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Thread: YAG Capsulotomy and near vision...

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    Compulsive Truthteller OptiBoard Gold Supporter Uncle Fester's Avatar
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    YAG Capsulotomy and near vision...

    OK as you know I'm no doctor or whiz at ray tracing but I wonder if some of you who are could feed my curiosity regarding patients who have trouble with near vision after YAG treatment.

    I know how complicated rays of light can get in passing through multiple curved surfaces on the way to the fovia. Does that explain why some post IOL secondary cataract patients find their near vision seems to deteriorate from what it was right after YAG treatment?

    Are the size and location of the tear(s) critical? How are they determined?

    Would a specific OC placement in a sv near lens help?

    This questions nagged at me for a while now so do you guys have any helpful thoughts or experiences?

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    You might be able to determine some of the remnants of the capsule with a slit lamp. Could be he isn't clearing enough room for vision when looking down. If you have a good reasonable surgeon who actually thinks opticians and technicians might be thinking intelligent human beings, he might modify his technique for you. If you have one who views non-physicians as a sub-species you just plain out of luck.
    Had one once who was leaving elevated pupils (pre pseudophake days) and apakic contacts tended to lag, which wasn't working well with elevated pupils. He changed technique and solved the problems. Had others who "were the ophthalmic surgeon" and not to be questions, so thier patients suffered.

    Chip

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    It would not be normal for a pseudoaphake to have worse near or far vision after a YAG (which is ablation of the central part of the posterior lens capsule). There could be a dozen things wrong if this is true. YAGs are specifically done to improve acuity. A dilated exam would have to be done to check things out. The patient needs to check with their doctor. There is no special OC placement that would help in such a situation.

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    Could it be that the clouding effect of the capsule was not central, giving a pin-hole effect?

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    Pinhole...probably not...because they would have a pinhole effect at distance too...not affecting vision

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    Quote Originally Posted by fjpod View Post
    It would not be normal for a pseudoaphake to have worse near or far vision after a YAG (which is ablation of the central part of the posterior lens capsule). There could be a dozen things wrong if this is true. YAGs are specifically done to improve acuity. A dilated exam would have to be done to check things out. The patient needs to check with their doctor. There is no special OC placement that would help in such a situation.
    Thanks to all for the replies so far!

    This happened to a patient today who felt near vision right after the laser was noticeably better than now (4 months later). My mom had the same thing happen 4 years ago when she had it done and no matter what combination of lens powers or styles I tried she felt she had to use a hand magnifier to do her beloved crossword puzzles.:)

    Chip- My docs (OD"s) did follow up and found the work looked good. Funny thing was she could read in the chair the 20/20 reading line but in the "real world" the near was always an issue.

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    Quote Originally Posted by Uncle Fester View Post
    Thanks to all for the replies so far!

    This happened to a patient today who felt near vision right after the laser was noticeably better than now (4 months later). My mom had the same thing happen 4 years ago when she had it done and no matter what combination of lens powers or styles I tried she felt she had to use a hand magnifier to do her beloved crossword puzzles.:)

    Chip- My docs (OD"s) did follow up and found the work looked good. Funny thing was she could read in the chair the 20/20 reading line but in the "real world" the near was always an issue.
    If in the chair VA is ok, I'd bet on crappy lighting being the culprit. I do a lot of low vision home visits, and it's incredible what poor lighting a lot of people have in their homes. No wonder their low vision aids work well in the office and not at home!

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    I may have misunderstood. I thought you meant the VA was worse immediately after YAG...not 4 months later. But in 4 months, anything can cause VA to go downhill. It would be best to have it checked.

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    I'm with peringrinerose on the lighting. I have seen many aphakic (not pseudophaic) SV CL wearers that could read J-1 or almost with a good bright light in the chair and complain with +2.50 add at home.

    Now this would be accentuated if some of the capsule were left in the viewing area with the eye down and converged.

    Also there is a shockwave that passes in the eye during laser capsulotomy, might temporarily "bruise" the retina. One might also ask what does the laser beam do after passing beyond the capsule? I know it's focused at a distinct point but it stll keeps on going albeit out of focus.

    Chip

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    YAG capsulotomies are usually quite large. VA getting worse after 4 months post-op YAG...I dunno...doesn't sound like a lens capsule problem to me. Much more likely to be CME or ARMD, but hey, what do I know?

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    Quote Originally Posted by Uncle Fester View Post
    Does that explain why some post IOL secondary cataract patients find their near vision seems to deteriorate from what it was right after YAG treatment?
    I'll assume that the surgeon has been notified of their patient's concerns and symptoms.

    Except for complications and the typical risks associated with this procedure, I haven't seen this occur with my clients, although it could be a matter of expectations. For instance, there's usually a somewhat dramatic improvement in vision after cataract surgery, and most express exhilaration with both their corrected and uncorrected vision. This giddiness subsides with time, leaving most clients generally satisfied with their vision.
    However, some folks feel that their vision should be better than it is, with some night glare or ghosting distubances, and a general feeling that their vision is not as good as it should be, or was, when they were younger. It rarely is of course, and hopefully someone told them this somewhere along the way, preferably before the surgery.

    The same thing may be happening after the capsulotomy- these folks may have been somewhat unhappy with their overall vision three to six months after the cataract surgery, but after being told that there was a complication (posterior capsule opacification), they say to themselves "Oh, that's why my surgery didn't turn out as well as my friend who said that he/she could see so splendidly after their cataract surgery!" So, they have the capsulotomy and the process starts over again- the initial high, and then the letdown.

    If true, all you need to do is put on your bartender's hat and have at it, along with a first-rate refraction and the appropriate, optimized, eyeglasses.
    Science is a way of trying not to fool yourself. - Richard P. Feynman

    Experience is the hardest teacher. She gives the test before the lesson.



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