I love this story and I am a proponent of using the laser measurement device for higher accuracy. I use it in every laser-assisted surgical case. Congratulations!

Glad for you. Mine has been 6 months and still black halo. Left eye feels bulging. Wish I never did it. My dr is very dismissive.

@@kaylenemiller1804 mine was too. She asked me why do I need to drive at night?! Like excuse me?? Why is that any of your business? 😅 Maybe I work at night, or I want to have a social life, which may include going out to functions that occur during the late hours. Mind you, I was and still am in my 20s when this occurred. I’m still young and want to achieve things. We can’t always rely on others to drive us around everywhere. 😭

What kind of lens did you get, monofocal or multifocal or EDOF? Glad it worked out for you.

@@CCdarling98 Get well soon, how is your vision now?🙏

All of us need our vision, including our dogs. They matter too, good grief!

Thank you for the kind words.

Thank you!

Thank you for the kind words and I hope you are doing well!

You are very welcome!

@@notarobertomd my vision in the right eye is amazing. No pain, no swelling, how long should I wait to have the other eye done?

@@jonmajarucon51 Usually as soon as you are ready. Since you already have your medical clearance, it makes it easier to move forward with the next eye. In addition, your surgeon will use insights from the first eye to make any adjustments to the second eye. It will also "feel" better to see in a balanced fashion without a potential difference in image size or disparity between refraction in each eye.

@@jonmajarucon51 OP

Thank you for the detailed explanation. I am sorry you had such an experience. Can you clarify if you had glaucoma, retina surgery, or cataract surgery, please? Typically glaucoma or retina surgery will utilize freeing therapy. Freezing is not normally used with cataract surgery. And I apologize for the delay, I had a family crisis and needed some time.

Your welcome!

Have you had an evaluation by your Ophthalmologist to assess the cause of these symptoms? By your description, it appears your vision changes based on the environmental lighting. When full daylight is available, typically your pupil is smaller. This allows several things to take place, one being less influence of aberrations from the mid-peripheral and peripheral cornea. Additionally, there is a mathematical reciprocal relationship between depth of focus and pupil size, thus your depth of focus improves in full daylight. There could be "scar tissue" affecting the clarity of your lens implant as well. A good evaluation of your cornea and lens can assist in finding the root of the problem so you can maximize your visual potential. Let us know what your doctor finds!

Did you get Panoptix lens?

It is possible that you you have some post operative refractive error. This is not uncommon. On average somewhere between 75-90% of patients will reach 20/40 or better without glasses. But reaching 20/20 or 20/25 without glasses is a much smaller percentage. These are international statistics. If your ocular health is optimal (i.e no glaucoma, macular degeneration, abnormal anatomy, good corneal surface, etc.) then it is likely a refractive error that can be corrected with glasses, contact lens or LASIK.

Fuchs is a corneal dystrophy that if present prior to cataract surgery may complicate the recovery. Fortunately, there are many ways to mitigate postoperative corneal decompensation that can be implemented intraoperatively. Unfortunately, these proactive methods do not always work. This issue you are having can sometimes be managed and improved with medical treatment. When it is not, then a partial corneal transplant can neutralize the issue and restore clear vision once again. What is your status now?

There can be several reasons for double vision after cataract surgery. From the information you posted, I am assuming you have had one eye completed and the other eye still has a cataract. It may be likely the refractive error (optical prescription) is too disparate between the two eyes. When this occurs, one may have the sensation of imbalance, vertigo, or double vision. There are other causes, of course, you should ask your surgeon their thoughts. Let us know!

The floater is likely due to either a portion of your vitreous gel detaching from the retina or an actual retinal tear/detachment. The great majority of the time it is the vitreous gel (the gel that fills the majority of the eye) that will, with age or trauma, release itself from its attachment to the retina. Pieces of the proteinaceous gel can consolidate and become opaque, the gel normally is optically clear. When this happens you can see the shadow of the floater with good light and an uncluttered background. If the vitreous floater happens to be in the central area of your vision, it can cause your vision to be not as clear. You should obtain a second exam from your Ophthalmologist or Retina Specialist. There are times when the vitreous floater is deemed to be benign (harmless) but it is actually evolving and can still develop a retinal tear or worse a retinal detachment. More for peace of mind, especially after cataract surgery where the risks for retinal tears or retinal detachment inherently increase.

@@notarobertomd Or it could be just PCO.

I had major floaters and had a Floater Vitrectomy - floaters all gone, NOTHING anymore :).

Could you share more information such as where you had the floater vitrectomy done and the dr name​@@sjorlando7282

JR, thank you for the detailed explanation, it is very helpful. Inflammation after any type of intra-ocular surgery (cataract, glaucoma, retina, etc) can become chromic for a small percentage of people. This is true of any type of surgery on the human body. Fortunately, it is not common. When the eye is inflamed, one of the most common symptoms is photophobia, also known as sensitivity to light. This can vary in severity and at times be painful. Topical anti-inflammatory drops can not only help but suppress this reaction. Can you give me an update on your mother and let me know if it has resolved?

@@notarobertomd I sure will. She just had a follow up with the eye specialist on Jan. 3, 2023. I wasn't able to be with her but will ask my mom what happened with that last visit. I was with her during her December visit and the eye specialist suggested that my mom decrease the usage of the Prednisone eye drops to 3x/day instead of using 4x/day. My mom is just feeling very discouraged because the 1st time she had cataract surgery on her other eye the healing process did not take this long. If you have an office website where I can reach out to you, kindly forward. My mom may need a 2nd opinion. Thank you and happy new year!

@@notarobertomd Had a chance to speak with my mom about her Jan. 3rd follow up and the doc that she's been seeing still has her on the Prednisone eye drops. Unfortunately, my mom's eye is not getting any better according to her. My mom says there's an area of her eye that feels tender and she feels that the doctor who performed the surgery did something wrong. I suggested to her about getting another opinion at this point. March of this year will make it 6 months of this ongoing discomfort. She did not have this much discomfort or side effects with the original doc who performed the surgery on her other eye and does not feel that her eye nor sight is getting any better. Unfortunately, the original doc that performed the cataract surgery around 5 years ago retired. So, she had to go with a new doc and is the one who did this last surgery in September 2022. Do you have or know of any eye doctors in the NYC area that you could recommend? If so, can you link their information. Thx

@@jr9941 I completely understand. This does underline how surgery is a delicate and unique experience not only for every individual but each individual organ. If your mother is still taking the topical prednisone, it would imply that she still has some type of inflammatory response. This could also explain the delay in visual recovery. I know quite a few excellent Ophthalmologists in the tri-state area. Which state and the localized area would be convenient for her?

Deborah, it appears you have two separate ocular issues that are both affecting your quality of vision and quality of life. Diplopia (or double vision) can occur for a variety of reasons. Foremost, one should seek the consultation of a neuro-ophthalmologist if your general ophthalmologist cannot assist you. It should be investigated in case the cause is central or vascular and may be the harbinger of something worse. Once that is ruled out then you should move on to a solution. Prism spectacles can help as well as surgery on your extra-ocular muscles in some cases give you a permanent solution. The "flat" appearance of images is likely due to the loss of binocular vision. Again, a neuro-ophthalmologist can you with this issue. The dry eye problem also should be addressed and treated aggressively. If topical artifical tears are not providing you with relief, then you should seek more effective solutions. There are so many excellent treatments for dry eye syndrome available today!

How are you now?

@@pleaseshare8891 Eye stuff still the same.

