So frustrated with blurry vision 6+ weeks after surgery
Posted , 5 users are following.
I had my first eye done a little over 6 weeks ago. For a couple days post-op, the vision was great. Then the blurriness hit. The outer edges of my vision were really blurry, leaving a tiny window in the middle that had good vision. At my 1-week optometrist visit, he said my cornea was dry and gave me some lubricating drops. I tried them and my vision got a lot better right after, but I got a terrible headache. I tried many other drops, but none of them had the same effect, so I went back to the original drops (Systane Hydration) and my vision started to clear up again. I ordered a box of them, and they seem to be completely different--not nearly as viscous. At my one month appointment, the doc gave me another sample package of the "same" drops--again, more viscous and my vision started clearing up again. I ran out, and it's getting worse once again. A few days ago I had my second eye done and at the day after appointment, I told the surgery center doc that I was having problems with blurry vision in my first eye. She said there was some inflammation and increased my steroid/antibiotic/NSAID drops (and I had just finished them the day before--drat!)
The lubricant drops that really seemed to work well from the optometrist were really oily--I ended up with an oil slick on my eyelids, but they did help my vision. The packages I've purchased don't leave the same oily residue, so I suspect they've changed the formula, and the new drops don't work as well.
I'm also freaking out a little bit because no one has dilated my eye to look at my retina at any of the appointments, and with diabetic retinopathy there's a higher risk of complications. The optometrist says if there was a problem my acuity would be worse, but I should contact the surgeon if there are problems. The surgeon's office says the optometrist will do it, and refers me to him.
Since one particular brand of eye lubricant seemed to help I'm inclined to think that it might be a dryness issue, but I'm wondering if I need a trip to my retina doc just to be sure. (I contacted his office before the surgery and they said there was no reason to come in before my regular appointment in December.)
Anyone else having problems with blurriness this long after surgery? The vision also seems a little dimmer than in the eye with the most recent surgery, and whites don't look as white--but that might just be inflammation.
And are there any recommendations for a good oily eye lubricant?
0 likes, 9 replies
RonAKA lucy24197
Posted
On the eye drops my wife uses them daily for dry eyes. She likes a product called HYLO which we get at Costco. The active ingredient is 0.1% sodium hyaluronate. I use drops occasionally and use another product from Costco called HydraSense Advanced. It contains 0.15% sodium hyaluronate, or 50% more. The HydraSense is probably about 1/5 the cost of the HYLO. HydraSense is made by Bayer, and I am not sure it is available in the US, or if it is, perhaps under another brand name. We have tried another product called Systane Ultra and neither of us like it as much. It does not contain any sodium hyaluronate.
lucy24197 RonAKA
Posted
I'll have to check out the active ingredients on the many drops I've purchased recently and see if any of them have sodium hyaluronate. I'm getting some new drops delivered tomorrow. I'm starting to wonder if I've got some issues with my oily tear film, and am getting some drops that are supposed to help with that. My upper lid has been a little swollen since the surgery, so there may be something going on there. I've been doing warm compresses today--too soon to see if it helps--and some drops that are for mixed dry eye. I think my vision is a little better tonight. No telling if it's the extra prescription drops, the different formulation of tears, the compresses, or the phase of the moon.
jettesun lucy24197
Edited
Strange that they've not done a dilated exam to have a look at your retina, especially given your situation. It must be frustrating to be thrown back and forth between surgeon and optometrist like that, with neither one willing to call it.
I also noticed that things got darker in the operated eye, between 1st and 2nd week after surgery. It was like the wonderful brightness and colors I saw just after surgery, now had a blue/grayish blanket thrown over, and the unoperated (still has cataract) eye is now the brighter one. In your case, I would think both eyes should be the same brightness, now that you've had 2nd eye done. If first eye is darker, it seems to me that "could" indicate a problem, and I'd at least want to have it checked out.
I have an old amsler grid I pulled out and have been using, but you can download and print out one if you don't have. I've found it useful to gauge changes in my eye. When the retinal swelling was at its worst, there was a soft donut-shaped washed out circle around the center dot where the grid lines were totally occluded. It went at least half-way out to edges of grid. Between that area and edges, there were scattered blank spots, but I could see some of the lines out there (peripherally). They were wavery/curvey.
For whatever reason, I feel like my eye surgeon's office (All of them, there are several surgeons and other professionals in that organization), did Not want to diagnose me with anything. He did do a dilated exam, fussed about my BP but didn't see a reason for my loss of VA, and even put in my chart "subjective visual disturbance". This was halfway into 2nd week after surgery (day 10 to be exact), when I began to panic about my vision being so much worse first half of day. You're probably aware I got 2nd opinion from totally unaffiliated eye professional, she did extended retinal exam and saw problems. Then back to original surgeon who finally acquiesced to OCT scan, which had my macular looking like a mountain with big boulders inside. Curiously enough, he also dilated my eye that day and looked at my retina, and commented under his breath, "well, I don't See any inflammation!", which instantly made me regret choosing him to operate on my eye.
I have an intuition (and of course, this IS totally subjective), that all the eyedrops have either caused or are contributing to the problem. I suspected the steroid drops after using them for a couple weeks, as I saw my vision worsening and getting so bad. I was also told to double up on them when I began to have issues, which I did at first. When my vision continued to deteriorate, I stopped the steroid one (this was 2 days before completion of 3rd week). I was told to stop the antibiotic at end of first week, which I had done. Had not used the Nsaid at that time.
