Posterior Capsular Opacity

[Jerry_NJ]

Had left eye cataract surgery done first with standard distance lens.  Vision was good at start and got better over the next two weeks.  Then at the two week point I had the right eye done, with a bit more trauma in my opinion, and the vision was very poor on the drive home, yet next morning the right eye was crystal clear and I believe better than the best the left had given me.  The right remains so now almost two weeks later. However, the left eye got blurry at the time the right eye was done and the surgeon on the next day follow up said I have macular problems, a factor I already know, but he gave no further opinion.  I had an appointment with my optometrist the following week. He said the lese implants looked good, healing well and said the blurry vision in the left eye may be due to posterior capsular opacity.  He prescribed eyeglasses for my astigmatism (mild at -0.75) and said I should make an appointment with him again two weeks out.  I got one three weeks out.  He said if the blur doesn't clear by then it may be necessary to refer me to a YAG laser capsulotomy doctor.  He gave that treatment, if needed, very likely to fix the problem.  I'll clearly not go back to the cataract surgeon given the lack of concern on my bringing the blur to his attention. Then, he may not do YAG anyway.    I don't yet consider the surgeon at fault for my problem in left eye, but his "bed side manner" and follow up  care is zero in my book.   As I have a follow up appointment, I am looking mostly here to learn if any have had a similar experience and have had it clear up without an YAG laser treatment.  It may be additional time will resolve the problem, e.g., if I still have some swelling in the left eye.  I finish my swelling eye drops at the end of next week.

[JohnHaganMD]

What kind of 'macular problems' did you have prior to your cataract surgery that you already know about.  This is not likely a yag laser problem.   You need to be seeing an ophthalmic surgeon not your optometrist.   You should have had prior to surgery a macular OCT to make a macular diagnosis BEFORE surgery and a discussion of how it might affect your expected vision. You need a macular OCT NOW to see if you have cystoid macular edema a common cause of delayed vision return after surgery.  So either return to the surgeon that did the surgery. You paid for 90 days of post op care and get the test and get answers or see a different ophthalmologist.  You may need to seek one out on your own. Optometrists like to use a small group of eye surgeons that 'co-manage' that means essentially they do the surgery then turn you back over to the optometrist rather than following you till you are healed and happy. The faculty of a medical school ophthalmology department would be a good place to go. If you live in New Jersey you should have access to some top world class progarms such as Wilmer Eye Institute of Johns Hopkins,  Mass Eye & Ear, NY Eye & Ear

[Jerry_NJ]

Thanks, I have had diagnosed macular degeneration for years and have been taking AREDS and Lutenin.  I had a full workup on the macular on November 27, about 5 weeks before the eye cataract surgery.  It was stable, no significant changes in the macular in the past 12 months.  My optometrist who referred me to the surgeon has made referrals to the surgeon for 20 years and the surgeon referred me back to the optometrist.  Much of what I don't like about the surgeon is his manners, he is reportedly among the best in the Central NJ area at the surgery.  From what I learned taking with staff at the surgery center he does about 30 eyes a month.   The optometrist gave me the diagnosis of possible posterior capsular subject to a couple more weeks for healing and if not better then refer me back to the MD level.  I'd prefer a different MD if YAG laser is the next step.  Reading on the Web I see PCO occurs in as much as 20% of the time.   Thanks, I'll keep your advice in my pocket if this isn't resolved in the next few weeks.

[JohnHaganMD]

Depending the amount of ARMD you have you eye may not recover 20/20 vision. You have a new lens not a new eye.  ARMD is the most common reason that adults do not recover 20/20 vision after cataract/IOL surgery.   30  cataracts a month is not that much.  I sometimes use to do that many in a week.  Also your optom should not be so uncertain about the status of the posterior capsule.  all that is necessary is to look at it and see if it is cloudy or not. Like looking at a window to see if it is clean or dirty.  With your team I think you will need good luck and again I would encourage you to travel to a center of excellence in ophthalmology.

[Jerry_NJ]

Now almost 1.5 years after surgery and YAG ON BOTH lenses I can say my vision is good, but some trouble with small distant print(T.V. or paper, road signs...). This varies maybe a function of how tired my eyes are.  In any case "great to see" and I understand absent the cateract surgery I'd have far worse vision.  Think that means I'm satisfied.  

[John C Hagan III, MD, FACS, FAAO]

Thanks for the follow up

[SandyMR]

Did this issue get resolved or did the starbursts go away?  
I’m asking because I had IOL done in December of 22, right eye was still blurry and they recommended the YAG PCO. Immediately after the dilation wore off I have starburst from indoor LED lights and my night driving is full of starburst everywhere. It’s been a month and I’m hoping for some insight. I hope this is temporary

[Jerry_NJ]

I never had starburst or any unusual bright light problems.  Yag sergery cleared up poor vision in left eye.  I have standard cataract lenses and use eye glasses for astigmatism problem. One eye, forget which, requires small correction for distance.  I see well enough to drive a car without glasses.

[John C Hagan III, MD, FACS, FAAO]

SANDY MR  I am not sure of your question. Has it been since Dec 2022 that you had the cataract/IOL surgery or since you had a Yag capsulotomy. In either case have you been tested and fit with glasses to wear post operatively?  Are the starburst only in the RE or do you have some in the LE. Has the LE had cataract surgery? Did you get a standard spherical intraocular lens or an upgraded toric (astigmatism) or multifocal IOL  Need to know to answer you.