Vivity toric result: monocular diplopia
Posted , 4 users are following.
It’s been one week since I had a Vivity toric lens implanted in my dominant eye. Since the 2nd evening after surgery I noticed a degradation of image quality at all distances. It seems to be a doubling (ghosting, drop shadow) and is generally most noticeable with black-on-white text or worse yet white-on-black LCD screen text. Larger objects and text have a distinct doubling, whereas smaller text is just a jumbling or fuzz in the background (due to the offset of the 2nd image) which really lessons my acuity. Other than that, I don’t see halos or experience other negative issues. Low light contrast is not a problem.
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I found that the issue completely goes away when I look through a pinhole! I think that this essentially blocks additional light rays that create the diplopia. I also thought this meant I was seeing residual astigmatism and/or that it indicated the problem was a lenticular one as opposed to something going on with my eye health (inflammation, etc).
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I visited the doctor one day after surgery and again six days after surgery. When doing a refraction test, the optometrist was unable to get the image I see to look clear! But the surgeon/doctor said the lens is well-centered and doesn’t appear to be out of rotation. He said my residual astigmatism is at -0.25 and that I can see 20/20 distance and intermediate down to around 19”. Essentially, he is pleased with the results and said the math was done correctly.
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While I can see well enough to read the 20/20 line, because I can mentally filter what is the dominant image and what is the secondary image, that doesn’t mean I have good eyesight. The doctor says resolving the diplopia is a matter of neuro-adaptation and that hopefully things will improve over the next few months. He did mention decentration as a possibility of what could cause what I’m seeing but didn’t suggest that there’s a way to reposition the lens to improve the situation, ie: rotating it two degrees or a fraction of a mm.
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He offered that if I’m not happy with the vision in a few months he could do a lens exchange. Assuming my vision does not worsen and hopefully improves over the next few weeks or months, I can’t imagine giving up what is generally very-much improved vision compared to the cataract I was living with, let alone risk a worse outcome from a lens exchange.
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That said, I’m wondering if anyone thinks it is worth getting a second opinion about:
- the position of the lens – what can really be done at this point? and who would realistically do that?
- what it means that it resolves completely when looking through a pinhole,
- why I can’t get a refraction/prescription that resolves the issue, and
- any other options or suggestions to improve what I’m seeing.
0 likes, 6 replies
RonAKA jay3210
Edited
A couple of comments. First one week is not much recovery time. Normally it takes 3 weeks before it is worth taking a vision test, and 6 weeks if you are planning to get glasses want to avoid a further correction. So one option would be to wait and get another optometrist test at at 3 weeks. The effect may have gone away by that point.
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The issue you describe is exactly the same as what I have in one eye that has 0.75 D residual cylinder (astigmatism). I see a drop shadow on letters, and particularly when the letters are white on a black background. In my case the drop shadow is to the right and lower than horizontal - about 4:00 or 5:00 on the clock. The important point is that this drop shadow is not all around the image, just as an offset. I have a monofocal and should have gotten a toric. When I go to the optometrist and ask to see the eye chart with and without astigmatism correction there is a major difference, and with the cylinder correction I can see 20/15 distance easily. Torics come in fairly large steps, so while the angle may be correct, the power may not be right on what you need. But, that should be correctable like it is for me.
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The pinhole effect almost always sharpens things up for me due I believe to the extra depth of focus it provides. With the Vivity it may also force you to only use the center portion of the lens, and disable the stepped power change on the Vivity lens. If the shadow you are seeing is symmetrical all around letters, then it may be the Vivity technology providing a second out of focus image. If that is the case you may adapt to that over time and learn to ignore it. An eyeglass lens cannot correct for this Vivity EDOF effect, and in that case would point more toward the lens design being the cause, rather than residual astigmatism.
jay3210 RonAKA
Posted
Thanks for your thoughts. No question that i will be giving it more time and see how things shape up.
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In my case, I see a single drop shadow to the horizontal left of letters, and just a hair lower than the primary image.
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One thing that is interesting to me is that the distance seems to be consistent regardless of the size of the letters, so with larger type it looks like a drop shadow that kind of accentuates the letters, but on smaller type, the double occurs as a jumble with other letters. it's a little hard to explain but it's as if the doubling is a consistent 2mm (approx).
RonAKA jay3210
Posted
That is similar to what I have been seeing with the eye that has 0.75 D of irregular astigmatism. According to the surgeon and optometrists it is due to the astigmatism. This is in my near eye which is -1.00 sphere and -0.75 D cylinder which gives me a spherical equivalent of -1.40 D. It limits my ultimate ability to read very small text quickly. I can read J1 on the Jaeger reading test in bright sunlight at 14" though. The pupil closing down obviously helps.
freddi23948 jay3210
Posted
Where there are questions after the surgery, it is always useful to get a second opinion.
jay3210 freddi23948
Posted
yes. I wonder how many weeks i should wait for things to settle before getting that 2nd opinion.
Guest jay3210
Posted
I felt the same way but how does that even happen? If your surgeon works in the public system and you ask for a second opinion (which is a bit touchy when he says everything is perfect but whatever) you could be waiting 6+ months for that. There are private clinics too but they just want to sell $7,000 cataract surgeries… not offer a follow-up for someone else's surgery. Seems like a conundrum.