Stopping the steroid drop at 19 days post-surgery did Not cause the CME, because it was already in full swing at that time. More likely, it was the fact that I hadn't used the Nsaid. Initially, I was given generic drugs, which I have since learned are not so good. I've now been doing the one dose a day Prolensa (Nsaid), since 4 weeks after surgery, not a generic. If I'd been given this one to begin with, this whole situation may have been avoided. Pharmacist told me insurance company won't pay for this until you've tried generic and it didn't work. I didn't use the generic ketolorac at first because I've had bad reaction to Nsaids in the past, but this Prolensa is just one tiny drop once a day, and I pinch off the corner of my eye so it doesn't go down my tear duct and get systemically absorbed. It hasn't caused any issues so far.
Some of the Systane formulations have polyethylene glycol 400. You might want to research that. It is a petroleum product. I actively avoid that ingredient in Anything. But it might not trouble you, everybody's different. I get the feeling that some of those eyedrops make your eye feel better temporarily, but can also cause issues with continued use. I've read only good things about the ones Ron mentioned, however I've been unable to find those in my area.
I can sincerely empathize with you, been traveling the same road. Hoping for an excellent outcome for us both, may take a bit more time than what other people's experience seems to be.
lucy24197 jettesun
Posted
I hope you're seeing some improvement now that they've figured out what's going on. It's wretched the way the doctors are afraid to take responsibility and help patients that have problems after surgery. This "co-managment" approach that my doctors are using means that everyone wants the other guy to take charge.
I've got an Amsler grid and I've been checking it pretty regularly. I haven't notice any real changes. I've had a couple little spots on the grid all along; other that those everything seems the same. I'm really surprised the doctors didn't tell me to use it regularly after surgery with my retina problems.The drops the surgeon has me on is a compounded mixture of Prednisolone acetate, moxifloxacin and nepafenac. Since it's a mixture it's not available through the pharmacy--I suspect it's made up of generics. My poor first eye is now on its 7th week of drops.
I may have to find a new optometrist after this. I'd only seen my current doctor once, when he referred me for cataract surgery. The previous optometrist completely missed my retinopathy until it was moderate to severe (sitting in the corner saying to himself over and over "I can't believe I missed this" was a pretty big clue that he missed it.) I'd been telling him for a couple years that I was having problems with my vision. First he blamed my glasses since I didn't get them at his shop. Then he told me I just needed a bigger tv. My problems with glare he blamed on floaters.Now the current optometrist isn't doing the dilated exam he said he would do, and tells me things like this can't be PCO because that won't show up for 3-5 years, and he doesn't need to check my retina since I can see the Snellen chart ok. I just wish I could find someone who would do their job and not pat me on the head and act like I'm a complete idiot.
Bookwoman lucy24197
Posted
lucy, have you been seeing an optometrist, as opposed to an ophthalmologist? If so, hie thee to an actual MD, preferably a retina specialist.
lucy24197 Bookwoman
Posted
Yes to seeing the optometrist--I wasn't given a choice. My optometrist referred me for cataract surgery, and the surgical practice "co-manages"--they do the surgery and toss you out the door. (Really--if I was in post-op for 5 minutes it was a long time.) There's a followup the next day, and then you're basically on your own, with visits scheduled with your own doctor. (They had me see an optometrist at the surgical center the day after the surgery--didn't even see an MD for that.) In theory you can contact the surgeon, but when I've tried, I was put on hold for while the receptionist asked a "triage nurse" about my problem--I didn't even get to speak to a medical person myself. I was told to see my optometrist. I have a call in with my retinologist to see if I can get him to take a look at things and am still waiting for a callback. I might try calling the surgical center after hours to get the medical person who's on-call to see if I can bypass the receptionist blockade. Based on the options when you call and get their recorded message, they'll either tell me to see my optometrist or go to the emergency room. It's infuriating.
lucy24197
Edited
We have another winner the the "Macular Edema" sweepstakes. Got in to see the retinologist today. Lots of inflammation, swollen macula. More drops, and I get to go back in a month to see if a steroid injection is needed. On the very, very positive side, the doc said that he didn't think it was anything permanent.
jettesun lucy24197
Posted
So Sorry to hear this Lucy!! I wondered all along if that was maybe your issue too, since we seemed to have the same blur thing going on from near the beginning.
My one-month-later (from diagnosis) checkup is next Tues the 26th, where he will do another OCT scan and see if the swelling has gone down enough to not need the shot in the eyeball. I've pretty much decided not to do it anyway, unless the swelling is way worse or something. But I don't think it is because I can tell that more light is getting through. When I look out of just that eye now, it no longer looks like there's a dark grayish blue shadow over everything. But there's still a waviness to the lines on the amsler grid, and there is an area that still looks a bit washed out, though I can now see light lines through it. Before, they were totally occluded in a soft donut shape. So its not gone away, but I do think it's improved.
I read online that uncomplicated macular edema from cataract surgery (Irvine-Gass Syndrome, as they call it), usually resolves by itself, with or without treatment, about 80% of the time. From everything I can tell, it does have a good prognosis. Just takes time. I sure hope you don't get it in your 2nd eye.
lucy24197 jettesun
Posted
So glad it sounds like you're seeing some improvement. It's strange--I have an Amsler grid that I was checking pretty regularly, and it doesn't seem to be any worse than it was before the surgery. Maybe it's the location of the swelling. The image the doc had up from the OCT scan had a circle over the macula, and most of the swelling was in one quadrant and not in the middle. I just had an OCT test done in June, and there was a huge difference--no swelling in June, big red swollen area today. That's a relief that the prognosis is good. It would stink to go through this and have things end up worse than they were before the surgery.
Tomorrow I have my 1-week surgery followup with the optometrist--the one who said I didn't need a dilated exam since I could read the Snellen chart ok. It will be interesting to see what he has to say about this.