Post-Surgery Vision Issues After Retinal Detachment Treatment

Retinal detachment

Hello doctor, I had a scleral buckle and vitrectomy with silicone oil insertion for retinal detachment in my left eye at the end of March.
Due to severe cataracts, I underwent cataract surgery with an artificial intraocular lens in early September.
Before the surgery, the doctor carefully measured the axial length of my eye multiple times because of the silicone oil, hoping to achieve the best possible vision after the silicone oil is removed.
It has been over a month since the surgery, and my vision is at 0.7, but I have 2.00 diopters of hyperopia and 5.00 diopters of glare, which is quite bothersome.
I would like to ask you if the high glare is related to the silicone oil or the intraocular lens, since I am using a monofocal aspheric lens that reduces astigmatism.
Can changing the angle of the lens reduce the glare, or should I wait for a while longer for my vision to stabilize before the astigmatism issue improves? Thank you for your guidance.

jiao, 30~39 year old female. Ask Date: 2017/10/06

Dr. He Jianxian reply Ophthalmology

Because you have undergone more complex retinal surgeries, which can alter the original refractive power, it is recommended that you monitor your vision for a while before deciding on the next steps.

Reply Date: 2017/10/06

More Info

After undergoing surgery for retinal detachment, including scleral buckle and vitrectomy, followed by cataract surgery, it is common to experience various vision issues as your eyes heal. Understanding these issues can help you manage your expectations and navigate your recovery effectively.

Vision Changes Post-Surgery
1. Visual Acuity and Refractive Errors: It is not unusual to have fluctuations in vision after such surgeries. Your reported vision of 0.7 (which is approximately 20/30) is a positive sign, but the presence of 200 degrees of hyperopia (farsightedness) and 500 degrees of astigmatism (which can cause blurriness and glare) indicates that your eyes are still adjusting. These refractive errors can be influenced by several factors, including the presence of silicone oil, the healing process, and the characteristics of the intraocular lens (IOL) used during cataract surgery.

2. Silicone Oil and Its Effects: If silicone oil is still present in your eye, it can affect the shape of the eye and the way light is focused on the retina. This can contribute to visual disturbances such as glare and halos around lights, particularly at night. The oil can also cause changes in the eye's refractive status, which might explain the astigmatism you're experiencing.

3. Intraocular Lens (IOL) Considerations: The choice of a non-spherical IOL is intended to reduce astigmatism and improve overall visual quality. However, if the lens is not perfectly aligned or if there are residual effects from the silicone oil, you may still experience glare and halos. It is essential to give your eyes some time to adjust to the new lens, as it can take several weeks to months for your vision to stabilize after surgery.

Management and Next Steps
1. Monitoring and Follow-Up: Regular follow-up appointments with your ophthalmologist are crucial. They can monitor the status of the silicone oil and determine the optimal time for its removal. Once the oil is removed, you may notice further changes in your vision, which could improve your refractive errors.

2. Adaptation Period: It is common for patients to experience an adaptation period after cataract surgery and the placement of an IOL. During this time, your brain and eyes are adjusting to the new visual input. It is advisable to be patient and allow some time for this adjustment.

3. Potential for Further Correction: If after the silicone oil removal and a sufficient adaptation period you still experience significant glare or astigmatism, your ophthalmologist may discuss options for further correction, such as glasses or contact lenses specifically designed to address these issues.

4. Lifestyle Adjustments: In the meantime, consider using anti-reflective coatings on your glasses if you wear them, as this can help reduce glare. Additionally, wearing sunglasses with polarized lenses outdoors can help manage brightness and improve comfort.

Conclusion
In summary, the visual disturbances you are experiencing post-surgery are likely multifactorial, involving the effects of silicone oil, the characteristics of the IOL, and the natural healing process of your eyes. It is essential to maintain open communication with your ophthalmologist, adhere to follow-up appointments, and give your eyes time to adjust. If issues persist after silicone oil removal, further interventions may be necessary to optimize your vision.

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