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Restor Lens Problems
I had cataracts removed 9 weeks ago right eye, 7 weeks ago left eye. I had the Restor lens put in both eyes. I have had nothing but problems and curious if anyone else has had similar problems. My first problem was light sensitivity. I had to wear my sunglasses inside for almost 8 weeks (my husband refers to our house as the Bat Cave). Fluorescent lighting is the worst and thats whats in my office. I had to work with the lights off for the first 8 weeks, I can turn them on now but the light still bothers me. I have dry eyes and it has gotten worse since surgery, the doctor put plugs in my tearducts but I'm constantly putting artificial tears in, which blurs my vision. Then my eyesight kept getting blurry with double vision. The doctor said I have Blepharitis and gave me Azisite. That seems to help but I have to use it every day along with warm compresses and a cleansing routine or the blurry vision gets worse. She now wants to perform laser surgery on me for a slight astigmatism I have. She says this will help, they gave me glasses to try on with the way it should look after surgery. I can see clearer but still double vision and she doesn't know if that will go away.
I went to another doctor for a second opinion and he said don't do the surgery if there is a chance I'm going to extract the lens and put in a monofocal lens. Now I don't know what to do. I'm scared to have these lens' extracted and would like to try and keep them in. We won't even get into the issue of the so called "halos" around headlights. They are such HUGE spider webs that I can not drive at night any more. Has anyone had any or all of my problems? Has it gotten better with time? Has anyone had the laser surgery for astigmastism after implants? Any help would be appreciated, my quality of life is 0 these days.
I went to another doctor for a second opinion and he said don't do the surgery if there is a chance I'm going to extract the lens and put in a monofocal lens. Now I don't know what to do. I'm scared to have these lens' extracted and would like to try and keep them in. We won't even get into the issue of the so called "halos" around headlights. They are such HUGE spider webs that I can not drive at night any more. Has anyone had any or all of my problems? Has it gotten better with time? Has anyone had the laser surgery for astigmastism after implants? Any help would be appreciated, my quality of life is 0 these days.
At 4 weeks the lens may not have been healed completely in the capsule, I'd see what they say at the 2 month mark to see if it is lens movement within the capsule or the capsule moving from loose zonules (either from pseudoexfoliation or whatever other reason). If it is loose within the capsule past when it is supposed to have healed, I'm wondering if suturing/gluing would be an option if that movement is the likely cause. You could mention where you live in case anyone has any recommendations for surgeons experienced with dysphotopsias or other issues there.
The lens I mentioned that is physically larger and comes closer to filling the capsule is the WIOL-CF, a premium lens (extended depth of focus/possibly accommodating) which isn't approved in the US yet. Although it is approved in Europe, from what I've read however they are still focused on doing more testing and potentially refining the product more before they start widespread commercialization of it. That suggests being cautious before considering it, which is part of why I hadn't tried to get answers regarding whether it can be used for a lens exchange or needs to be implanted only right after removing the natural lens before the capsule collapses, and whether or not its larger size could potentially have any impact on iris movement (I wonder in retrospect if I'd not have had an issue if I'd gotten that lens to begin with).
One surgeon who sometimes posts on this site, wanlien3, had expressed concerns in email to someone about the design of the lens however since it doesn't have haptics to keep it in place, though he hadn't personally used the lens and was just speculating about concerns (they expect filling the bag to keep it in place). I do see one paper online talking about case reports of 2 people where the lens dislocated, but I don't know what the overall statistics are since other types of lenses can dislocate also.
The lens I mentioned that is physically larger and comes closer to filling the capsule is the WIOL-CF, a premium lens (extended depth of focus/possibly accommodating) which isn't approved in the US yet. Although it is approved in Europe, from what I've read however they are still focused on doing more testing and potentially refining the product more before they start widespread commercialization of it. That suggests being cautious before considering it, which is part of why I hadn't tried to get answers regarding whether it can be used for a lens exchange or needs to be implanted only right after removing the natural lens before the capsule collapses, and whether or not its larger size could potentially have any impact on iris movement (I wonder in retrospect if I'd not have had an issue if I'd gotten that lens to begin with).
One surgeon who sometimes posts on this site, wanlien3, had expressed concerns in email to someone about the design of the lens however since it doesn't have haptics to keep it in place, though he hadn't personally used the lens and was just speculating about concerns (they expect filling the bag to keep it in place). I do see one paper online talking about case reports of 2 people where the lens dislocated, but I don't know what the overall statistics are since other types of lenses can dislocate also.
