Post-Cataract Surgery Discomfort: Insights on Vision Issues and Solutions

Q: Post-Cataract Surgery Discomfort: Insights on Vision Issues and Solutions

Hello： <br>1. <br>Poor visual fusion when using both eyes simultaneously may be related to a previous macular issue in your right eye. <br>Problems with the macula can increase sensitivity to disparity, leading to a decline in visual quality when both eyes work together. <br>This

Monocular vision & refractive error & postoperative discomfort after cataract surgery?

Hello, Director Gao.
Below is a summary of my medical history regarding my "right" eye (the left eye is normal):
1.
In 2001 (at age 20), I experienced significant distortion of lines in my right eye, which was diagnosed as a choroidal neovascularization issue.
After surgery, my vision was preserved at 0.7, but I still noticed slight distortion of lines.

2.
In 2020 (at age 40), during a routine examination, my left eye was measured at 475 degrees with a vision of 1.2 and astigmatism of 50.
My right eye was measured at 550 degrees with a vision of 0.6 and astigmatism of 50.
3.
On August 15, 2023, I underwent surgery for a macular hole and vitrectomy in my right eye.
After lying face down for over ten days, I returned for a follow-up, and the doctor informed me that cataracts had developed.
4.
On March 15, 2024, a 300-degree monofocal, astigmatism-free intraocular lens was implanted in my right eye.
One month post-surgery, my vision remained at 0.9, but I still experienced slight distortion when reading with my naked eye, although it felt better than before.
5.
During my follow-up on April 15, the attending physician indicated that everything was normal and that any discomfort would improve over time.
The appointment ended quickly, and I couldn't ask many questions.
Since the surgery, I have been wearing new glasses with prescriptions of 450/300 degrees, but I continue to experience the following issues and would like to hear your opinion, Director Gao:
(1) When looking with each eye separately, it feels comfortable, but when using both eyes simultaneously, I experience poor fusion and noticeably reduced clarity compared to using my left eye alone.
This also leads to eye strain and fatigue.
Could this be due to the previous macular issue in my right eye, causing my vision to worsen when using both eyes? Will this improve?
(2) During the day or in bright light, I notice that the amount of light entering the artificial lens in my right eye is greater than that in my left eye, occasionally causing a slight loss of focus.
Will this situation improve?
(3) Wearing polarized sunglasses provides about 50% improvement for the above issues; however, they are too dark for nighttime or indoor use.
Are there any methods to improve this? I have seen yellow polarized lenses available; would they be suitable for me?
(4) Occasionally, wearing transparent plastic safety glasses (which have a slight curvature and can be purchased for around 200-300 NT dollars) seems to improve the fusion and clarity issues.
Why might this be the case?
(5) One month post-surgery, I tried wearing contact lenses, which provided a certain degree of improvement in fusion and comfort, but clarity was worse than with glasses.
What could be the reason for this?
(6) I visited two optical shops for refraction.
The first focused on my left eye (healthy) with a prescription of 450 degrees plus a "prism," while the second focused on my right eye (with the artificial lens) at 300 degrees plus three "prisms." Both prescriptions improved clarity when reading.
Do I need to use these special lenses? If so, which eye should they be added to?
(7) Are these symptoms related to focusing issues, diplopia, significant refractive disparity, visual acuity differences, or something else? Is it possible that I may need to wait until both eyes have cataracts removed for improvement?
I have many questions, and if you have the time, I would appreciate your response.
Thank you.

