IOL Questions

[Bob J]

Hello, I'm new to the OptiBoard Forum so my apologies if this topic has already been addressed. I had IOLs put in both eyes about 4 years ago. I was extremely near-sighted (-12). The lenses have been great but I've noticed a couple of things. First of all, the amount of glare at night seems to be getting worse. This is especially noticeable when I'm driving into oncoming traffic with their headlights on. Someone suggested a glare reducing lens that I can wear at night. Don't know what that is or whether or not the glare can be reduced in some other manner. Secondly, my vision sharpness seems to be deteriorating somewhat. It's not bad enough to cause me to wear corrective glasses during the day, but I'm using "driving glasses" at night, especially if it is very dark and raining. Is a reduction in vision correction normal over time? I've spoken to my optometrist and he doesn't think anything is wrong.

[Chris Ryser]

Probably not your glasses......................probably a matter of age.......at least in my own case.

I used to love driving at night....I saw the glare but it did not bother me. Now it does.................with or without glasses. Your optometrist might be right.

[Lewy]

Sounds like a build up on the capsule surrounding the implant. We find it is quite common and you need to have the film removed by laser. Speak to an ophthalmologist.

Lewy


YAG laser capsulotomy

Approximately 20% of patients will develop haze of a membrane behind the intraocular lens (IOL) implant following cataract surgery, which results in diminished vision. The vision may be blurred, hazy, or is associated with significant glare and loss of visual acuity. This condition, known as posterior capsule opacity, is sometimes referred to as “secondary cataract.” Cataracts, however, never recur following cataract surgery.



Posterior capsule opacity may be thought of as a scarring process in the capsule or membrane, which contained the natural lens (cataract) of the eye. The condition of posterior capsule opacity is not preventable, but fortunately, is treatable and nearly always restores or improves vision. Top of page





Posterior capsule opacity may be treated with an in-office or outpatient minor laser procedure known as a YAG laser capsulotomy. In this procedure, a laser is used to remove the hazy capsule situated behind the IOL implant. This usually requires dilation of the eye prior to the procedure. The procedure takes only a few minutes, is entirely painless, and is not associated with any post-operative discomfort. Most EyeMDs will recommend an anti-inflammatory eye drop medication following the procedure.



Following a YAG laser capsulotomy procedure, patients may resume normal activities immediately. Most patients may expect their vision to improve within a day following the procedure. As with any eye procedure, patients should contact their EyeMD immediately if visual acuity worsens or fails to improve. Patients should anticipate some “floaters” following this procedure, however, these will likely resolve within a few weeks time.

[Bev Heishman]

What brand or brands of IOL's were used? Are they front(anterior) chamber or posterior implanted lenses?

Are you on systemic meds? Do you wear good sun & glare protection outdoors during the day.

All of this contributes to problems at night as we get older.

[drk]

Yikes, guys.

This one is too complex to discuss over the board. It has way too many possible causes.

Get another opinon, if your current Dr.'s is not satisfactory.

[Jedi]

Someone suggested a glare reducing lens that I can wear at night. Don't know what that is or whether or not the glare can be reduced in some other manner.

I'm going to assume that with the IOL you're visual acuity is 20/20, and that you presently don't use glasses for distance. Unfortunately, the suggestion you received about glare reducing lenses is incorrect. An anti-reflection coating will only reduce glare on a pair of spectacles, not from other sources, such as a windshield. If my assumption is incorrect and you are wearing spectacles, then an anti-reflection coating will reduce the reflections on the lenses and may provide some relief.

[chip anderson]

Can't you get Alize on an implant? Heh, Heh.

[Bob J]

Thanks for the feedback everyone. In response to some of your comments, I have Staar IOLs, model AQ2010V (if that matters). My acuity is normally 20/20 but it does seem to be worse at night. I had a JAG laser treatment about one month after the implants (June 2000) because the lenses were becoming cloudy (doctor says that the eye was continuing to produce "lens cells"). Since that time nothing has been done to the lenses in the 5 years they've been in. I believe they are anterior chamber implanted lenses. I am not currently on systemic meds. I've noted a lot of floaters in my eyes over the past year. Probably the result of my myopia. The optometrist I go to says everything is normal considering my age (58) and my eyes. Unfortunately I cannot see my ophthamologist unless the optometrist says there's a problem (Don't you just love Canadian medicine!).

[Lewy]

get a secondopinion from a different optometrist


Lewy

[chip anderson]

Won't an ophthalmologist see you if you pay him money? Must one be a ward of the state to see a doctor?

[Jedi]

Does the optometrist happen to work for the ophthalmologist or in the same office? If not get another optometrist, if they do, you might want to replace both.

[Andrew Weiss]

Gotta agree with drk on this. While I'm learning from everyone's posts, I believe the patient should get a second opinion from another opthalmologist who sees him in person.

[Bev Heishman]

Are your Staar Implants because you had a cataract extraction or are they as I know them for myopia or hyperopia (refractive correction instead of LASIK)? The YAG you are talking about though indicates you had cataracts.

If they are than you need to see a refractive ophthalmologist and of course that does not require a referral as refractive surgery at least in this country is not covered by medical coverage.


No matter what type of surgery the retina is effected by various things. Anterior chamber lenses seem to catch more light and may produce a ghost image or flare that can be annoying. Wearing sunglasses routinely allows recovery of the photochemical process occuring in the retina to rebound and may help with night situations. I would recommend Transitions with AR coating to at least reduce glare produced from over correction lenses and polarized wraps. Our patients that are looking for help love Cocoons from LIVE Eyewear & recommned them to their friends. This may help but not eliminate the problems you are experiencing but make life more tolerable.

Age also effects the problems you are complaining about. How is your tear film? Do you have a dystrophy or degeneration that may effect the quality if sight? Eventually we have to accept limitations because they are caused from the aging process. While annoying they are not a result of implanted lenses. Many times after a cataract is removed the window is now clear to see the retina and often the reveal is some form or retinal problem that now is effecting the sight and has its own effect on the visual process. I relate problems to patients with these diagnosis that the retina and the eye in general is like a radio dish that feeds impulses to the brain where vision occurs and degeneration or slowing down of tissue affected by aging changes impairs and has annoying symptoms that can not be restored but learned to live with.

Hope this helps. Get a second opinion and pay an out of pocket visit to an MD.

[ecsoptical]

I work for an MD and I'm ABO AND COA. Most likely it would be a cloudy capsule. but check with you OD for a referral to a reputable MD (better payments for both) both should be able to spot it. It stands out.

[Bob J]

Thanks all for the wise advice. I will be speaking to my MD to get a referral to my ophthalmologist or to another one if I'm still stuck with working through an optometrist.