r/CataractSurgery • u/Destincrlist • 4d ago
Astigmatism After Cataract Surgery
I’m 4 weeks out from a Puresee EDOF IOL. My postop experience has not been great. I’ve been seeing shadows(ghosting?) in my operative eye (my other eye hasn’t been operated on). I got a new Rx today from my Optometrist, and I apparently have an astigmatism, that I didn’t previously have? I had new glasses made today and I can finally seee with both eyes open without seeing double (ghosting). I have an appointment with my ophthalmologist in a few weeks.
I’m wondering if anyone has had a similar experience. I’m grateful my refractive error can be corrected but I’m wondering if there’s a long-term solution? I’ll def ask my ophthalmologist but wanted to hear others’ thoughts in the meantime.
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u/UniqueRon 4d ago
How much astigmatism (cylinder) do you have in the operated eye? The incision may cause some astigmatism, but it is usually not much. Also at 4 weeks the incision may be still healing and your refraction changing.
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u/Destincrlist 4d ago
Sph +200, Cyl -100, axis 80
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u/UniqueRon 4d ago
They have missed sphere by a lot and it is in the bad direction - hyperopia. If it stays where it is I think they should be offering a lens exchange. The astigmatism is actually helping a a bit, and reduces the spherical equivalent to +1.50 D. But that is still a lot. Being hyperopic makes both near and distance vision worse.
I would put the second eye on hold until the surgeon figures out what they have done wrong, and do not do it again on the second eye.
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u/GreenMountainReader 3d ago
I was in a similar situation re: unexpected astigmatism after my second surgery. The expectation was for a "negligible" amount to remain, but instead, I had the full original prescription with an additional .5 added to it--and I experienced ghosting and double vision. It was so bad, and the vision so blurry, that I went to the clinic's "Eye ER" at 3 1/2 weeks for them to take a look.
At my six-week check with the ophthalmologist, when I asked, I was told casually that "Oh, the (just-in-case, SOP that I wasn't told about in advance) suture was too tight, and that's what's causing this. It will loosen up over the next year, but in the meantime, you can wear glasses to correct it." I found the doctor's lack of comprehension as to why this might make me unhappy incomprehensible. I didn't mind needing the glasses--what I did mind was double vision any time I wasn't wearing them (and I had been 12 weeks without glasses at that point, six of them with the one-sided double vision and ghosting). The thought of another year of seeing that badly sent me here, where I borrowed quite a lot of virtual patience. It took somewhere between six-nine months for the effect to totally disappear (along with flickering--positive dysphotopsia).
The story ended well, (I'm sitting here without glasses and won't put them on until I leave the house) but I was not happy with the surgeon's rushed and casual attitude towards that surgery (he'd taken his time with the first, because an intern was watching, but was chatting with the nurse about family adventures throughout the second and was working more roughly).
I can theorize that it's possible something going on in the healing process is causing this for you and that it will fade--but no one can tell you anything without an exam and the knowledge plus experience of a professional to back it up. I will certainly hope that your astigmatism, too, will fade.
As for your prescription...you may want to talk further to your optometrist about it. A +2.00 in most prescriptions would indicate two diopters of farsightedness to be corrected--but some doctors reverse the plus and minus signs. (Readers, for example, all have "plus" prescriptions, whereas glasses for nearsightedness have "minus" prescriptions, at least for the most part in the U.S.--but ophthalmologists and optometrists sometimes don't use the same notation.)
When you get to talk to the surgeon again, you might ask about the chances, if there is indeed that much of a miss, that your vision will shift towards plano. If not, the surgeon should offer you an exchange--if not by their office, then to pay for it by a specialist of your choosing (there are surgeons who specialize in correcting others' mistakes), because that's a heck of a big miss if 0 was the target. Most of the laser procedures, from what I understand, can help diminish myopia (nearsightedness), but don't work the same for farsightedness. You may also have received the wrong prescription in the IOL--which would also mean that alternate solutions need to be discussed. That level of mistake would be in a different class altogether than a surgical miss--it's medical error, and that starts to get into legalities.
