Eye more cloudy and out of focus 7 weeks after cataract surgery

[Wolfhall]

I had cataract surgery on my right non dominant eye on 29th of June.  It was a standard IOL adjusted for distance.  Afterwards I was very greatful for the improvement, although it is was and is very difficult to read at present,  as I have quite a large cataract in my other eye which is growing quickly now, and it is too soon to get glasses.  28 days after the op I had a few minutes of rapidly moving, flashing lights and I knew I was experiencing a PVD.  The next day I woke up to a very large white  floater right in the middle of my field of vision.  I had had this happen in the other eye years ago but that one is off-centre.  I know that these shrink and you learn to see through them but it was disappointing.  I went back to see my surgeon and he was ready to answer all my questions about having a Symfony implant in the other eye.  However I was concerned mainly about my right eye.  He had a quick look with dilation and said there retina looked fine.  However, 10 days on I have a lot of new, tiny black floaters and now my vision in this eye is slightly out of focus even when I flick past the floater.  There is a little astigmatism this eye but immediately after the op I could drive easily without glasses.  Now I can only drive in bright sun.  I realise the floater has lost me some vision and my brain is now taking more info from my left eye but even despite this I am positive the vision has deteriorated in the operated eye.  It was red a few days ago and hurt, but both of these symptoms have now subsided.  I do have Sjogren's Syndrome but use the drops and also have controlled border-line glaucoma. Would it be possible for the capsule to be clouding already?  Could a very slight movement of the IOL cause this? I am very upset, I know things may well work out fine but I can't stop worrying. I can still see the TV up close but road signs are blurry.  Any advice would be gratefully appreciated.  I have emailed the surgeon and I was waiting for a nurse at the local eye hospital to ring me back too but have not had a reply yet.  Thank-you.

[JohnHaganMD]

Well best of luck. I think I said this in a posting but a Restasis like eye drop is in testing and should be available in Europe.  SS can be severely damaging to the eye and cornea and remember there is a 6 month lag time after your start Restasis so do consider trying to get access under some supervision.

Best of luck
JCH MD

[Wolfhall]

Hello Dr Hagan, yes, I have Sjogren's Syndrome but now I am a bit less stressed about my eyes and I still have  the punctal plug in the worst eye, so the symptoms are not so bad as they were. When I asked about Restasis my surgeon looked horrified so I suppose it is much less common here, but it sounds like a godsend for people with really bad dry eyes.  I use drops called Hyabak which seem to work very well for me  I don't really want a plug in my other eye as for ages I could fell the one in  the right eye when I looked left.  In fact I had to shut my eye when I looked sharp left as I could feel the plug rub otherwise.  I don't think they offer you the dissolving plugs on the NHS .  The tweezers to remove the plugs looks scary to me but I'm a bit of a coward.  If my eyes got worse again I would definitely consider Restasis.

[JohnHaganMD]

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[CBCT]

Thanks.  I have a friend who uses them.  I will pass the word.

[JohnHaganMD]

We put our opened vials in the fridge in a measuring cup.  Some people after being on the drops for several years can get by with once/day however don't recommend it as my wife tried it and break through symptoms then it took 3 months of misery going back to twice/day for the restasis to kick back in.

JCHMD

[CBCT]

Great advice about saving money on Restasis.  Do you have tips about proper storage of an open vial?

[JohnHaganMD]

If you have dry eyes and dry mouth you might have Sjorgren's syndrome and you should be tested for that.

Restasis need not be expensive. This is what some people do. a 30 day or 90 day supply is based on using one vial  then throwing away the rest remaining and in the evening using a second vial thus you use two full vials/day.  Most people use up all the medicine in one vial before opening a second one. This way one vial lasts two days so in effect it reduces the cost 75%    It is a wonder drug for dry eyes. Done miracles for my wife and me and scores of my patients.

JCH MD

[Wolfhall]

Hello Dr Hagan sorry for delay in getting back.  I had to wait a long time to see my surgeon.  I have no tear thank goodness although the little black dots are still driving me crazy when I let them.  l find tinted glasses help and just keeping busy.   I am getting used to cobweb as I did with the other eye.  I got glasses from my opticians and this has made a worlld of difference.  I know I do have some astigmatism,  but less, I think, in  the dominant eye which still has the cataract.  I have postponed this other surgery for a few months. With my new glasses, through the dots, I can see the windows in tiny houses about half a mile away, seemingly in focus.  This is pretty good with only one decent eye! I can only drive in the dark on slow roads as the cataract blows up lights at a distance but otherwise I can see the road super sharp, even through the cobwebs, on a sunny day.  There is a bit of double vision in the non- operated  eye for close up vision but I am so relieved to see distance well. Reading is not so good but I will have to have the other operation in a few months and then I hope it will be ok.