Hello and thank you for the description. Can you tell me the model of the lens implant you had implanted and if you have any medical/health issues?

The PanOptix lens implant is one of the best if not the best engineered lens implant available today. When a patient adapts to the lens, they are the happiest. PCO, or posterior capsular opacification, can be considered scar tissue that can form behind the lens implant. This is not uncommon and can happen within weeks to years later. Fortunately, a safe procedure in the office can remove the PCO within minutes and restore clarity almost instantly. There are a few reasons why a patient may have PCO right after surgery. One reason is that typically when we polish the capsule, we do not remove all of the cells that can cause this to grow faster. There are times when the capsule is unstable or if there is existing thick fibrous tissue already there, it may be prudent not to mechanically remove the tissue and wait to remove it with the laser after cataract surgery. If the posterior capsule is breached there can be an increased risk of complications over time. So in the interest of patient safety, the surgeon may choose a more conservative approach requiring the second procedure after the primary surgery. This is one of many reasons why we choose these actions because we place patient safety first. I hope this helps.

That is fantastic news regarding your recovery from a detached retina and having vision that is not only usable but normal post-operatively. This is not always the case after a retinal detachment surgery for most people so I am very happy for you. Regarding the PanOptix lens, which is currently one of the best intraocular lens implants in the world today, it is one of the best ways to achieve the widest range of vision possible with the least amount of secondary issues. Additionally, the fact that you had such a high cylinder (or astigmatism) and the lens is able to correct this for you, is a huge benefit in terms of acquiring clarity at all ranges. Technology truly has come a long way since we started implanting lenses. Regarding your question specifically about the vision coming in at this time postoperatively, it is not unusual to have a delay in visual rehabilitation. Due to factors such as corneal swelling, prolonged dilation, adaptation to the lens, and surgical healing itself, some patients may not see as clearly the first or second day as others. Every surgery is different and every patient is unique. You should see a steady increase in vision and clarity on a daily basis as you continue to heal. If this is not happening then there could be a few things that may be limiting your postoperative expected visual result. An analysis of the retina and specifically the macular will be necessary to assess its health. The PanOptix lens requires an anatomically stable and healthy central macular to be able to process the data that is being projected to it by the lens. The lens is a sophisticated piece of optical engineering but to take advantage of what it can do, a healthy macular to process the data is needed. Of course there are other reasons that this could happen specifically residual astigmatism or residual myopia or hyperopia. These will be determined at your next postoperative visit. If you are not seeing this you should contact your doctor. Keep us posted and let us know how things are progressing.

@@notarobertomd thanks so much Dr Neil for your time and response. I do now have better visual acuity 6 days post-op. I'm about 20/50 on the Snellen chart. I still have to better assess my night driving ability before I see my surgeon as it sees that may be the biggest obstacle to wanting another Panotix in the other eye. I see my doctor in one week and I will report back.

I'd like to update the status of my cataract surgeries. The vision in the Panoptix eye cleared up and now is 20/40 with decent near vision (I can read my cell phone in natural lighting but need glasses if the light is not so good) and I can read my car dashboard fairly well. If I had not had a detached retina in that eye I believe my daylight vision would be near perfect in that eye. My night vision is another story with the Panoptix and halos from lights were too intense. I went with a monofocal toric lens in my left eye. This gave me 20/20 in that eye. I find that my brain is amazing in how it chooses the best eye for each situation so at night my left eye cancels out the halos and allows me to be able to drive at night. If I had went with 2 Panoptix then my daytime vision would have been high defintion, but I would not be able to drive at night which was important for me. The mixed combination that I did allows me to drive without glasses both day and night. but I do use readers to see my cell phone and my laptop. Thanks for giving your time to help people who have questions regarding cataract surgery.

I apologize for the delay, I had a family crisis and needed some time. Can you give me an update on your vision and case please?

You had a fantastic lens implant placed in your eye. It offers excellent distance vision with very good intermediate vision with a very high rate of adaptation. I have used this lens in many professionals (riverboat pilots, airline pilots, police officers, physicians, etc) who wish to have clear distance both at night and daytime while still being able to see their instruments clearly). What it appears your describing is a phenomenon known as "positive dysphotopsia". This is not uncommon. The good news is that in the great majority of patients this will diminish every week and soon should not be an issue. There are many theories why this occurs, the general consensus is that light from an extreme angle will catch the edge of the lens implant causing some of the light to be diffracted causing the phenomenon you are experiencing. As the pupil continues to constrict post-operatively and the brain neuroadapts to the lens, you should see this effect diminish and in most cases go away completely. If this phenomenon persists, there are solutions to neutralize the situation. Please give it time and try not to fixate on this so you allow the brain to adapt and overcome this issue. Please keep us posted!

How do you feel now ist things going better As you describe your case its similar to mine I have done my surgery 2 Weeks ago and i still have blurred vision

@@ahmadrachid5799 it's not too bad I had some glasses made with a prism and double vision is sorted though my right eye is still a bit off focus without glasses. For now I've decided not to do my other eye cos if I did I would have to carry a pair of glasses for reading as it is I just lift my glasses up for reading better than having to carry a pair more convenient . My brain has adapted to this situation so for now I'm happy . I don't think they could have done better because my right eye is very long .

Obviously, you have been through a lot over time with your eyes. I give you much credit for being strong through all, I know it is difficult. If indeed you have macular edema, it can be treated with a variety of methods (e.g. topical drops, laser, injection, surgery). Ask your doctor for a referral to a retinal specialist for guidance. We have had great success with all of the above-mentioned treatments and I am sure you will. Regarding the dietary supplement, methyl-sulfonyl-methane (MSM), please be cautious with any medication (natural or man-made) since anything may have untoward side effects. An article in the Journal of Glaucoma cited that MSM was likely responsible for the anterior rotation of the iris-lens diaphragm, ciliary body edema, and choroidal effusion in a patient. You should discuss the usage of any additional treatment with your doctor (medical or natural) so the effects can be monitored. I hope this helps!

@@notarobertomd Thank you doctor for your kind attention and excellent advice. I have a follow-up OCT scheduled for next month and will proceed according to the results.

CiCi, thank you for the detailed history. The event that occurred is likely not related to the cataract surgery. I cannot rule that out completely without a full a review of her medical course, but in general the time line does not lend itself to one being directly related to the other. Regarding her vision recovering asymmetrically, though not usual, it is not uncommon. Each eye is independent of the other in terms of possible anomalies that may influence the course of surgery and vision. There are many possibilities why the second had a slower visual recovery. Regarding the bruise at the lower lid or lower orbital region, it likely was due to capillaries in that area hemorrhaging. The question is why and that could again be for a variety of reasons. From something as simple as a patient inadvertently rubbing the lower orbital to hard in while sleeping to something as serious as an inferior mass. As your doctors suggested, further workup is recommended. The fact that she had a headache and developed diplopia could likely be related and possibly indicate a cardiovascular event that could have caused these issues as well. Again, without an extensive exam and review of the medical charts, it is all theory but likely as you suggested. The workup should reveal answers. Keep us posted. Our prayers are with her.

A lens implant (and any implant in the human body) can incite an inflammatory response that will cause "scar tissue" formation (put simply but not scientifically accurate). This scar tissue is called an "after cataract" or "posterior capsular opacification". Prior to the advent of lasers, surgery could be performed to remove the opacified tissue. Now a laser, called a YAG laser, can perform the removal in the office without pain or surgery. This phenomenon and procedure are not uncommon.