I've been told IOL position is good. Operated RE distance vision is 20/20, near vision good w/reading lens. Eye health pre- and post-op good. No dry eye, pressure problems, glaucoma, etc. No capsular tear or vitreous loss occurred during/from surgery. Lens jiggle was noted at 4 weeks as was iris fluttering. Eye has been examined before and after dilation. I will ask about pseudoexfoliation at my next appointment but it hasn't been mentioned. I have searched for and read other threads and articles about flickering on the net, seeking answers.
It would seem the surgery was a success but the patient still has a vision problem! From the 1st day, the flickering has been there and there has been no change or improvement. Maybe it's the floppy iris or maybe issues with the zonules. I certainly don't know and the doctors I've seen haven't had definite answers, which is why I turned to this forum with its doctors and knowledgeable participants. I appreciate the responses. I certainly want to take a cautious approach and not make my situation worse. Maybe I should try hypnosis to attempt to speed up neuroadaption!
It would seem the surgery was a success but the patient still has a vision problem! From the 1st day, the flickering has been there and there has been no change or improvement. Maybe it's the floppy iris or maybe issues with the zonules. I certainly don't know and the doctors I've seen haven't had definite answers, which is why I turned to this forum with its doctors and knowledgeable participants. I appreciate the responses. I certainly want to take a cautious approach and not make my situation worse. Maybe I should try hypnosis to attempt to speed up neuroadaption!
re: "If only I could know whether there will be any improvement, even it takes months. "
I should add that unfortunately that isn't possible for anyone to predict since each person's case is different, in addition to there being multiple potential causes for the issue. There are a few threads around the net about the "flickering" issue from people whose surgeons are usually stumped. Some of them see the issue resolve in a few weeks, or a few months, others in a year or so, some report still having issues years later. In my case I've seen glacially slow improvement over the 1 year its been since my surgery now, but it has improved, so it is possible it will eventually go away. I may take another stab at trying to find options, perhaps consulting an expert on dysphotopsias. I've just been cautious about risking making things worse if there is a chance I can neuroadapt. There are some cases of things that might be described as flickering that are due to stray light reflections in the eye that are resolved with a 2nd piggy back lens.
I should add that unfortunately that isn't possible for anyone to predict since each person's case is different, in addition to there being multiple potential causes for the issue. There are a few threads around the net about the "flickering" issue from people whose surgeons are usually stumped. Some of them see the issue resolve in a few weeks, or a few months, others in a year or so, some report still having issues years later. In my case I've seen glacially slow improvement over the 1 year its been since my surgery now, but it has improved, so it is possible it will eventually go away. I may take another stab at trying to find options, perhaps consulting an expert on dysphotopsias. I've just been cautious about risking making things worse if there is a chance I can neuroadapt. There are some cases of things that might be described as flickering that are due to stray light reflections in the eye that are resolved with a 2nd piggy back lens.
re: "plus had read IOL exchanges should be attempted as early as possible"
I suspect part of that may be fear that you will eventually get PCO and need a YAG treatment, since after a YAG the replacement lens usually can't be put into the capsular bag, which is where they prefer to put it. Different lens models are used outside of the bag and there are fewer choices, but it is still possible, even if the risks are a tiny bit higher. A prominent surgeon I had a followup with said that it appeared based on how I was healing that it was unlikely I'd ever get PCO and since the surgical result looked good that I could get a lens exchange at any time in the future if needed, even years later. It could be that a lens exchange would be easier before the capsular bag healed around the lens in the first 6-8 weeks, but you would be past that by the time you got an exchange now.
re: "Ophthalmologist has seen iris "fluttering" and lens "jiggle" in the capsulary bag."
My impression is that usually by 7 weeks the capsular bag should have healed around the lens well enough to keep it from moving , think the guideline I'd read was 6-8 weeks, but perhaps those are merely the usual cases and you are just a low probability outlier and it hasn't yet finished healing to prevent the lens from moving.
The question is whether as the Dr. mentions the issue isn't the lens moving within the bag, but the bag itself jiggling due to the zonules (like ligaments) holding the bag in place being loose. Unfortunately if the zonules are weak, any additional surgery like a lens exchange risks making things worse.
If the zonules are loose, in some cases they suture the lens to another part of the eye to stabilize it, presumably in this case if your iris is moving that would need to be the scleral wall. I have heard that this has risks itself , and again the trauma of surgery might make the zonules worse.
