Positive Dysphotopsia; Monofocal

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Hi all.

I just had cataract surgery on my left eye, 5 days ago. It was reported as dense after the surgery. I am mid 40s. Zeiss CT Lucia 602 Monofocal (3 piece) was placed inside with a similar power of my right, uncorrected, so I would have a more balanced image. I am still healing and still see an unfocused image (as it should look) behind a frosty window (should not be there) but towards end of day, when I've been taking steroid drops all day, the window frost gets lower and I can see more of the unfocused image). I will not be performing any work on the right eye until it is absolutely medically necessary.

3-4 days in and Positive Dysphotopsia has commenced. It started out as an arc of light from the right corner and now it radiates on the whole image in concentric circles as I move with the light source hitting the corner (eye facing from center inward to nasal).

This is a bit of a hazard situation as one cannot see through these rings.

This happens in day, night, indoor and outdoor.

I can actually see the lens corner in my eye if i put myself in the spot where it is happening and then slightly shift my head / eye outward. When I did that it seemed like I was looking out from thick glasses on the thick part (where it usually gets distorted).

My left side had RD with Mac off a few years ago. Retina was reattached with gas bubble and scleral buckle. I had a vitrectomy.

I am highly myopic (past ~-20+ diopter in contacts). This eye never developed like the right and it is a lazy / amblyopic'ish eye and does slide (which I correct consciously / routine throughout all day / every day). After the retinal reattachment, I likely would just get ~20/60. I do have some image distortion (used to have more but things have smoothened out (i.e. straight lines appear wavy, pictures arc, text can be a bit twisted the more corrected things become, etc.).

Do you feel the lens needs to be potentially repositioned to alleviate the PD?

Perhaps while I heal my eye will better position it and the PD will vanish in a short time? I can't really operate like this. Anywhere with lights really. No such issues were present before (with the natural lens).

Thank you for your time.

0 likes, 14 replies

14 Replies

  • Posted

    In theory, you could get a different opinion as to whether your lens was centered on the pupil.

    • Posted

      Thank you.

      Ya; I have 1 week follow-up this week and I'll inquire.

  • Posted

    I do also want to mention that when this happens, it is a bit of a binocular effect; as if i am wearing thick glasses. It can make one feel woozy if subjected to it for a slight bit of time and moving (like in glasses).

    The more intense the light, it would seem the more intense the strike / effect.

  • Edited

    While I cannot get dilated, as of yet (waiting for 6 weeks), the lens position appears to be ok upon initial look. I'll update as things progress. PD remains unchanged.

    • Posted

      Why can''t they dilate the pupil? They checked my iol a few days after surgery (and gave me pupil dilation eye drops)

    • Edited

      I was told that it 'may' move things at 1 week post op. My pupil was constricted 1 day post op. It is symmetrical with right now (unoperated) and is responsive.

      I did get checked at 1 day, 1 week and the extra 2nd week post op, without dilation. I presume I will get dilated at 6 weeks so I can be ultimately cleared for contact lens use. I do want them to dilate, so the retina is inspected (to ensure these fragments post-op did not potentially make its way to the back from the front which may cause issue) and lens positioning, accordingly.

      I did meet with the surgeon, and was told there was not anything that can do surgically and it will be under a wait and see and should get better. I'll see how things go in the next few weeks once I get off the meds and my eye is fully healed (there is a little inflammation left). I'll make a determination (or not, hehe) then. I do have ghosting as well, but I do not recall if i had this prior and to what extent (given this particular eye and the way I used it in conjunction).

      I'm moving towards accepting of this (PD), after going through the barrage of emotions / states, but in the next few months if I have not adapted / found tricks to overcome when particularly hazardous / bothersome, etc., then I'll see what my options may be at that time.

  • Edited

    Do you see the glowing circles in the center of your field of vision. I do (I have Zeiss' multifocal - AT LISA). It's not a circle around the light source itself, but the circles come when I walk past a light source (or stand or sit still for that matter). If I cycle quickly past street lights, it almost looks like the circles are coming towards me, like a soap bubble getting closer and then bursting. And then a new "bubble" comes, again and again.

    I've always thought it was light reflections jumping from circle to circle in my multifocal lens. But a monofocal lens - like the one you have - doesn't have any circles.

    Do you recognize my description or is it different for you?

    I have to have my lens changed to a monofocal lens now on Monday due to the discomfort, so I am very curious as to whether I run the risk of them still being there.

    • Edited

      Yup. The concentric semi-circles are activated on non-diffused / concentrated lights above me, side of me, across, etc., hitting me in the corner and runs the depth / across the visual field if it hits the left side of it, as i move through it. They are the color of the light source. If the other sides get hit they also move but more confined to their own edges and then they run off on that side. The more light sources, the more concentric semi-circles of light. The more intense the light the more intense the appearance. They are not translucent. The bands could be connected. If connected, the middle piece appears translucent'ish (looking more like a split open PVC pipe except the color is that of the light source(s). It can be faded (depending on the intensity of the ext. light sources).