You have valid concerns. As a cataract grows it can expand in the anterior-posterior direction and may cause a forward push of the anterior structures. This may in cases narrow the angle you are speaking of and contribute to an increase in ocular pressure. Removing the cataract can help this as you mentioned. If you are now positive for Lyme, you should have this evaluated and treated by your infectious disease specialist. Lyme disease has been divided into three stages: early localized, early disseminated and late disseminated. Ocular involvement has been reported during all stages of Lyme disease. Due to therapy's effectiveness in eradicating infection among early Lyme disease patients, the diverse range of clinical symptoms, potential variations in manifestations caused by various strains of B. burgdorferi, and the persistence of positive Lyme serology despite proper treatment, ophthalmologists must approach the treatment of Lyme disease patients in a thoughtful and systematic manner.

Though all critiques regarding your current vision post-operatively are important, let us focus on your foremost concern of vision quality. If your vision is hazy then the cause must be elucidated in a step-wise fashion to determine the etiology, this is the only way to find your solution. Ironically I examined this exact complaint with the exact lens implant this past Monday. First I looked at the tear film. There are many tests to determine the quality of your tear film. This is the first refractive surface of the eye and if it is incomplete or poor then your visual clarity will suffer as well. Then I performed a refraction to see if there was any residual refractive error. (In this case, I did discover some mild astigmatism and will proceed to correct it for my patient, she was able to improve from 20/40 to 20/25++) . I proceeded to examine her macula and optic nerve with high-resolution anatomic scans. These proved to be normal. She did have some "posterior capsule opacification" but it was minimal and could not account for the haze she was complaining about, but in a number of cases this is seen as a causative factor. So as you see, a step-by-step evaluation should provide the answers you are looking for in this case. Can you follow up with us after you have this evaluation?

Thank you for the question and detailed description. It is not uncommon for the debris from the YAG laser capsulotomy to enter the vitreous cavity (the interior of the eye) and then cause some of the symptoms you are complaining of. The good news is that there are modalities to treat floaters if they are bothersome. But the great majority move out of the central visual axis over time and are less bothersome. Please feel free to reach out anytime.

Theory: Some cells become damaged and scatter light. However, they are replaced every ~7 years, so these problems will go away on their own. My left eye was YAGged ~7 years ago and ever so gradually cleared up. My right eye was YAGged early this year and has definitely improved since I posted above. I suspect I just need to wait a few more years for my right eye to clear up. My goal is to have the best possible vision - when I am 90. Things seem to be on track for this.

Having the barrier laser for retinal issues prior to cataract surgery is very important and provides you with an elevated level of safety during and after surgery. The EDOF lens implants available today are fantastic works of optical physics that provide enhanced vision in patients today. Many manufactures produce this type of lens implant now going by different names. We have had great success with these lenses in our patients as well. Addressing your specific concern, if your near vision is clear but distance is blurry, this usually indicates you are "near sighted". With an EDOF lens, this typically means distance will not be clear if your lens power was targeted for near sightedness. Your doctor may have targeted that range because some near sighted patients prior to cataract surgery wish to retain their near vision and wear glasses for distance. Ask your surgeon what your poet operative refraction is and what did he target as your final outcome. Let us know. Thank you!

Thanks! Doctor, I shall get back to you, Regards@@notarobertomd

When the posterior capsule is ruptured during cataract surgery, the incidence of post operative retinal detachment increases. The retinal detachment rate in uncomplicated cataract surgery is 0.21%.

The crescent shadow you are seeing is called "Negative Dysphotopsia " and it caused by a shadow being projected on the peripheral retina. There are many theories of why this occurs after cataract surgery, but most think it is due to the interaction between the edge of the intraocular lens implant and the pupillary size. This fortunately resolves with time in most patients. There are both pharmacological and surgical procedures that can help the very uncommon few that have chronic issues. Regarding your floaters, that is a more complex issue. Some floaters were ones that were there prior to surgery and are just more apparent due to the increase in light that enters the eye. We do not see the actual floater but see the shadow the floater casts on the retina. More frequently, the vitreous gel is disturbed by the surgery itself causing additional floaters to appear. This is not uncommon. Uncommonly, additional image to the retina can cause a detachment or tear. Fortunately, it sounds like you do not have a more serious event. Some floaters can be caused by inflammation extending to the posterior portion of the eye as well. In most of these cases, the floaters become less apparent with time as they move away from our central visual field. They become less annoying as well. I typically let a patient wait about 6 months before offering surgery as an option to remove the floaters. In the mean time, reducing the amount of light entering the eye can help reduce the appearance of the floaters (e.g. polarized sunglasses, lower the brightness of monitors, dimming lights, etc.). There are also pharmacological methods to perform this as well and you should ask your Ophthalmologist. I hope this helps.

Thank you for the question and good description of your symptoms. Can you please let me know the model of your lens implant and if possible your refraction from your doctor? That will help me better answer your question. And I apologize for the delay, I had a family crisis and needed some time.

Thank you for replying, I hope your family is fine. The lens was Vivity. The refraction was6/6 and N6, but it was not possible to read anything. The flickering of digital screens was very intense, could not see anything properly. But on record everything is fine. @@notarobertomd

There are certain situations during cataract surgery where the vision will not be clear immediately after surgery. Some of the more common issues are increased intra-ocular pressure (high pressure inside the eye), intra-ocular hemorrhage, corneal swelling or not having an intra-ocular lens implant placed in the eye after cataract removal. These are all manageable with time, medication or an additional procedure. But there are some cases which are more serious. These also would require additional management. In most cases, some or all vision is usually recoverable. Do not panic, I understand how you feel, we all share the same love for our health. According to your post, it has been 3 days. What has your doctor communicated to you at this point?

Raymond how are you now? Does your vission gets to normal no

My mom had cataracy surgery. Before that mom was not able to.see at all but after the laser she still cant see... its been 4 days now. our appointment is in 2 days. But she was able to see shadows ang lights

There are potential solutions to your problem depending on the actual diagnosis. What was the cause of your vitreous humor becoming cloudy? (e.g infection related, calcifications, etc?). And secondly, what was the diagnosis for your "wrinkled" retina? Was it from post operative swelling, infection, retinal detachment, a hemorrhage , etc?

Thank you for responding, Dr. Notaroberto. Since I did not receive papers describing the exact problem, I'm left to rely on memory of discussions with the various doctors. The cloudy/milky substance was the result of bleeding. Causing also swelling. The diagnosis was the that eye would have to self heal. After two years with a Retina Specialist, and numerous injections of steroids, the specialist said healing had progressed as much as it was going to.

Please excuse the delay in answering. There was no indication of your recent response. As for the retina problem, the doctor who performed the cataract operation did not tell me the specific reason for cloudiness within the eye. Just that, "it happens in about 20% of people". The "wrinkled" retina was explained the same by another specialist, 20% for that result also. Leaving me in The 20% - twice. Perhaps fear is setting in but the eye seems to be getting worse, gradually.

Excellent point and another etiology that falls under the broad umbrella of 'corneal issues', but as you illustrated I did not specifically mention Fuchs. I felt that since Fuchs would be a preexisting disease that can be exacerbated by cataract surgery, it would be more of a "known" entity to the patient as a cause of poor vision post-operatively. (Rather than an unexpected complication) The patient and surgeon would have a serious discussion about the possible effects and possible second surgery when they have Fuchs corneal endothelial dystrophy. Regardless, YES and thank you!