As I've mentioned in my post, my issue seems likely to be from iridodonesis, iris jiggling, but I hadn't been told of any useful approach to consider treating that. There are some larger lenses I've heard of in clinical trials in Europe that may fill the capsular bag more, but I I hadn't tried to get an opinion about whether they might make any difference, or whether its too late after having the smaller lens in the bag for a year now (and I'd read negative comments about the one I was wondering about since it doesn't have regular haptics and so a surgeon was concerned that if it didn't fill the bag well it might move).
I have read that the lens jiggling, psuedophakodonesis (though there are a few variations on the spelling) can be harder to see if the eye has been dilated with drops that are cycloplegic, which most drops they use for dilation are. A cycloplegic is a drug which reduces accommodation and tends to tighten the zonules which may reduce the jiggling. Often eye surgeons see a patient after their eye has been dilated by staff, so you might ask about that if that is what has been done so far. There are non-cycloplegic dilating drops, so perhaps the doctor might consider using them to look at you, or looking at you before your eye has been dilated if he hasn't.
I suspect part of that may be fear that you will eventually get PCO and need a YAG treatment, since after a YAG the replacement lens usually can't be put into the capsular bag, which is where they prefer to put it. Different lens models are used outside of the bag and there are fewer choices, but it is still possible, even if the risks are a tiny bit higher. A prominent surgeon I had a followup with said that it appeared based on how I was healing that it was unlikely I'd ever get PCO and since the surgical result looked good that I could get a lens exchange at any time in the future if needed, even years later. It could be that a lens exchange would be easier before the capsular bag healed around the lens in the first 6-8 weeks, but you would be past that by the time you got an exchange now.
re: "Ophthalmologist has seen iris "fluttering" and lens "jiggle" in the capsulary bag."
My impression is that usually by 7 weeks the capsular bag should have healed around the lens well enough to keep it from moving , think the guideline I'd read was 6-8 weeks, but perhaps those are merely the usual cases and you are just a low probability outlier and it hasn't yet finished healing to prevent the lens from moving.
The question is whether as the Dr. mentions the issue isn't the lens moving within the bag, but the bag itself jiggling due to the zonules (like ligaments) holding the bag in place being loose. Unfortunately if the zonules are weak, any additional surgery like a lens exchange risks making things worse.
If the zonules are loose, in some cases they suture the lens to another part of the eye to stabilize it, presumably in this case if your iris is moving that would need to be the scleral wall. I have heard that this has risks itself , and again the trauma of surgery might make the zonules worse.
As I've mentioned in my post, my issue seems likely to be from iridodonesis, iris jiggling, but I hadn't been told of any useful approach to consider treating that. There are some larger lenses I've heard of in clinical trials in Europe that may fill the capsular bag more, but I I hadn't tried to get an opinion about whether they might make any difference, or whether its too late after having the smaller lens in the bag for a year now (and I'd read negative comments about the one I was wondering about since it doesn't have regular haptics and so a surgeon was concerned that if it didn't fill the bag well it might move).
I have read that the lens jiggling, psuedophakodonesis (though there are a few variations on the spelling) can be harder to see if the eye has been dilated with drops that are cycloplegic, which most drops they use for dilation are. A cycloplegic is a drug which reduces accommodation and tends to tighten the zonules which may reduce the jiggling. Often eye surgeons see a patient after their eye has been dilated by staff, so you might ask about that if that is what has been done so far. There are non-cycloplegic dilating drops, so perhaps the doctor might consider using them to look at you, or looking at you before your eye has been dilated if he hasn't.
If your refractive error is +0.25 and your eye is healing otherwise normal your vision without glasses should be 20/20 or there abouts. Without glasses or contacts your distance vision should be much better in the operative eye than in the unoperative. Eye you would then have "full monovision" Operated eye for distance unoperated eye without glasses/contacts for near. If your operated eye is not 20/20 at distance (and 20/20 at near with about a +2.50 reading glass) then you would need to have an explanation. Its not at all likely that the minor "flutter and jiggle" you describe (usually due to torn or lax zonules) would create a problem with a yag capsulotomy. You might confirm with the surgeon that you do not have "pseudoexfoliation" a condition that predisposes to lax/weak zonules (and glaucoma) and also that there were no operative complications such as capsular tear or vitreous loss.
JCH MD
JCH MD
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