Mr. Huang, 40~49 year old female. Ask Date: 2024/04/18

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
Poor visual fusion when using both eyes simultaneously may be related to a previous macular issue in your right eye.
Problems with the macula can increase sensitivity to disparity, leading to a decline in visual quality when both eyes work together.
This condition may improve over time with visual training, but it is also advisable to consult an ophthalmologist regularly to ensure stability.
2.
The increased light entering the right eye due to the artificial intraocular lens may lead to focusing issues.
This situation may require time to adapt, but if it persists and affects your quality of life, further ophthalmic examination should be considered to determine if adjustments or other treatments are necessary.
3.
Polarized black lenses may be effective in alleviating focusing problems, but they may be too dark for nighttime or indoor use.
Yellow polarized lenses may help improve contrast and reduce glare, but it is recommended to use them after evaluation by an ophthalmologist to ensure they are suitable for your condition.
4.
Transparent plastic goggles may help improve focusing issues due to their special design.
This situation may be related to changes in the angle of light incidence or scattering patterns caused by the goggles' design, which in turn affects your visual quality.
5.
Contact lenses may provide some improvement in fusion and comfort, but clarity may be inferior to glasses due to the different way contact lenses interact with the cornea, which can lead to a certain degree of visual distortion.
6.
The need for prisms may require further evaluation in your case.
Prisms can help adjust alignment and improve specific visual problems, but whether they are necessary depends on your specific situation.
It is advisable to consult your ophthalmologist and take action based on their recommendations.
7.
These symptoms may involve focusing issues, diplopia, and disparity problems.
Improving these issues may require individualized treatment approaches, including glasses, contact lenses, surgery, or other therapies.
It is recommended to consult your ophthalmologist for a more detailed diagnosis and treatment advice.

Reply Date: 2024/04/18

More Info

Post-cataract surgery discomfort and vision issues can be quite complex, especially considering your medical history and the specific procedures you've undergone. Let's address your concerns systematically.

1. Visual Discomfort and Fusion Issues: The discomfort you're experiencing when using both eyes simultaneously, leading to reduced clarity and increased fatigue, may indeed be related to your previous macular issues. The brain requires both eyes to work together harmoniously, and any discrepancies in vision quality or clarity can lead to fusion problems. This is particularly true if one eye has a history of macular degeneration, as it may not process visual information in the same way as the other eye. Over time, your brain may adapt to these differences, but this process can take time and may require visual therapy or exercises to improve coordination between the two eyes.

2. Light Sensitivity and Focus Issues: The sensation that your right eye's artificial lens allows more light in than your left eye could be due to differences in lens design or the way your eyes are healing post-surgery. This can sometimes lead to a feeling of being slightly out of focus. If this issue persists, it may be beneficial to consult with your ophthalmologist about potential adjustments or treatments that can help balance the light entering each eye.

3. Use of Polarized Lenses: Polarized lenses can indeed help reduce glare and improve contrast, which may explain the partial improvement you've noticed when wearing them. However, if they make your vision too dark in low-light conditions, you might consider trying yellow-tinted lenses, which can enhance contrast without significantly reducing brightness. It's essential to consult with your eye care provider to determine the best option for your specific needs.

4. Improvement with Protective Eyewear: The improvement you noticed while wearing transparent plastic goggles could be attributed to the way these lenses alter the light entering your eyes or how they fit your face, potentially reducing glare or providing a more comfortable visual experience. This suggests that the shape and fit of eyewear can significantly impact visual comfort and clarity.

5. Contact Lenses vs. Glasses: The difference in clarity between contact lenses and glasses can often be attributed to the way light is refracted through the lens material and the distance from the eye. Glasses sit further away from the eye than contact lenses, which can sometimes provide a clearer image, especially if there are any irregularities in the cornea or lens. If you find that contacts improve comfort but not clarity, it may be worth discussing with your eye care provider about different types of contact lenses or adjustments to your prescription.

6. Prism Lenses: The use of prism correction in your glasses can help align the images seen by each eye, potentially improving clarity and reducing strain. If both optical shops noted improvements with prism lenses, it may indicate that your eyes are not perfectly aligned, which can lead to visual discomfort. Your eye care provider can help determine whether prism correction is necessary and which eye it should be applied to.

7. Underlying Issues: The symptoms you're experiencing could stem from a combination of focusing issues, diplopia (double vision), and significant differences in refractive error between your two eyes. It's not uncommon for patients to experience these challenges after cataract surgery, especially if one eye has a history of significant ocular issues. While waiting for both eyes to undergo cataract surgery might lead to some improvements, it’s essential to address these concerns proactively with your eye care provider.

In summary, your post-cataract surgery experience is multifaceted, and while some discomfort and visual discrepancies are common, they can often be managed with the right interventions. Regular follow-ups with your ophthalmologist are crucial to monitor your recovery and make any necessary adjustments to your treatment plan. Don't hesitate to ask your doctor about any concerns you have during your appointments; they are there to help you navigate this process.

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