Hey how is your eyes now

A toric lens can rotate post operatively. And dry eye syndrome frequently is also a causative factor of blurred vision after surgery. The good news is that both of these issues can be addressed and corrected with conservative methods most of the time. Since it has been a few months, how is your vision now?

Thank you for your reply Dr. The dry eye has gone after about 4 weeks with the eye drop given by the Ophthalmologist. But I have had eye floaters on that eye and was told it was due to the something moving in my vitreous humor. He said that cannot be treated and asked me to just ignore it. But it's very disturbing actually. I was hoping the floaters will go away as before cataract surgery I didnt have it at all, but now after 5-6 months still not improving. I am not sure what can be done. Any advice for supplements for eye floaters? and I come across an article saying collagen supplement for skin will contribute to eye floaters, I wonder is that true because I have been taking few years@@notarobertomd

I would be so grateful if you could give your valuable advice. Thank you

By the data you provided, it appears that the doctor attempted to give you a variant of mono-vision. Essentially where the dominant eye is refracted or set for distance vision and the non-dominant eye is set for near vision. This tends to give the patient a wider range of vision. Additionally, with the Vivity EDOF lens, you also benefit from an even larger range of vision due to an enhanced depth of field. It appears your left eye is performing the way you would expect for a distance eye , whereby the Vivity lens giving you both distance and intermediate vision. It appears your right eye is not performing as you expected. Sometimes a patient will discuss with their surgeon after one eye performs like your left eye that they wish ed they could see near better, and in that case they can attempt mono-vision as you have. Are you adapting to this now that you are one month out? Let us know so we can answer your other questions. Thank you!

There are both medical and optical reasons for your blurred vision. Two medical complications I have seen more so than the others can be related to prolonged inflammation (swelling) of the cornea (front clear portion of the eye) or the retina (the tissue in the far back of the eye that transduces light into electricity.) Of course significantly more serious conditions (i.e. hemorrhage, infection, detachment, etc.) may occur as well. Your surgeon should be made aware so they can examine and rule out any of these issues. More than likely when we see this issue, it is related to residual refractive error (optical). Meaning that there can be a bit of nearsightedness, farsightedness, astigmatism or a combination of two remaining post operatively. If this is the reason then it is correctable with glasses or contact lens after you are healed. In summary, at your next post operative visit, describe your symptoms to your surgeon and I am confident they will give you the exact reasons.

Thank you for the time in explaining my medical and optical condition. Your explanation makes me worry less and have some ideas on how to explain my condition in my next visit.

Hello! The two issues you are describing are not uncommon after cataract surgery. The first described as a sticking feeling in the corner is likely due to dryness of the cornea in most patients after cataract surgery. Topical over-the-counter artificial tears will help alleviate the discomfort you feel and should eventually resolve. Other causes may include redundant conjunctiva (the transparent membrane over the white portion of the eye) or infrequently an irregularity on the cornea where an incision was made and the epithelium over that area may be irregular. All of these can be managed by your surgeon. The second issue is called "negative dysphotopsia". There are many theories of why this occurs, but it does tend to become better with time. Uncommonly this can be caused by a retinal detachment. You should have this complaint addressed by your surgeon as well. I hope this helps!

Ok Sir. Thanks a lot for your support.

These are great questions! There are two issues you describe and I will address them individually. The first issue described is the crescent shaped shadow you see in daylight. This is a phenomenon known as negative dysphotopsia. The prevailing theory is that negative dysphotopsia occurs when the light from extreme angles bends at the edge of the lens implant causing a shadow to form. This is a simplified or layman's explanation but it serves the purpose for illustration. In the great majority of cases this phenomenon resolves itself without intervention. There are a small portion of patients who persistently see this phenomena and for these individuals, there are medical and surgical solutions that may work. The literature does reveal that there is not a widely accepted solution for this problem but many of them work very well. What I find more interesting is how the brain adapts to this phenomenon in the people who are no longer bothered by it. Regardless, a fully dilated examination of the retina and optic nerve to rule out less common causes of a "shadow in your peripheral vision" (e.g. retinal detachment, etc). Give the eye a little time to heal and if the problem starts to lessen in severity then you may well be on your way to resolution. If it is persistent, then you should seek a solution to neutralize the issue. The second issue regarding your balance is more than likely due to an imbalance in Refractec air between your completed by Andy either has not had surgery yet. When there is a gray reflective difference between two eyes people will have the symptoms you're describing until the other is completed and both eyes are balanced. So this problem will likely be solved for you once your other eye is completed. I hope this helps and open a kind and respectful discussion with your physician who definitely has a vested interest in you and your happiness. Remember , we all work very hard for our patients to see to their potential. Not all patients are the same and though your surgery was successful from a surgical standpoint, we (yes even me!) are bound by the laws of physics and the unique anatomy of the individual.

@@notarobertomd thank you so much Dr Neil. I am very much appreciated for your comprehensive answers. They gave me hope. However, I am still puzzled about the Negative Dysphotopsia phenomenon. As far as I understand it is about the cresent shadow only. How about the hazy and cloudy temporal vision that I also have? Isn't it part of ND or can be caused by something else? Thanks again for taking time from your busy schedule to reply to us.

@@lechipham2787 You are correct, negative dysphotopsia (ND) typically presents itself as a crescent moon shaped shadow (or dark area) at the periphery of your visual field. The hazy or cloudy temporal vision usually is not part of the spectrum of ND. Usually one would consider fibrosis of the lens capsule (scar tissue forming around the membrane that holds the intraocular lens in place), or retained particles from the cataract. Neither of these cause permanent vision loss and can be treated as well. Sometimes, the vitreous gel can detach from a portion of the retina and consolidate causing a translucent haze in a sector of the visual field. And there are other less common but emergent causes of cloudy temporal vision such as retinal detachment. A good dilated exam of the retina by your doctor can identify any of these issues so plan can be put in place to mange them. I hope this helps as well and thank you for the kind words.

That's weird, my eye doctor who did my cataracts surgery said the same thing..."don't worry, your brain will adjust to it". What the ????. Well guess what, it's been 3 months and my brain 🧠 is like..what the hell. My brain didn't tell my eyes a damn thing.

Sorry to hear that and sounds like you have a bad surgeon. I just have cataract surgery on my left eye 5 days ago having Vivity+Toric lense for my astigmatism (I also had lasik surgery 15 years ago). I didn't have any issue in the first few days except my vision wasn't so clear, but today I can see everything (driving, TV, computer) so crystal clear and I can even read without reading glasses except very tiny fonts. I'm going to have 2nd surgery on my right eye next week and hope it will be just like my left eye. I think I have 1 of the best cataract surgeons in the country. I hope you can get some help to fix it and hope all the best for you.

I understand your frustrations and ask if you have returned to your Ophthalmologist for an evaluation of the cause? Your description shows that the vision after cataract surgery declined over time. There are reasons for this to occur, and most of these can be remedied to restore your vision. I typically would look at the anterior segment first (front of the eye), looking for refraction changes, corneal dryness, or corneal disease. Also, we would look for any "scar tissue" formation around the lens implant that could be causing opacification. Then we would investigate the posterior of the eye, evaluating the vitreous, retina, and optic nerve closely. If those prove fruitless, then evaluation of the central visual pathway would be in order. Rest assured, there is a reason for your vision change, it needs to be evaluated for your quality of life. Please update us after your evaluation!

