dry most days in the night when I wake up. Does this mean that my eye is not healed fully?
  6. Sensitivity to bright lights

My questions

Everything I identified also comes as PCO symptoms but I've been having the symptoms from the day of the cataract surgery. Could this be from PCO Vs Positive Disphotophsia?

What I've heard is Halos and Starburst can get worse with YAG sometimes. How often does this happen?

Flickering may get better and there may be also be floaters from YAG. How often does this happen?

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  • Posted

    It is very normal to have sensitivity to light for months. I recall wearing sunglasses even inside the house.

    For dry eye you can use artificial tears - they help a lot (i like Systane brand)

    Are you sure you have pco - was it confirmed by your doctor? I saw my optometrist a few days ago (yearly exam - i had cataract surgery in July and Aug 2017). i thought i was experiencing pco but turns out I have ERM.

    Once you do have a yag it is much more difficult to have a lens exchange and there can be other complications like more floaters and increased glare. You will want to hold off till it is confirmed and bad enough to affect vision.

    • Edited

      Sue - Thank you so much for the reply. My PCO has been confirmed by two different optometrists. One as early as 1 month check up - it was in the visual axis. The 2nd month checkup with another doctor confirmed that PCO has gotten worse and the doctor recommended the YAG procedure 60 days after the original surgery.

      Out of a scale of 5, the doctor said it was a between 2 and 3 - right in the visual axis. I can easily feel the deterioration in my eye sight. I feel the haze and cloudiness.

  • Posted

    panoptixman.

    I have a long thread on my experience that's moved to the 4th page of posts. It's titled "Cataract Surgery Completed - Sharing My Experience - PanOptix Tri-focal".

    If you read that thread, you will see:

    • I had PCO suspected in left eye at one month follow-up
    • confirmed at two month check, but doctor to be conservative waited a little longer to do YAG.
    • YAG at 15 weeks post-surgery.

    YAG improved vision, but still not as goo as it was immediately afte surgery. Doctor ordered OCT scan and compared scans with earlier scans and diagnosed dry eye.

    Dry eye is pretty common post-cataract surgery and will impact vision. how did you doctor rule out dry eye, particularly when you feel eyes are dry when you wake up.

    For dry eye, my doctor suggested eye drops. Gave me sample bottle of Hylo (main ingredient is hyaluronic acid), but said it's very expensive and suggested looking for ones with Trehalose instead. So I'm using Trehaloz Duo which contains Trehalose (3%) and Hyaluronic acid (0.15%). I also found that Hydrasense (known more for nasal rinses) seems to have an eye drop with Hyaluronic acid as well that less expensive.

    I'll be seeing my eye doctor in 2-3 weeks. I'll update my old thread with results of next exam.

    • Posted

      "YAG improved vision, but still not as goo as it was immediately afte surgery." - that is disappointing

    • Posted

      Hoping the eye drops for dry eye brings it closer to what it was before just after surgery. Wasn't diagnosed with dry eye until last visit. We will see what next appointment shows.

      As far as halo and starburst. The halos were always very mild, and are even more mild now. I think PCO temporarily made starburst a little more noticable, but with YAG, I feel the starbursts are now less than after surgery (and starbursts for me were fairly moderate to start).

  • Posted

    It's been 6 months since my surgery and not quite 3 months since my YAG. My comments on your points and questions;

    1. my vision gradually improved up to 2 months after surgery when PCO was diagnosed. I did not notice any cloudiness
    2. small halos
    3. minor starbursts
    4. very minor flickering in my left eye when there is a bright light off to the left
    5. not aware of dry eyes but optometrist recommended Systane Complete which I now use 5 or 6 times a day, and that seems to help with distance vision that is not sharp
    6. I have no sensitivity to bright lights

      Only your eye care specialist can determine if it is PCO or PD.

      There were no observable differences after YAG for me, but my eyes were measured at 20/20, three weeks later (from 20/25 & 20/30)

      I did not see any floater after the YAG.

    • Posted

      so u did the YAG even though your vision was not compromised by PCO?

    • Posted

      Yes, but in my case I was not aware of the onset of PCO. My distance vision was blurry from right after surgery, and not something that I noticed as degrading. My optician observed the PCO at the 2 month checkup, and this was confirmed by the surgeon.

    • Posted

      well my optician / surgeon confirmed PCO at 5 weeks. they said it was mild. It was 2+ at 10 months but i could see 2020. so the surgeon said as long as your vision is not impacted you don't have to do YAG. 12 months is where the vision got impacted.

  • Posted

    my questions this is my 8 th week after surgery

    1 typically how long after cataract surgery did you overcome slightly dry eyethe only time i notice it is when i wake up my eyes are dry

    2 i have PCO for sure . but i noticed the symptoms pretty much after surgery. since the sumptoms of pco and positive dysphotopsia are very similar from google. are there any nuances that will help me identify?

    • Posted

      my questions this is my 8 th week after surgery

      1 typically how long after cataract surgery did you overcome slightly dry eye the only time i notice it is when i wake up my eyes are dry

      8 weeks is early days.

      Dry eyes can clear after 8 weeks, 8 months, 1 year or never.

  • Posted

    my questions this is my 8 th week after surgery

    1 typically how long after cataract surgery did you overcome slightly dry eyethe only time i notice it is when i wake up my eyes are dry

    2 i have PCO for sure . but i noticed the symptoms pretty much after surgery. since the sumptoms of pco and positive dysphotopsia are very similar from google. are there any nuances that will help me identify?

  • Edited

    my questions this is my 8 th week after surgery

    1 typically how long after cataract surgery did you overcome slightly dry eyethe only time i notice it is when i wake up my eyes are dry

    2 i have PCO for sure . but i noticed the symptoms pretty much after surgery. since the sumptoms of pco and positive dysphotopsia are very similar from google. are there any nuances that will help me identify?

    • Posted

      My understanding is that PCO causes a cloudiness of vision not unlike a cataract. PCO requires cell growth over time and should not happen immediately after the surgery. PCO can be seen visually by the surgeon and diagnosed.

      PD tends to be worst right after surgery, and the effect of it seems to decrease over time. Some suggest this is due to PCO cell growth attenuating some of the reflected light. "Positive dysphotopsias produce visual artifacts that appear as areas of bright light, streaks and flashes central in the visual field.", not general cloudiness. PD cannot be observed by the surgeon. They have to depend on the patient telling them what they see. That seems to be one of the reasons it may be under diagnosed. The patient says they are seeing things, and the surgeon says everything is fine.

    • Edited

      You are so right re PD - the surgeon cannot see what you are seeing so rely on your description. Because they cant see it and cant always fix it, you are advised that the brain will adapt over time. No doubt the brain is very powerful and the more you concentrate on an issue, the more troublesome the issue becomes. Its always best to give it time before doing any further procedures as at 8 weeks, things are still settling . From my own experience i have noticed a positive change between week 8 post surgery and now week 10.

      Wish you all the best.

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