furhter info on vision problems

[golfadkt]

I had crystalens put in 1 1/2 years ago. Vision now 20/70 in left eye and 20/40 in right eye.
I did get a new glasses prescription which I am being told corrects my vision to 20/30. The prescription reads OD- sphere:plano, cylinder +.75, axis 090 Os is sphere -1.00 also with antireflective coating....  But it still seems to me like I struggle driving at night time even with the glasses. When I drive with bright lights on it is better. I do not experience halos or car headlights bothering me it just seems like I do not focus in well enough. No I have not had any previous surgery in my left eye nor any previous eye history of problems. I also have several floaters in BOTH eyes since the cataract and yag procedures.That is also very upsetting!I .I am also being always told that my dry eyes may be making my vision worse. When we tried twice now to put the plugs also in the upper ducts I had alot of tearing and they had to be removed I cannot recall if my vision was actaully better at that time I just know I haD alot of tearing.Perhaps I should try that again? Smartplugs were put in the bottom ducts several years ago and I also wonder if they have washed away in time?
The retina specialist(best in our area) indicated that there was a thin layer causing the macular pucker in the right eye and surgery at this time was not recommended unless it was so bothersome or if it gets worse. Perhaps I should also be looking at this option? Could the floaters and macular pucker be making my night time driving difficult.  
As you can imagine I am VERY distressed at the fact that I cannot drive safely at night and I am searching for answers! I also wonder why my eyes are so sore since these procedures?One other thing I will mention IF it sheds any light. I have Roscea(of the face) and have recently even tried a course of Doxyclycline to see if that would help my hurting eyes and vision issues(thinking that maybe I have occular roscea but it has not seemed to make a difference).

[JodieJ]

Yes, a macular pucker (aka epiretinal membrane or ERM) could affect your night driving ability.  In most cases, acuity doesn't get worse over time because of the pucker.  However, recent research shows that visual outcomes are significantly better when surgery to peel the ERM is done sooner rather than later.  (There is some evidence that delaying surgery may result in irreversible damage to the macula.)  You would want this type of surgery to be performed by the most experienced retinal specialist in town.  If you can travel for surgery, consider seeing Dr. Steve Charles in Memphis.  His website has good information about this condition.  (Try googling)

[golfadkt]

what are the other options you refer to?

[Sandy Feldman, MD, MS]

Dear golfadkt,

It does sound as if you might have a number of different issues with your eyes including the following:  crystalens implants, small refractive error, macular pucker, dry eyes and rosacea.  All of these may be contributing to your vision issues and it is important to sort out how much each contributes.  The first and foremost issue is your nighttime driving vision.  For this, your eyeMD might want to prescribe an eyedrop, known as alphagan to assist you.  Please ask him or her if this is an option.  It is important to note that all intraocular lens implants do cause some glare and halo and some people are bothered by this while driving at night.  There are other possible treatments as well which might be beneficial for this.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California