During surgery two distinct portions of the cataract are removed, the nuclear fragments and cortical fragments. The nuclear fragments are usually removed first. These are typically dense pieces of the cataract that are broken into smaller pieces by a laser or sonic disruption until emulsified. If a sliver of the nuclear fragment is left behind then you usually would like to remove it. If it is very small then in some cases you can manage this by observation. These pieces are usually a surprise for the surgeon since we willingly do not leave these behind (I admit in my 21 years I have had a couple of surprises!), but it is possible a small fragment could "hide" behind the iris, theoretically caught in the ciliary fibers or in the posterior iris and then migrate out after surgery. The other portion of the cataract that is removed is called the cortex. The cortex is usually aspirated out with suction. There are times when the cortex is so adherent to the bag holding the cataract and the bag may be compromised with too much manipulation, that a surgeon will leave behind a very small amount behind. In certain circumstances this is the safer option for the patient. These small pieces can be observed and over time managed with medication if necessary until resolved. So in short, yes, based on the limited data and lack of images stay the course. Have faith in your doctor and communicate with her your questions and concerns. We as physicians are committed to our patients. Communication , knowledge and faith are the foundation for minimizing anxiety and enhancing success!

Thank you for the information. I have a few questions. What model lens implant did you receive? Can you see clearly with glasses? Can you describe in more detail the "flutters, trails, and spots" please? Thank you in advance.

@@notarobertomd as far as explaining my spots , trails ,and flutters that's exactly what they are. All day. At night my eyes feel tired and heavy. It has changed my life. As far as the brand of lens they are something that begins with a Q ,I can't find the cards

Hello! I am sorry to hear that you are having issues after cataract surgery. It sounds to me that you are describing new corneal edema (fluid retention or swelling) that occurred after your surgery. The two major reasons for this are either high energy use during surgery to break up the cataract or decompensation of the cornea from Fuchs disease. Both can occur with a successful surgery and any skilled surgeon. But it needs to be managed so you can regain clarity. Conservative treatment using medications can be effective. Your surgeon can measure your corneal thickness at each visit and objectively give you data if you are improving with this treatment. If you are not, then surgery for the cornea can help tremendously and in the great majority of cases restore clear vision. Ask you, surgeon, if the current treatment is working. If they feel it is not then a referral to a corneal specialist will be beneficial. Keep us posted!

Tq for yr clarification. Yesterday my doctor checked and concluded that there is retina tear and i must go for surgery. He also mentioned i my not get full vision. For such problem and due to too many cases for operation my doctor phosponed the opp almost two weeks. Can i wait for too long for this type of problem ?

@@sarasvathygouindan2346 I am not clear on the sequence of events. Did you already have cataract surgery, then developed corneal edema, then a retinal tear was diagnosed and the repair of the retina is postponed due to the cornea or postponed due to the poor prognosis to recover vision? Thank you for the clarification.

I am experiencing the same issue with my vision. I chose to have the IOL for distance implanted. Three months after surgery my distance vision is poor but my near vision is noticeably improved. I no longer need reading glasses to read even the smallest print. I am very disappointed with this post surgery outcome.

It appears your lens implant powers are optimized for near vision and not distance. Speak with your doctor about either a LASIK/PRK procedure or lens exchange to correct this if you do not wish to wear contact lenses or spectacles. The lens powers we choose are calculated by one of several advanced mathematical formulas. Though the formulas over time have continued to improve, they still reach the target in our patients about 88-92% of the time.

Thank you for the question. Can you please expound on "night wings" please so I can better answer your question.

There are many different refractive errors that an artificial lens needs to correct for vision to be clear post cataract surgery. The lens chosen by the patient and doctor will determine how clearly the patient will potentially see. If your sons postoperative refractive error contains any residual error (near sighted, far sighted, astigmatism, single vision, etc.) , then glasses or contact lenses will be needed to correct the deficit. If you have additional questions, please feel free to contact me.

What type of lens implant did you receive and do you have any potential complication factors (e.g. diabetes, macular degeneration, glaucoma, etc)? Also, conduct a small experiment for me, take a small piece of paper or cardboard and place a small (very tiny) hole in the center of the paper. Then cover your non-operative eye with your hand and look through the small hole with your operated eye. Does the image seem clearer to you? Thank you in advance.

Yes it is possible and the odds are increased based on a variety of factors. Some are the time between the onset of infection and initiation of treatment, the type of bacteria and the effectiveness of the antibiotic used. I have had some cases respond within days and others that were more severe have restoration after weeks.

The various trifocal intraocular lenses available require a period of neuroadaptation where your brain adjusts to the visual input from the new lens. Additionally, some patients will require some time for swelling and dilation to improve after surgery. Please update us in about 10 to 12 days. Thank you!

@@notarobertomd Yes I will it’s my 9th day but no progress same foggy 🌫 vision I had fallow up check up yesterday on 9th November Doctor said for the 3 thing you can’t see clear vision 1. It will take May be 3/4 Weeks 2. You have scars behind the cornea which is fixable by Laser after 3/4 weeks so I make appointment on December 1st week 3. Some people need to have glasses So let me see what will end up

Raj, I usually tell my patients that visual recovery is variable after cataract surgery. It is dependent not only on the type of surgery one has undergone bur also if there are concomitant ocular or systemic diseases that could retard healing. Though many patients see well the next day, on average 50-80% of your vision should return in 24 hours and on average about 10% additional every day thereafter.

Does your double vision go away when you close one eye and then the other separately? Or if either eye is closed do you still see double with one or the other. Thank you in advance.

@@notarobertomd Yes doc my double vision goes away when I close on eye, as soon as I open the two eye I now see double of everything.

Just give it a few more days

After cataract surgery, there are cases where the energy placed into the eye to break the cataract can cause excess inflammation. Commonly the cornea will develop edema (swelling) and rarely can be persistent. If you have an underlying issue with the cornea (e.g. Fuchs corneal dystrophy), then this may be exacerbated and require a surgery to help the cornea. Since it has been several months, how is the cornea and vision at this time?

If vision deteriorates after cataract surgery, a reason for this exists and can usually be elucidated. Common reasons are rebound inflammation causing swelling of the macula (called cystoid macular edema or CME), corneal issues (e.g. dry eye syndrome, inflammation, etc), recurrent anterior inflammation or clouding of the lens implant called an "after cataract" or posterior capsular opacification. Sometimes, the lens implant can shift or move due to fibrosis or scarring around the lens causing a shift in refraction and thus changing your vision. If you are not obtaining the answer from your doctor, please seek a second opinion before the issue potentially worsens.

Dear Dr. Neil@@notarobertomd , thank you for the reply. The condition has improved. Small issues are still there but hopefully I will be able to recover fully in next few months.

I am very happy with your success. The PanOptix lens implant has been very successful in the right patients! We love this lens as well. Regarding your question, there are limited reasons for your issue. Fortunately it is not occurring in primary gaze (straight ahead) so you can maintain functionality for the majority of time. The issue involves either one of the 12 muscles that control ocular movement or one (or more) of the nerves that innervate a muscle mentioned. Therefore it can be a mechanical or neurological issue. There are solutions for both in most cases and I recommend an evaluation by a neuro-ophthalmologist which your surgeon may be able to facilitate for you.

