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Cataract Surgery and Blurred Central Vision - Retina OK

Hello, All -

I am a 45 year old male.  In middle school, I became very nearsighted (20/400) and developed a long string like floater in my right eye.  At about 20 yoa, I traveled to Windsor, Canada and had successful PRK performed on my eyes (before refractive surgery was legal in the USA).  During my initial eye examination in Canada, elevated eye pressures were noted in the upper 20's, IOP.  After several months, my vision settled down (right eye to longer to stabilize) and both eyes were better than "normal" at 20/15.  I enjoyed this vision for many years.  During eye check ups, my IOL pressures continued in the mid to upper 20's, but no optic nerve damage was ever noted and the disc to cup ratios were between .2 - .4 in my left eye and about .6 in my right eye.  

Three years ago, I had a floaters only vitrectomy in my right eye and was thrilled with the results.  This procedure eliminated all of the many floaters that had developed in that eye over the years.

Fast forward to December, 2014.  Punched in the right side of the face, broke my eye socket, nose and right eye swollen shut.  Eye exam showed left eye normal (except for IOP in the mid 20's).  However, the right eye pressures were running into the low 30's with disc to cup ratios of between .8 and .9, depending on the doctor - even, after healing.  In January, 2015 - I noticed some flashing in my right eye and had to have a small, "horseshoe" shaped retinal tear repaired.  Following the retina surgery and after consulting with the glaucoma specialist, I had an initial cataract and trebectome surgery performed on March 26th, 2015, Due to an incorrect IOL being selected, the lens had to be exchanged two weeks later (AcrySof IQ, model SN60WF, power 20.5D implanted as the end result).  The end result has been vision that has been blurry up close and far away (the goal was plano in the right eye). Due to post-op complaints, I saw a retinal specialist who confirmed that the retina in my right eye "looks great."  This brings us to the present...

As I have healed from the injuries and surgeries, I have been put on Combigan (3x), Azopt (3X) and Pilocarpine (1x) for my right eye. However, I am experiencing some troublesome symptoms in my right eye that weren't present before the surgery.  I now see a black arc along the outer edge of my vision, especially when tying to focus up close.  Along that edge, I also see shadowing, ghosting or double images, especially when near a light source.  I believe that this is negative dysphotopsia and not a retinal issue as the retina specialist confirmed the good condition of the retina.  The small central area of my vision is blurred and the outside 2/3 is noticeably more clear.  If I look at the television news, the anchor person's face is blurred out, but the area around them is visually more distinct.  After several visits to the surgeon, she indicates that "there is no medical reason" for my symptoms.  

Has anyone out there had anything similar to this that can share their experiences?

Thanks a lot...

2 Responses
Avatar universal
If you are able and willing to travel, I suggest seeing Sam Masket MD in Los Angeles.  He is an expert in negative dysphotopsia.
Avatar universal
It sounds like you've done your research, it does match the symptoms I've seen described for negative dysphotopsia in terms of the "black arc". Recent threads give some links on the topic, there are potential treatments for it like a 2nd piggyback lens, but the central blurred area suggests more is going on which a 2nd lens wouldn't address (perhaps a lens swap might be needed if it doesn't resolve). Perhaps someone else knows more, but I don't recall that as being among the usual dysphotopsias, but perhaps its somehow related to the prior PRK and just a rare side effect that isn't encountered enough to be mentioned in summaries of issues.

Due to recently having had cataract surgery its seems likely a retinal specialist  would assume by default its most likely something to do with the lens rather than the retina, so perhaps they overlooked something. Since it does seem you do have a negative dysphotopsia it seems like a specialist in that might be able to suggest whether there that is definitely the explanation for everything or whether there is another issue going on, whether perhaps you need a 2nd opinion from a different retinal specialist if they could have missed something or some other eye speciality.

I'm guessing you've researched possibilities enough that the blurry up close and far away isn't something obvious like residual astigmatism.  I'm guessing by "blurry up close and far away" you mean at all distances, not that intermediate is ok  (indicating   that is where they left your best focus so other distances aren't as good).

Just to speculate about unlikely things (given an unlikely symptom), I'm not an eye doctor so I don't know if this is possible. I've seen mention that the  power of at least some lenses will   vary from the center to the edges .  I don't know if you are more sensitive to it for some reason   and perhaps your refraction is set so the periphery is in better focus than the center.  Usually we aren't aware of the difference since our eye scan and piece together the usually better central image of what we are focused on, a longshot is to wonder if something about the trauma to the eye impacted its movements.
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