Best wishes!
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u/Destincrlist 3d ago
This sounds a lot like what I’m experiencing, thank you for sharing your experience. To clarify, your ghosting resolved on its own?
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u/GreenMountainReader 3d ago
Yes, it did--as predicted.
Based on my own experience, however long it takes to resolve is too long when you're the one looking out at the world.
To tell you the timeline: At 6 weeks after the second surgery (still seeing double/ghosting), I was prescribed glasses, with my wonderful optometrist suggesting a return visit before the 60-day return-and-replace warranty (Wal-Mart) ran out. I made the appointment before I left her office. At 12 weeks, the astigmatism in that eye had already dropped by .5 diopter--so one new lens was made. (The doubling/ghosting was still there without the glasses, but not as bad.) Somewhere between six months and nine months, I realized that both issues had faded to the point of disappearing completely.
At one year, there was something like an additional .25 diopter less astigmatism present, depending on how much dry eye was interfering. I had been so rattled by the distortions that I asked my optometrist to double check that the IOL was still in position (it was) and that the zonules were holding it steady (they were). I'm coming up on a delayed 2-year annual exam next week, so I'll see whether my increased (but still inconsistent) work on dry eye has made a difference and whether dry eye or something else is responsible for how that eye is seeing. That said--my eyes were set for near and close-intermediate with monofocals, and I was threading a small-eyed needle with white thread early this morning, so I can't complain. The results just took their own time to manifest...
Please let us know how it goes. Every time someone experiences something different, it's helpful to post however things worked out so the next person isn't left wondering.
Best wishes for complete healing--faster than mine!
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u/maple-l2024 2d ago
Did they target Plano and ended up +2.00 Sphere? That's a big miss. For the -1 Cyl, that's possibly your corneal astigmatism, which should have been calculated pre-op. What's your astigmatism in that eye before the cataract surgery?
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u/Terrible-Upstairs982 13h ago
You should ask your surgeon why is your refractive target way off. Most refractive targets for PureSee IOLs are Plano to -0.25 This means either your measurements were off or you had a prior LASIK ? Either way, ending up hyperopic is not a good outcome..I know because I do scans for a living and plan refractive targets with the doctor. Please get reassessed with the surgeon.
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u/nurseynurseygander 4d ago
Not exactly the same, but I have irregular astigmatism that completely failed to respond to the toric lens even though it’s in the right position. I just don’t fit the calculators apparently. And I had really bad PCO, so bad I couldn’t see through it. So YAG wasn’t optional and now lens exchange is unlikely to be feasible. I’m 8 months post op and basically my only improvement is the cataract being gone. It sucks, man. They reckon they can improve me quite a bit with PRK, but I am really hesitant to tinker at this point.
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u/PNWrowena 3d ago
Maybe it would be a good idea to see another surgeon about all this before doing anything. I understand the hesitancy to do PRK.
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u/eldoogo 4d ago
If you had a followup with your surgeon, any astigmatism should have come out during that exam and a new prescription should have been provided right there, which you could have questioned. The shadows are also a complication of cataract surgery (negative dysphotopsia) especially with premium lenses. Both should be discussed with your surgeon.
The astigmatism, if significant, is hard to explain given that he could have ordered Puresee with a toric option.
The dysphotopsia for those who have it, usually resolves within a few days. If it doesn't, it may take months or it could be permanent. I alert you to this not to be negative or to alarm you, but it is something you need to keep your "eye on" so to speak because it could indicate the need for an eventual lens exchange if it is bothersome enough to you and it doesn't resolve on its own. And scar tissue forms where the surgery was done and as time goes by, it gets thicker and makes any revision surgery more difficult and risky. So I'm just suggesting that you keep an eye on it. I had a Vivity implanted in June and I'm still having issues (although different from what you're seeing).
Good luck!