@@notarobertomd……Dr. Notoroberto….thanks so very very much. At the 3-month point…..Yes…. I will consult with a neuro-opthamologist

I am sorry you have had a rough journey. This should be an illustration to others who are considering surgery to not only have a good relationship with your surgeon (this applies to any type of elective surgery) but to be your own advocate for your healthcare. I always hope that other peoples experiences, like yours, are shared with everyone so people can ask the best questions of their doctor prior to surgery. Regarding your specific case, once a surgeon and patient realize the initial outcome is not where the patient is satisfied, then options must be discussed. Depending on the cause of suboptimal results, a lens exchange , LASIK, PRK, spectacles and contact lenses are the usual choices. It appears you and your surgeon made the decision for LASIK correction to neutralize the refractive error. By your account the LASIK flap is very thin and multiple attempts were completed to achieve the refractive results. I am assuming the "fluids" you describe are actually prescription drops that will help the healing process. These are important after LASIK to prevent infection and reduce inflammation. These drops can cause discomfort, burning, stinging and blurred vision after insertion. But this passes and can be normal. Please use the medication as directed by your doctor. I understand and empathize with your concern and anxiety. It can take some time for LASIK after multiple attempts after cataract surgery to settle. Be patient and give us an update in a few weeks please.

Neil your the best - huge thanks for taking the time out of your busy days - unfortunately I will have to let it heal naturally - if I put in dry eye tear drops - antibiotic etc. I will loose the vision instantly - happened 3 times in a row - waited months between each procedure as you know you have to - vision never came back just got worse- so this time Ill have to deal with dry eye symptoms and hope for the best - Bless you Neil have a wonderful day

@@notarobertomd Can LASIK be used after Panoptix lenses are placed? Will there be more glare and increased dry eye?

I am sorry to hear that. This could occur for a variety of reasons with some reversible and others possibly within a certain window of time. Please bring your father back to the surgeon for examination immediately. And for anyone reading this, please remember if there is any change in your vision after cataract surgery, contact your doctor immediately. Please keep us posted on his condition. Thank you.

@@notarobertomd i want to ask is there's any treatment for this problem?

@@notarobertomd dr told us laser treatment and 3 injections... Is these are good in this situation?

@@tubazahra3861 It could mean one of several problems has occurred so it will be challenging to give you a firm answer. Retinal laser and intravitreal injections for the retina are prevalent treatments we use to restore anatomic restoration and functional recovery. But the prognosis depends on the amount of pathology or disease prior to commencing treatment. In general, these treatments are successful. Can you be specific with the diagnosis?

How is your father now. Is he okay already?

Your primary doctor shouldnt do cataract surgery.

Magnifying mirrors were invented for putting on makeup.

During surgery, it is possible the cornea (top layer of eye) can become scratched for a variety of reasons, but this is rare. The good news is that it usually heals very quickly and does not cause permanent issues. More concerning is that you developed a retinal tear after surgery. This underscores how important it is to follow up post operatively and always let your surgeon know of any irregularities post operatively. Thankfully it was treated! And lastly, your observation also underscores that a single vision distance lens does not help with near vision requiring reading glasses to read and a magnifying mirror for close facial work. That is why there are other lens implant choices available that can give you a range of vision. If near vision without glasses is important to you, please consider contact lenses to help fulfill this goal.

"developed a retinal tear" after surgery ?? or as a result of the surgery ? The surgery is an invasive procedure. Everything can go wrong OR right. I've got retinal damage (I'm convinced) from the procedure. Dark room peripheral flashing and floaters like never before. I'm not complaining about the remarkable after surgery vision improvement. I'll just have to endure the floaters and hope the flashing does not get worse. @@notarobertomd

You had a skilled and great surgeon then! Cataracts of that nature are typically more difficult to remove without complications. Congratulations and enjoy your vision every day!

I am 65

And worried . Ok advise

So I would like to break down your questions into two parts. The first, seeing the haziness. To better understand the possibilities, I must ask a few questions. Did you receive a single vision (monofocal) lens implant or a multifocal lens implant? Was your lens implant a "toric" lens? Lastly did you have prior refractive surgery (e.g. LASIK, RK, etc)? The second portion of your question relates to your balance. Again, I must ask a few questions first. Describe your balance issues in detail please. Also, do you have balance issues with your glasses prescription on and when they are off, or just when the glasses are on? Thank you in advance.

follow thread...

There are times when cataract surgery is recommended even when patients have rate-limiting factors that prevent good vision after the removal of the cataract. The first thought is why you will be limited in how well you can see. Your surgeon should be able to explain to you if it is an issue with the cornea, retina, or optic nerve. Any of these would have to be managed separately. The second thought is why one would recommend cataract surgery if you will not "see" better. It is possible, as you state, that the acuity or the resolution of what you are seeing will not be improved centrally but outside the central zone your vision will be improved enough to help you navigate around your environment or possibly decrease your risk of accidents or falls. This is a great discussion for you and your surgeon as well so you can better understand the purpose of the surgery in your particular case and feel more confident about proceeding forward. Please let us know!

I need a good honest answer please.july 14 i undergone combined macular jole.and cataract (still small but doc said we can remove it ) surgery.why upon removing.my.bandage.my vusion is zero not even blurry For the two consecutive weeks, the doc gave me a.week of medicine intake and addedeye drop for.glaucoma On 2nd week he reffered me to a glaucoma.specialist bec i think he cant justify what cause the blindness when the retina is intact and presssure is.normal The glaucoma specialist also sees nothing wrong. she told meaube it was only delayed maybe the reaction depends on the person. She gave.me.diavision amd.lutein.for.two.weeks to regulate blood flow even .not diabetic. Niw it s.my 2nd day taking diavision amd still no sign.of.even a blurry vision but yes i can see spark when lights are turned on Please enlighten me. Do i need to.seek another retina.specialist to check on this?i really appreciate any feed back from your end.God bless your good heart. Thank you so.much

@@momme7728 Thank you for the details and timeline. It is obvious you had complex problems to address prior to your surgery and had problems after surgery. So let us tackle them in order. A macular hole in many cases will limit the best-corrected vision you will have after any surgery. This would be the case whether you underwent macular hole surgery alone or cataract surgery alone. But if after removing your bandage, your vision was 'zero', then there likely was another issue (expected or unexpected) that occurred. It appears by your description of being on glaucoma drops after surgery, you must have had high intraocular pressure after surgery. If your vision was black with no light after surgery, we can only surmise that the pressure was so high that the blood flow to the optic nerve and/or retina. may have been compromised. If the glaucoma specialist did not find any issues from their end, then by the time you saw them, your intraocular pressure must have been normal. In this case, I agree with you to seek a second opinion. But I urge you to discuss this with your retina specialist again and see if he/she can discuss with you what they think happened and what their plan is. Please keep us posted.

It would appear by your description the refraction or power of your lens implanted allows for a focal plane closer to near than distance. As you stated, a "single vision" lens implant is optimized for one focal length. Patients will choose either distance or near. In your case, you chose distance but see near instead. You should ask your surgeon what your options are at this time. Glasses, contact lens, LASIK, piggyback lens implant or a intraocular lens exchange are likely possibilities. Please let us know how your next visit turns out.

@@notarobertomd Dr. Notaroberto, I appreciate your reply very much. Thank-you for your time. I will update you to let you know as I work with my eye care team to resolve this issue.

