Vision Changes After Cataract Surgery: Common Concerns

Postoperative vision after cataract surgery?

Dear Dr.
Gao,
Thank you very much for your detailed response to #166210.
I have three questions to ask you today:
1.
I had cataract surgery on my right eye (monofocal aspheric) and my vision was 1300 degrees without any residual prescription.
It has been a month since the surgery on March 4th.
In the first week post-surgery, my vision was still 0.8, and I could read license plates and posters from a distance.
However, I noticed a decline starting from the second week (at that time, I was mainly concerned about presbyopia).
Now, after a month, my vision has dropped to 0.5, making the text on posters and license plates blurry (similar to how it was before the cataract surgery).
When I followed up with my doctor, they said everything was normal post-surgery.
I did some online research and found that this could potentially be due to lens displacement, but the doctor assured me that there was no such issue.
The nurse reassured me to wait a bit longer and suggested that it might be a slight astigmatism issue.
However, this was not mentioned during the pre-operative assessment, and they were unclear about the degree of astigmatism afterward.

- 1.
Could my vision of 0.5 be potentially caused by astigmatism?
- 2.
What is the typical recovery time for normal vision after cataract surgery with an artificial lens?
- 3.
Based on your clinical experience, what could be the possible reasons for this issue? Are there any methods to improve it?
2.
My left eye had the artificial lens implanted on April 8th, and it has been a week since then.
Before the surgery, my vision was 1300 degrees.
To avoid the hassle of constantly putting on and taking off reading glasses, the doctor reserved 150 degrees instead of 200 or 250.
Since I am not familiar with these calculation formulas, I simply communicated my desire to see clearly for reading and at the computer distance, which the doctor assessed.
Post-surgery, I find it somewhat difficult to see up close; I can read text larger than 14 points, but I still need to focus for a few seconds to see clearly.
Text smaller than 12 points is challenging, and I struggle to read the small print on the eye drop container.
I can see clearly at the computer screen distance, but distant vision is unclear (with a reserved 150 degrees from the original 1300 degrees, is this considered nearsightedness? If so, what degree would that be? The vision chart showed 0.3 during my follow-up).
Since it has only been a week, the nurse advised me to relax and not to worry or cry.
Given that the outcomes of both surgeries exceeded my expectations, despite my extensive research and preparation, I have considered the possibility of redoing the procedure if the results are not satisfactory.

- Could you please advise on the feasibility of removing the lens again? Would this cause further harm to my eyes?
Thank you, Dr.
Gao, for taking the time to respond amidst your busy schedule.
I wish you good health, peace, and happiness.

Jane, 40~49 year old female. Ask Date: 2021/04/17

Dr. Gao Pilin reply Ophthalmology

Hello Jane,
1.
Is it possible that the suspected astigmatism issue is causing a vision of 0.5? Yes, astigmatism can potentially affect vision.
2.
What is the normal recovery period for vision after cataract surgery with an intraocular lens? It varies; it depends on the surgery and recovery conditions.
3.
Based on your diagnostic experience, what could be the possible causes? What methods can improve the situation? I apologize, but since the examination showed no issues, I cannot speculate.
The 150-degree adjustment is meant for computer distance; for reading small text, you may need at least +1.00 diopter reading glasses.
A 150-degree adjustment for distance will naturally not be clear, similar to having -1.50 diopters of myopia.
As for removing and redoing the procedure, it may cause more harm, so it is not recommended.
Relax, don't be anxious or worried; over time, you will adapt to this situation.
Wearing appropriate glasses will still allow for a convenient lifestyle.
Taiwan E-Hospital Puzi Hospital Ophthalmology:
Monday, Tuesday, Thursday, and Friday from 8:00 AM to 12:00 PM
Wednesday from 2:00 PM to 4:30 PM
Online responses can only serve as a reference; if necessary, you should visit a medical institution for treatment.
I hope to have the opportunity to serve you.
Dr.
Gao Pi-Lin

Reply Date: 2021/04/17

More Info

After cataract surgery, it's not uncommon for patients to experience a range of visual changes and concerns. Your situation raises several important questions about post-operative vision, and I will address each of your concerns based on common medical knowledge and practices.

1. Vision Changes and Possible Astigmatism
It is indeed possible that your current vision of 0.5 could be related to astigmatism. Astigmatism occurs when the cornea or lens is irregularly shaped, causing blurred or distorted vision. If your surgeon did not mention astigmatism during the pre-operative assessment, it may not have been a significant concern at that time. However, post-surgery, if you are experiencing blurred vision, it could indicate that some degree of astigmatism has developed or was previously unrecognized.
Astigmatism can sometimes be corrected with glasses or contact lenses, and in some cases, additional surgical intervention may be necessary. It’s essential to have a thorough eye examination to determine the exact cause of your vision changes.

2. Recovery Timeline for Artificial Lens
The recovery period after cataract surgery can vary significantly among individuals. Generally, most patients notice a significant improvement in their vision within a few days to weeks after surgery. However, it can take up to three months for your vision to stabilize fully. During this time, your eyes are adjusting to the new intraocular lens (IOL), and any residual refractive errors, such as astigmatism, may become more apparent as your vision improves.

If your vision has not stabilized or improved after a month, it’s crucial to follow up with your ophthalmologist. They can assess whether your visual changes are within the normal range or if further intervention is needed.

3. Possible Causes of Vision Issues
Several factors could contribute to your current vision issues post-surgery:
- Lens Positioning: Although your surgeon indicated that there was no issue with lens displacement, it’s worth monitoring. If the lens has shifted, it can affect vision quality.

- Residual Refractive Error: As mentioned, astigmatism or other refractive errors could be present. Your surgeon may recommend corrective lenses or further evaluation.

- Cataract Surgery Complications: While rare, complications such as posterior capsule opacification (PCO) can occur, leading to blurred vision. This condition can be treated with a simple outpatient procedure called YAG laser capsulotomy.

4. Options for Improvement
If your vision does not improve or if you are dissatisfied with the results, there are options available:
- Glasses or Contact Lenses: These can help correct any residual refractive errors, including astigmatism.

- Refractive Surgery: In some cases, additional procedures, such as LASIK or PRK, may be considered to correct vision after cataract surgery.

- Lens Exchange: If necessary, the IOL can be removed and replaced with a different lens. This procedure is more complex and carries risks, so it should be considered carefully and discussed thoroughly with your ophthalmologist.

Conclusion
It's understandable to feel anxious about your vision after cataract surgery, especially when expectations are not met. Open communication with your ophthalmologist is crucial. They can provide reassurance, conduct necessary examinations, and discuss potential solutions tailored to your specific situation. Remember, many patients experience fluctuations in vision during the recovery process, and patience is often required.
If you continue to have concerns, seek a second opinion or further evaluation to ensure that your visual health is being adequately addressed. Your well-being and peace of mind are paramount, and there are pathways to improve your situation.

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