      When I get arcs of light shaped more like a crescent (if the external light source medium warrants it and its hitting me in the right way), if i stand still, i will see it flash in the middle then appear at edge again then vanish, the again, etc., as my eye micro moves, but i may not see it fluidly move like the above. I can see both types on the same light / light medium (all depends on how i position myself).

  • Edited


    1. Ghosting / Monocular Diplopia: Appears to start vanishing when I put nightly (medicated) drops in (comes back after a few minutes). I surmise, that this will likely improve once I get off the steroid drops and my corneal surface is allowed to heal naturally. Also, after putting a contact lens in this eye, it should temporarily make changes (really permanent in my case since I always have a contact lens in this eye and do not have it out for more then a few hours at a time) and 'should' further reduce it.

      1a. Noticing some starbursting on certain lights (usually bright) and particular angle of view.

    2. Positive Dysphotopsia: Appears to be more sensitive. Really any light(s) can do it at this point as long as the concentrated part of it hits me just so. I found one of the major spots which I can squint out, to reduce in times of potential hazard / craziness. For the one's I look at constantly (indoor; my monitor, etc.), my brain is (snail's pace) adapting and appears to adjust my gaze accordingly, somewhat. Unfortunately, I can't feasibly stare at all combinations in daily life (outdoor, some indoor) constantly for weeks on end, to expedite this. I've been overexposing myself every day / night so have largely gotten desensitized. Doesn't help in it being a blocker, but I'll keep riding it out, for the interim. I consciously adjust my gaze as best I can (my brain does it better via automation / adaptation and gets closer to a wipe for functional purposes).
    3. Some strain around eye sockets' muscles as my brain is just not used to / ready for the eye being boosted this high with the added power in glasses (the lens on left is near-mirrored to the right's on the particular spectacles I have) on top of the correction performed in the IOL (I can't put a contact lens in this eye yet). This should get better once I can put a contact lens in this eye and dial it better in, for longevity and adapting. I don't really wear glasses in a consistent manner so out of practice (acuity is not as good and doesn't work as well with my strabismus / lazy eye and would need to re-train myself).
    4. Some eye dryness (which is manifesting itself differently then what I know of eye dryness in this past) and at times foreign body sensation / lens poking. I suspect there is micro movement occurring as I heal and the lens gets further pushed in place / to the front as the bag shrinks and scar tissue forms and further fibrosis occurs. 'Should' get better once I am off all (medicated) drops.
    • Posted

      *1a should be 2a.

    • Posted

      2b. Also, noticing some maddox rod effect on certain light sources.

  • Edited

    Had a 6 week follow-up. All looks well in the front / back. Have been taken off meds and allowed to put a contact lens in the eye.

    Surgeon feels further surgery may make the problem(s) worst. He feels the Retina is where the origination point may be (I did have RD MAC off a few years back in this eye). I'm uncertain on that as these didn't start until the lens was implanted. I'll see about having that sanity checked to factor it out.

    I'll ride this out to the 4 month mark, observe and reserve judgement, until then.

    It does feel good to put a contact lens in this eye. I'm boosting it to the highest I have in a long long time. The dual eye image seems more lively, right feels less stressed and I feel my brain has more data to construct my visual view. Unfortunately, I have Metamorphopsia due to Mac off (which has been smoothened out some via neuroadaptation over the years but still not quite right) so I'd prefer not to let the left take control (I like to tuck this image underneath the right and just provide backing for it). I do see it trying to take more dominance / equality but my brain is starting to get the hint, hehe, and re-configure / orient things a slight bit to more avor the right.

    Unfortunately, these aberrations put a damper on things. Such is life, for the now.

  • Edited

    I wanted to update this thread.

    I have opacification forming. I'll need to YAG it, at some point. Problem is, it could make the aberrations I see, worst. It will also introduce floaters. I have a follow-up in 3 months, as surgeon is concerned over making the abberations worst, so do not want to do it at the current moment. The eye also has a touch of dryness. Retina, currently, looks good.

    I was told the bag itself seems very tightly clenched on the lens. No doubt there are likely wrinkle(s) there, attributing to the PD(s).

    I was also told explants are not really performed for cases like mine (sans an emergency situation), should I want it. Perhaps if I did want it, I likely then would need to find a specialist who deals with cases like mine. I have no plans to attempt an explant (astonished the eye survived all it did, thus far!)

    The eye itself usually has a haze about it. As if your contact lens was dry. After waking up from a sleep / nap, its decent for like an hour then starts reverting back. However, I do have good hours and bad hours, at times, hehe. Perhaps I'll look in to sparsely using drops, but do not want to be chained to them.

    The strabismus seems to have gotten worst with reconciliation of light and synchronizing it with the right. There is a difference in my perception of light with this lens versus my natural lens, which now only exists on the other side. I expected that, somewhat (not the strabismus going haywire, hehe). I was referred to a specialist, but I've been dealing with it for the entirety of my life, so I believe in time, I'll re-adjust / re-learn methods to control / keep it more at bay.

    I have neuro-adapted a bit of the Positive Dysphotopsias away and have largely been desensitized to the rest, currently (~5.9 months post-op). That does not mean they are not a thorn in my side, here / there. They are, I just have needed / needing to adjust (as all of us).

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