It has been one month since my last post about my cataract surgery on both eyes. My vision was disappointing after both surgeries. My right eye is 20/70. The left eye is 20/60. The surgeon informed me that I had developed PCO in both eyes within a couple of weeks of my surgeries. A YAG procedure was performed on my right eye a couple of weeks ago. Much to my disappointment, the acuity of vision in the YAG eye is still blurry and smudgy. I see no improvement in my vision. Anything past the length of my arm is not well focused. I feel like I have the incorrect prescription IOL. The doctor said that could be fixed with prescription glasses for distance. I am so deeply disappointed to be forced to accept the inconvenience and cost of prescription glasses for the rest of my life to be able to see distance.

@@-myal-8691- It appears since you have clearer vision within arm's length and blurred past this distance, you indeed have lens implant powers that are optimized for near vision and possibly intermediate. There are varied reasons for this to happen but I would rather focus on solutions for your current situation. When this occurs, there are several solutions and any of these can be performed at any time. The most conservative solution is spectacles or glasses of course. Contact lenses are another option. Mind you, if you are optimized for reading and intermediate, this means without glasses reading and computer work would not require correction and you would only need glasses to see distance. I have a subset of patients that choose this option surgically because they wish to work at their desk in comfort all day without the side effects of multifocal lens implants. Performing LASIK or PRK on the cornea would correct your vision for distance and is a non-surgical procedure. Lastly, a lens exchange could be performed in the O.R. and neutralize your refractive error as well. (I have one set up for next week in fact!) You have options and should discuss these with your doctor. Let me know how it goes!

@@notarobertomd I appreciate your reply. Everything you said makes perfect sense to me. I am considering seeking a second opinion from a different eye care center because I feel such great disappointment in the results from the eye surgeries at the current facility. Is it possible for an Ophthalmologist to examine my eyes and determine what lenses were actually implanted in my eyes without having to remove the implants? What is the risk of removing already implanted lenses to replace with correct power lenses? Thank-you so much for your time.

Me too 3 months after cataract surgery blurry dizzy shadow in left eye and many floaters 🙏🙏🙏 felling hopeless😪😪😪

The same with me after surgery . awful glare, floaters and vision blurrier than before. This was three years ago.

@@ruthvaught4647 hello mam are you ok now? Hope u will ok now❤🙏

@@jeffseguin4872Thank-you for asking. My condition never improved. I also developed night blindess and can no longer drive at night.

@@ruthvaught4647 so sad mam, how old are you? ❤🙏

Hello! It appears three complaints should be addressed. I will break down each one separately. The first is the "blurry shadow" with the left eye. The cause can depend on where the blurred vision is located. If it is central and affecting your acuity, then you may have some residual refractive error. This can be resolved with glasses, contacts, or additional surgery. If the blurriness is off to the side, then that could be a lens issue, cornea issue, or retina issue. Regardless, you should go back to your surgeon for an evaluation. The second, floaters, may or may not be an urgent issue. Sometimes after cataract surgery, the existing floater's people have become more prominent due to the increased amount of light entering the eye (we cannot actually see the floaters but see their shadows cast upon the retina). This also needs immediate attention in case there is a new problem occurring (i.e. retinal tear, detachment, etc). These are emergent issues so please call your doctor today. The last, regarding dizziness, may be due to the difference in vision after having one eye corrected and the other not corrected. Glasses can help this condition if the eye is the cause. But as you know, dizziness may be from a variety of other issues that can involve your semicircular canal, brain, blood pressure, blood sugar, or even your heart. Please have this evaluated by your doctor as well.

@@notarobertomd thank you verymuch Doc i hope you check my eyes🙏🙏🙏

Doc Neil actually i have cataract operation in march 2 2022 i have hemo stroke last oct12 2021 almost fully recovered then i have to decide to have operation bec the doctor said ihave cataract in left eye only but after operation my left eye im felling very different i have also anxiety felling scared always in my eyes i have eye exam OCT and PERIMITRY the result is normal and good but my vision in my left eye is very diffrent before i want to replace my IOL i think thats the problem bec after my surgery very different hard to focus felling dizzy always 😪 felling tired to wait if my vission is come back Doc help me please what can i do i have many doctor but my vission still dificult im from MANILA DOC Neil please help me please❤🙏

@@jeffseguin4872 What is the refractive difference between your eyes at this time? Specifically what is the difference in your prescription that you require to see clearly.

Great question. As stated by your doctor that may be the case. If one of the six muscles that control the movement of your eye becomes compromised, one will indeed suffer from double vision. Both eyes must focus on the object to see it as a singular object. (disclaimer: I am simplifying the explanation since there is a slight degree of offset to allow for depth perception). But there are other scenarios I have seen in my own patients. For example, one patient had developed your condition post operatively independent of the surgery. They had suffered a microvascular palsy due to a subsequently found cardiovascular issue. That is one of many possibilities. Ask your doctor to refer you to a neuro-ophthalmologist for an evaluation if you feel the need for additional workup.

Apparently, you are going to have to manage three specific issues about your upcoming surgery. The cataract you have developed appears to have become visually significant so your surgeon is scheduling its removal which should help you significantly. Simultaneously you will undergo a glaucoma procedure which should assist in lowering your intraocular pressure and thus protect you from rapid deterioration of your optic nerve. So far you are set up to positively impact your long-term vision and ocular health. (As you may have read, glaucoma is the "silent thief of sight" and should never be forgotten.) The last subject, regarding your high myopia and likely related retinal tear history, places you at higher risk for complications (e.g. retinal tear, retinal detachment, etc). If you are still feeling anxious after a thorough assessment by your surgeon, you should ask him for a referral to a local retina specialist to determine if prophylactic retinal laser treatment is indicated for any areas that appear at risk for the cited retinal complications. Keep us posted!

@@notarobertomd Dr Neil, Thank you very much for responding, helping me put things in perspective. I had my first cataract surgery last Monday, at the post op my reading was 18, down from 23. Needless to say I was disheartened. I kind of expected a lower point. The Dr didn't say anything.i had a near distance IOL on my left eye. Will be having ABIC on right, and near distance w Toric lense. I'm debating far distance for right eye. Monovision. I keep going back and forth. Because of torn retina from few years back (had horseshoe laser). I'm afraid it won't help. So I thought get near distance and contact lenses. The torn retina left me with a permanent vision loss 20÷40. What your opinion?

​@@eg1197 Thank you for the updates. This gives continuity for people following your outcomes and learning from them. Regarding your intraocular pressure lowering after surgery, do not be dismayed, usually, we would like an average reduction of 20-30% after glaucoma surgery. Recall the normal range is 10-21mmHg so each 1mmHg change is effectively around 10%. Your pressure lowering is very good and in many cases may continue to trend downward weeks or months after surgery. I understand that your vision is rate limited in the right eye due to the previous retinal detachment. I also understand being on the fence on whether or not to opt for mono-vision (one eye for near and the other for distance). I use mono-vision so I am aware of the strengths and weaknesses of this modality. If you have experienced mon-vision before with contact lenses or LASIK and were happy with it, I typically recommend emulating that with intraocular lenses as well. These patients are very happy afterward since their brains are already adapted to this. But if you have not used mono-vision before, experimenting with it using a permanent intraocular lens is not a wise choice. And specifically in your case, the fact that your vision is rate limited in this eye weighs heavily. For my patients on the fence, I typically place them in a contact lens prior to surgery to see if they can tolerate mono-vision. This sometimes helps guide the patient to a decision they feel comfortable with. Also, do not forget, if you opt for a distance lens implant, you can always wear a contact lens afterward to give you near vision in that eye if you so choose. Please keep us updated.