I asked my surgeon about Restasis.  He said he only prescribed it to his private patients who have red , really sore eyes all the time, as there are side effects such as kidney problems.  I have discovered that you can only get it privately and it is ever so expensive here. My dry eyes are only bad when I am really stressed , (when I get a dry throat too) or when I watch TV for more than 2 hours or other thingswork on the computer too long.  So I guess I'm' really lucky. Thank-you again for all your help.  This is such a great forum and it really did help me when I needed it most.  My family were so fed up with hearing about my eyes!

[JohnHaganMD]

Restasis stings most people when you first start. Lasts several weeks then stops. Can be eliminated by using steroid drops for 2-3 weeks when you first start them. That's what my wife and I did.

JCH MD

[Wolfhall]

Thank-you, very much, Dr Hagan.  I will look into it and report back.  I fall into your 90% category but I've noticed dry eyes are an increasing problem among the young who look at tiny screens all day. I only found out I had dry eyes by accident at the opticians after months of waking up suddenly because my eyes felt like they were sticking to my eyeball. As you know, it can feel like someone has crept up behind you and stuck something small and sharp in your eye.  I can manage it better now but the first few weeks after surgery were a bit tough.  I really didn't like the tear duct implants very much as I could always feel one rubbing when I swivelled my eye so I learned to shut it when that was necessary.My surgeon wanted to sew the tear ducts shut but I looked so horrified he changed the subject, I would much rather try Restasis even if it does sting a bit!

[JohnHaganMD]

I'm not sure how you might get Restasis (cyclosporine) check out their website.  www.restasis.com    Restasis is the most widely prescribed eyedrop in the US.  90% are post menopausal females; 10% males and pre-menopausal females.    Seems there should be some way to get the medication. a factor raised is the cost.  The drops are non-preserved and you are dispensed two dropperettes to use each day.  Everyone, myself and my wife also, use up one completely before opening another. One vial will last 2 days. Thus it reduces the cost by 75%  (use one vial/2 days instead of 4).

JCH MD

[Wolfhall]

Sorry pushed button early.  Thank-you for reassurance much needed.  I will certainly ask for my eye data and full exam before proceeding with LE

[Wolfhall]

Hi Doctor Hagan. Thank-you so much for answering me I will leave work early and get a full scale exam. My eyes have been super dry at night.  I have read all the articles written by you that you mentioned and was fascinated by your paper on dry eyes.  I had never heard restasis until I read this.. I got some omega 3 tablets in the post today and am using my current  drops before bed and again at night.    I had plugs in my tear ducts, but the one in the right eye seems to have popped out as my surgeon removed the mask the day of the operation (other also missi g in action).  We laughed about this but I think this may be part of the problem.  I too am worried about all the hundreds of tiny, tiny dots as I thought it might be evidence of bleeding somewhere.

[JohnHaganMD]

Wolfhall  Greetings from across the pond.

You have to prioritize your complaints:

1. The thing that most concerns me is the description of lots of tiny new floaters. That is more concerning that a few big floaters. This is especially true if you have had some flashes or light; if your refractive error prior to surgery was greater than -3.00 or of there is a history of retinal detachment. I would insistent on a repeat examination of the retina.  As for the big floaters you will get use to them or they will settle down below or lateral to your visual axis. I have a huge Weiss ring in my right eye and PVD both eyes and I have "tuned them out"
2. Cataract surgery is a stress for dry eyes and of course Sjorgren's often have severe dry eyes. If your vision improves with blinking or instilling artificial tears the variable vision may be due to drying of the cornea. Step up the artificial tears. Read the postings here about dry eyes. Both my wife and I are on restasis and it has done miracles (after about 6 months) on our dry eyes.
3. You don't want to do the fellow eye till your right eye is stable and you are "happy".  You will soon need an end point refraction and glasses prescription for the RE.  Then you and your surgeon can decide what to target the LE for uncorrected refractive error. Be sure you have read this article I wrote and the subsequent discussions    http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;
4. It is highly unlikely the capsule has clouded this quickly. Posterior capsular clouding is now only about 20-25% and usually years later.
5. It is unlikely the slight movement of the IOL would cause your changing vision.  The fixation is good and the IOL has a optical center several mm wide so that minor movement will not change the vision.

Get working on having the retina re-examined.

JCH MD