Refractive 'surprise'
Posted , 6 users are following.
Hello there, from extensive research and reading scores of posts, it seems my vivity lens is doing the opposite to what it should do. I had a Zeiss lara lens implanted in my non dominant left eye two years ago. Complete success, no issues. From the moment I took the padding off - boom - instant clarity, utter amazement. I had been told the right eye was developing cataracts so when I noticed vision in the dominant right eye was deteriorating I just thought, same again, nothing to worry about it etc. For reasons that were not made very clear to me the surgeon recommended I have the vivity lens this time. My near vision is good (right better than left) but anything beyond 2/3 ft is blurred. It took about 4 post surgery consultations for the surgeon to concede that this was not the outcome hoped for and is known as a refractive surprise (terrible term). He admitted that the lens was 'ever so slightly out'. He has suggested PRK lasery surgery but says this may result in losing quality of near vision. In addition, whereby I did not have any major issues with halo's etc. after left eye implant, the dominant right now dictates the overall image. Every kind of light I look at has a fairly large 'plectrum' (guitar pick) shape around it (the pointed end at north west) and closer lights the starbust is really problematic. Vehicle tail lights have a bright radius of about 4ft either side. Anything that has a light causes issues, the kettle, TV, the circular light around the top an electric tooth brush etc. casts a bright circle all around when I use it. I brush teeth with eyes closed. I am a year on from having the vivity implant, it hasn't got worse or better. It has been suggested to me that the lens was implanted back to front but that is not something I can proove. Have an appointment with new consultant tomorrow. Ultimately I would like the lens replaced. My former surgeon visibly recoiled when I asked if this something he could do and spluttered 'oh it's just so messy, and wet tissue, and slippery and ugh, horrible...' etc. I have just turned 50 yrs. and I am really depressed with the vision I have been left with. Each surgery cost almost $6000 (world renowned eye hospital) but I would not put a price on having clear vision. Thanks for reading.
0 likes, 11 replies
RonAKA Mallyog
Posted
You may be best to exchange the lens with a distance set monofocal. Perhaps ask the new consultant about that option.
Guest Mallyog
Posted
Did he explain exactly what he meant by "ever so slightly out"
Sue.An2 Mallyog
Posted
time for 2nd or 3rd opinion. Certainly would not opt for this surgeon. It is a more riskier procedure to exchange s lens. Best to do a bit of digging to find one that does this with success.
All the best of luck to you
greg59 Mallyog
Posted
A couple of surgeons told me that explants are becoming much more common and less risky than in the past. They just reopen the capsular bag, cut up the IOL, remove it and install a new one. The hole in the bag might be slightly larger and there is a bit more risk that the bag could be damaged and wouldn't support a new lens. In that unlikely event, you'd probably get a monofocal in the sulcus, not ideal but vision shouldn't be compromised.
The longer you wait, the the explants could become a bit riskier. The bag might adhere a bit more to an older IOL than a fresh one and increase the risk of bag damage when removed.
RonAKA greg59
Edited
Google this to find a youtube video of the explant procedure. This was posted by the surgeon that did my cataract procedures. He is a teaching professor at the provincial university in our city. This was 13 years after someone (foolishly) got a clear lens exchange. After my second eye was done it became apparent that I really should have had a toric lens. He offered to do an exchange, but I turned it down. It strikes me as a pretty invasive procedure, and I decided to let sleeping dogs lie....
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IOL Exchange 13 Years after Cataract Surgery Chris Rudnisky MD MPH FRCSC YouTube
greg59 Mallyog
Posted
I'd make sure I asked any other surgeon or optometrist who looks at your eyes about the possibility upside-down IOL insertion and how it could be diagnosed. If that happened, it's important to get it removed so it doesn't put pressure on the cornea and cause eye damage in the future.
Guest greg59
Posted
So they determine right side up by the shape of the haptics when the IOL unfolds in the bag. They should form a "Z" (or 7 and L as some say) as opposed to an S. It would be almost impossible for a surgeon to miss that I think. On the off chance an IOL did unfold the wrong way they would almost certainly notice it and flip it at the time of surgery.
greg59 Guest
Posted
True....but there are videos showing new surgeries where IOLs previously inserted are flipped from upside down to right-side up. Also some articles describe the problems that will be created if an upside down IOL remains in the eye too long. Undetected upside down IOLs must happen occasionally and when they do, myopia and unwanted optical effects will result.
YouTube Search: AAO In Situ Flip of Upside-Down IOL: When and Why?
RandallG Mallyog
Posted
I feel your pain. I also had a refractive surprise (terrible term, I agree) with the Vivity: +0.75. I was going to distance and now I have a focus well past infinity—which does not exist 😃 😦
As a result, I don't see clearly with my IOL eye at any distance and my least worse distance is beyond arm-length and much closer that, say, television. I can see my feet quite well without glasses and, I supposed, going to art galleries would be OK. Anything beyond that I need glasses ... and glasses with EDOF lenses are not as effective either ... How many things I wish I had known or had been told before deciding to get the Vivity.
It's been about a month since the operation.
It was VERY stressful at first, especially before I go my glasses to correct to the refraction so I could drive/watch TV/etc -- remember that I still have the myopic cataract in my other, non-dominant, eye*.
But I am getting more used the condition and less stressed anxious about it—and more philosophical. I am happy to share what helped to settle my thoughts and emotions if it will help because the emotional symptoms are often worse than the physical ones.
In terms of getting the replacement surgery to fix the issue, from what I understand the benefits are less than before (at least I don't have a cataract and I am much less myopic) and the risks higher (they have to cut up the old lens with micro-scissors ... what could go wrong.)
Thank you for sharing. You are not alone.
Guest RandallG
Posted
Randall, now that you know your refraction have you considered LASIK, SMILE, or PRK? I take it the surgeon didn't suggest or offer an exchange?
RandallG Guest
Posted
Hi David,
I considered all of the above, but since I can correct to 20/25 with glasses, I am not too keen on risking another surgery—even if it were offered for free. And definitely not before getting my other eye done (which will probably be with a different surgeon and a monofocal lens set for distance.)
As I mentioned, my reasoning is that if my vision from the IOL eye was like that before surgery, I would not have opted for surgery.
Since most cataract surgeries are successful, you tend to hear from the people who have done it and are very happy. And the media/doctors tend to minimize the risks: "it's a 15min routine affair." All fine and good ... unless you are one of those 1 in 10 or 20 that does not get the desired results (refractive surprise) or those really unfortunate 1/100 or so that have serious complications.
I learned A LOT about lenses and cat. surgery in the past month. And knowing then what I knew now I would have done things differently. Mainly:
Demand multiple pre-op measurements on different machines on different days.
Go with a monofocal lens set for distance in the dominant eye.