Hello! First I would like to say that I am happy you gave yourself the best opportunity for great vision. At the time, the PanOptix offers the best opportunity for a wide range of vision with the least amount of side effects. (I have seen the good, the bad and the ugly from all lens implants, so no one lens implant is the holy grail, every individual is unique and pre-operative testing helps reveal the best lens for the patient as you experienced). As far as healing time and visual recovery, there are several things to consider. First, each eye is different, with its own blood supply and unique physiology. Therefore, healing time may vary between eyes. Secondly, one eye may have a pathology of its own thereby delaying healing as well. Third, during surgery I sometimes perform additional procedures due to the unique anatomy or findings in the O.R. that may delay healing as well. These are commonly seen by the surgeon and patient when there is disparity between healing times. This list does not include inherent issues with the eye nor complications. By inherent issues, I mean disease of the ye that delay healing (e.g. Fuchs disease, diabetic retinopathy, etc.) or residual refractive error which can occur to any surgeon despite a perfect surgical case. Everything I mentioned is manageable and able to be neutralized to achieve the best you can be though, so give it time, continue having educational and professional discussions with your doctor so together you can cross the finish line! Please let me know how you do and congratulations again!

Thanks for replying doctor. Vision in my left eye is still blurry. It seems like I have double vision in my left eye. When I look with both eyes, my vision is good. But when I look with my left eye only by covering my right eye it seems I have double vision and hence I'm unable to see clearly. Should I be worried about this? Is it a normal symptom and will it heal over time or should I get another surgery to correct it? Thanks in advance.

@@jaswant6128 At your next post-operative visit, ask your surgeon what they think is the cause of the blurry vision. They will perform testing to determine if it is an anatomic or optical issue. Once identified, then a solution will be initiated. Here is a simple test to assess your potential vision and give you some peace of mind prior to that visit. Take a notecard and punch a small hole with a pencil or pen tip making a pinhole. Look through the pinhole and your vision should be improved indicating your potential vision is actually higher than what it is now. If not improved, you may want to call your surgeon sooner to see if they can see you today. I hope this helps.

@@notarobertomd thanks for your inputs. I tried looking through a pinhole with my left eye. I could see things clearly. Does this mean that my vision will improve gradually or will I need glasses to correct them? I'll also check about this with my doctor on my next visit. Thanks

@@jaswant6128 The results indicate your potential vision has the ability to reach that level. Since you remain in your post-operative period, further healing likely will take you to that endpoint. If not, then your surgeon will give you options to reach that level. This may include glasses, contact lenses, or another procedure to enhance the optical clarity. The positive takeaway is that you have elucidated your eye has the potential to reach the desired visual endpoint. I appreciate the updates.

There are many causes for a color tinge or color shift in your vision. Commonly when I see this I tell my patients that it could be a disease affecting the eye, retina, or the brain. The examination that ensues will narrow the location, leading to a diagnosis and then treatment. Most commonly I have seen in practice that cataracts, macular edema, optic nerve disease, and multiple sclerosis are the top 4. Obviously, you have had your cataract removed so that is excluded, but I have seen one case where the lens implant due to its specific tint caused a color shift. This issue needs to be investigated. Keep us posted!

Thank you for the feedback.

In many cases, that is indeed the correction of choice for residual refractive error. The majority of patients in this category do choose the option you mention. But when spectacles cannot correct the vision due to complications after surgery, then additional procedures are often warranted.

The SN60WF model of lens implant is a single vision lens implant. What this means is that it can be optimized for one range of vision, distance, intermediate or near, depending on the power of the lens your surgeon and you agreed upon. The great majority of patients with a SN60WF will be set for distance vision which means that your close vision will be out of focus without reading glasses. So in summary, this is to be expected with the SN60WF in the scenario I described. Thank you for the excellent question. This is why I have a great majority of patients opt for a multifocal lens implant. We take for granted how much we use our vision at various ranges until it is no longer available due to age or other conditions!

@@notarobertomd Hello Doctor. I have done cataract surgery to my left eye just one month ago but from the day 2 , I am feeling that something is stuck at the left side of my left eye ( towards ear) and one thing more, I am observing a crescent type shadow to the left corner of my left eye. Please explain me for my satisfaction. This is my earnest request to you.

You're full of sht,I know a whole alot of people who had cataract surgery and they are happy as they come.Telling somebody not to get that surgery hell why don't you tell everybody to just go blind because that's what cataracts do to after while.

Thank you for the feedback.

how are you now?did you recover from before

Sorr for the late reply! Somehow I missed this question. Since a month has passed, can you give us an update? Thank you in advance!

Hello Tanya and Doc Neil....sorry not sure if both are doc, didnt check yet bec.am excited to share my updates. On Sept 15 it will be my one month of taking the Vessel Due medicine that was prescribed by the former retina specialist(the one who was supposed to do the surgery but i refused bec of money constraint.He gave me vessel due to see if he can save my right eye. I am still hoping it will recover soon. For now , the black thing is getting greyer .not totally black anymore.Sometimes i see lots of white floaters and some like water with shape like lanterns on the peripheral of my vision. I can see flickers of.lights when i look in the bright light or day.My eyes redness keeps on appearing maybe bec im using it without any shield so i bought a black soft shield and use it every day time. Simbrinza is all the eyedrop am using 2x a day. Another vit s i continue to use are centrum silver, omega 3 fish oil in the morning, tozam for bp,vessel due and neurobion at bed time. Please tell me but am praying and hoping that soon this grey vision will come to light and i will have my eye turn to normal. Thank you so much for for all your prayers and happy thoughts for.my.eye s full recovery. God bless you all.🙏🙏🙏💓💕💞

@@taniyaghosh1191 not yet Tanya...but am still praying and.hoping for some.miracles thru God s grace🙏🙏🙏

How is your vission now? are you ok now?

You make a valid point, any surgery on any part of the human body has an inherent risk of complication. This is why you should only have surgery if it is indicated , necessary and all other options have been eliminated.

@@notarobertomd I eliminate everything else: 1) secondary cataracts occur in everyone after implantation of a piece of plastic into the eye and this cataract is not a NATURAL CHANGE IN THE ORIGINAL LENS, but the work of a SURGEON ,- AT DIFFERENT TIME PERIOD - in six months, in a year, in a couple of years, etc. 2) If the entire lens is removed, WHY NOT JUST MAKE A HOLE IN IT so that the light reaches the OPTIC NERVE (as for far-intermediate-near vision, I WILL CANDLE THIS USING GLASSES - that’s my concern.) .... I am sure THAT SUCH AN OPERATION IS POSSIBLE, and even more so - in the presence of laser TECHNOLOGY, BUT no one uses it because this operation is a CHEAP PROCEDURE and you can’t put a lot of money into your pocket right away!!!! 3) regarding secondary cataracts - RIGHT HERE, THE INTERESTED - all those interested, together with the NAIVE PUBLIC, begin to “assure me” THAT WITH THE HELP OF THE SAME LASER, THEY WILL MAKE A HOLE FOR ME (remove) in the posterior wall of the capsule which has become cloudy - thickened, etc. - as a result of the adhesion of a FOREIGN BODY OF WHICH HAS A COMPLETELY DIFFERENT HARDNESS AND OTHER THINGS..... THAN THE NATURAL LENS... BUT with this operation, the laser beam can disrupt the ARTIFICIAL LENS which, moreover, will no longer be separated from the vitreous body - where processes leading to damage to the VISUAL NERVE, AND THIS DAMAGE ENDS IN LOSS OF THE EYE - COMPLETE BLINDNESS...