Really poor night vision after cataract procedure

Hi

Im 52 years old. I had congenital cataracts and posterior subcapsular. I have no issues with eye pressure or glaucoma.

However I do not know what type of lens was put in, I don't know what material it is made of. It wasn't a multifocal not got astigmatism, just a normal one for shortsightedness so I will need reading glasses. But I'm now thinking was it a low quality one. I was going to ring them in the morning to say Im not happy about what they have previously said and want a 2nd opinion so I will also ask them what type of lens it was.

However l noticed something very unusual today I went for a drive around my estate tonight and everything was blurry and couldn't see. But when l looked out of the side wing mirror, it was perfect. So I stopped the car at few places where there were houses, cars, bushes etc behind me, I got out of the car and could hardly see them. It was all blurry and the darker areas were invisible to me, but when I sat back in and looked at them through the side wing mirror it was like l had 20/20 vision. There were no issues with night blindness, or was so sharp!! so l will mention this tomorrow too.

I think there is a definite issue with the lens.

I would ask if it is an aspheric lens, or spherical lens. Your eye cornea has some aspheric error, which is offset by the opposite aspheric error in the lens. When the lens is removed in cataract surgery the IOL if it is aspheric does this same correction and brings the aspheric error back close to zero. There are lower cost spherical IOLs that do not make this correction. When properly corrected the contrast sensitivity at night is improved. You could google this article for an explanation. We can't post links here, so you have to search for it.

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Eyeworld 2009 Aspheric versus spheric

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The other issue is whether or not the lens has blue light filtering. It is claimed that blue light filtering improves night vision as well. Blue light filtering IOLs are actually yellow in colour. It could be advertising propaganda. I don't know...

I should add some caution to my comment. While one lens may be better than another with respect to vision in low light, I don't think it would be a huge effect. If you just can't see at night, there must be more than that going on...

Thank you for this, I am going to ring them now and see what they have to say, They might not tell me much over the phone and might ask me to come back in. I will let you know what they say. Thanks

So they've said that I have to wait a few weeks until the opticians check my eyes. They said in their checks everything was OK. Eventually I got sick of arguing after trying to explain all my issues ie night blindness.

At the end she added that it might be I need glasses as there might be a refractive measurement like astigmatism that wasn't accounted for.

I do have astigmatism and it was on the prescription that was sent by Boots on my referral, so why did they not account for it!!! But at this time I had lost the will to argue.

Seems they've just put in the lens they wanted to.

So now will have to wait what the opticians say possibly sometime in January 😕😕

I assume you are from the UK? In Canada the way it works is out health care system pays for a basic lens, and if you get something more, you pay extra for it. Since healthcare is provincial it varies from province to province what they consider basic. Where I am, they cover the cost of an aspheric monofocal lens. In some provinces the basic lens is a spherical one, and you pay extra for the aspheric version. And, I assume in most provinces you have to pay extra for a toric lens for astigmatism.

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Astigmatism is tricky as the amount you have in your eyeglass prescription is the total astigmatism in the cornea plus what is in the lens. After cataract surgery the lens astigmatism is gone, and if you correct for this residual with an IOL then it only has to correct for the astigmatism in the cornea. Here in Canada, unless you pay for the toric lens, you are just left with the residual astigmatism to be corrected with eyeglasses. Another option is to have what is called limbal relaxation incisions to reduce the amount of astigmatism. Those we have to pay for as well. However, if you have a lot of residual astigmatism (>1.5 D) it is better to correct with a toric lens.

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When I had my eye done about 2 months ago, part of the package they gave me when I left the hospital was a card that has the specific data on the lens including the exact model number, power, and serial number. If you have that card, it should tell you what exact lens they put in.

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When you go for your optical check be sure they measure your eye pressure to see if glaucoma may be developing. They should do it as a mater of routine. A cataract surgery can change the pressure in the eye.

Thanks for this, yes I'm from England, and it seems they have done what you've said. They have just put in a monofocal lens and completely ignored the astigmatism reading. But what troubles me is that I have had glasses made in n the past without the astigmatism prescription and I could hardly tell the difference ie the glasses were fine and l could see clearly. But now when they have omitted the astigmatism reading in the iol. The result is completely different and in the evening and night time it seems that I'm walking about with no glasses on (I'm minus- 3.0)

So it's had a really negative effect. I wish they had told me this before and I would have had it done from elsewhere or paid for it myself be gone private 😕

Ron where you live would they not credit you the value of the basic lens if you had chosen something else? They do in New Brunswick. Procedure covered regardless of lens selection.

We never got into those details, but yes, that is my understanding. They would charge me the differential between a basic aspheric lens and a toric lens, or the difference between the basic and a multifocal or EDOF.

gmag21 that could not happen at the NHS. They only implant monofocal lenses. Have family in England.If you want a premium lens you must go to private clinic.

Yes I have checked, they said the implanted a monofocal lens. I have opticians appt in January and they will check. I haven't a clue what's happening so can only wait till after the opticians have checked. They have to wait a few weeks to ensure swelling etc has gone down. Hopefully will know more then.

Hi Juber

Yes, so 4 weeks post procedure Spa Medica called me and they checked my eye and said the lens was OK but back of the eye had become cloudy and it would require YAG laser, but have to wait 3 months. But due to one thing or another it got done 6 months later in June 2021. But it didn't change anything, so when I complained they called me back, checked me and said everything was OK. They wouldn't even refer me on to Manchester Eye Hospital. I then got it checked by Boots, they also said everything was OK. The NHS opthalmology dept checked and they said... Well I suppose you get the pattern... yep everything is fine!!! I said I couldn't see at night, eventually someone put me through to a local optician. He checked and said there was 2 pieces of debris which was either part of the old lens or debris from YAG laser, but more importantly he said the YAG laser had been done slightly off centre. So in dark light the pupil dilate but it was missing the hole made by YAG.

After a lot of to and fro - ing finally managed to see someone at Manchester Eye hospital, he also confirmed this but also added that apart from being in wrong place, the actual YAG was very small. So he lasered it again, he said it wouldn't be perfect but would improve a lot from where I was, and sure enough it has made a difference. Still not brilliant but a big improvement, so ask them to check for cloudiness behind lens.

If it needs YAG make sure they do right. You see skilled opthalmologist do the cataract procedure, but the YAG is just done by the assistants and they're not as experienced. Get it checked and let me know.

I had my cataract op a week ago and tonight was the first night i have slept without my eye shield, it really shocked me to notice that that i couldn't see in the dark, its like looking through thick fog, plus it seemed to get even more blurry towards the edges of my vision.

I'm now in a bit of a panic, when i look with the other eye, which i am having done in a few days my night vision isn't blurred.

I had my post op appointment a few days ago and my next visit is for the surgery on the other eye.

i am paying privately and have paid extra for the prescription lense which is also an oval shape which i presume is a toric lense to correct the astigmatism.

Unless there are some very compelling reasons, it does not make sense to schedule the surgery on the second eye for at least 6 weeks after the first surgery. 5-6 weeks are required for a full recovery of the eye that has had surgery. At that point you should have an optometrist eye exam to find out what the actual outcome of the first eye is. Then you can make a decision on whether or not you want to make changes for the second eye - the target, or type of lens for example. The surgeon should also be interested in the actual outcome so they can learn something from it.