Post-Cataract Surgery Vision Changes and Solutions

Q: Post-Cataract Surgery Vision Changes and Solutions

Hello： <br>1. <br>Right eye image magnification and its impact on binocular fusion： After the implantation of an artificial lens in the right eye, the difference in refractive power between the artificial lens and the original natural lens can lead to a disparity in vision betwee

Post-cataract surgery

Subject: Questions Regarding Post-Surgery Vision
I would like to ask the doctor a few questions based on my previous inquiry on April 18 (#207625):
1.
My right eye (which has an artificial intraocular lens implanted) sees images significantly magnified compared to my left eye (which is healthy).
Is this normal? Could this be the main reason for the poor binocular fusion?
2.
After the surgery, I visited three optical shops and tried on their prescription glasses (with black frames and smaller, round lenses).
I did not experience any fusion issues while wearing them, and everything looked comfortable.
What could be the reason for this? Can small-frame glasses help alleviate my problem to some extent?
3.
Does the hospital have any equipment that can assess or quantify the issues with my binocular fusion?
4.
Once I have glasses with a prism prescription, will the prism strength increase over time? Will it also raise the risk of developing other eye conditions?
Thank you for your assistance, and I look forward to your response.

Mr. Huang, 40~49 year old female. Ask Date: 2024/04/26

Dr. Gao Pilin reply Ophthalmology

Hello:
1.
Right eye image magnification and its impact on binocular fusion: After the implantation of an artificial lens in the right eye, the difference in refractive power between the artificial lens and the original natural lens can lead to a disparity in vision between the right and left eyes, resulting in differences in image size.
This is a normal phenomenon, and typically, over time, the brain will gradually adapt, allowing for improved binocular vision.
Other factors that may affect binocular fusion include:
- Misalignment: If the eyes are misaligned, such as in strabismus, esotropia, or exotropia, it can prevent the images from overlapping, thus affecting fusion.

- Abnormal accommodation: Accommodation refers to the eye's ability to adjust focus.
If the accommodation abilities of the two eyes differ, it can lead to unclear images and affect fusion.

- Ocular diseases: Certain ocular diseases, such as cataracts, glaucoma, or diabetic retinopathy, can also impact vision in both eyes, thereby affecting fusion.
2.
Comfort of prescription glasses: The lenses used in optical shops may have better optical properties and are often smaller, which may make you feel more comfortable.
Additionally, since the wearing time is shorter, it may be harder to notice any discomfort.
3.
Inquiry about binocular fusion examinations at hospitals: You may need to ask, as general hospitals may not offer this service.
Please refer to: https://iposition.org/
4.
Long-term effects of prism glasses: Prism glasses can help improve binocular fusion by adjusting the line of sight of both eyes.
However, long-term use of prism glasses may lead to the following issues:
- Visual fatigue: Due to the different line of sight between the two eyes, the brain has to exert extra effort to fuse the images, which can easily lead to visual fatigue.

- Headaches: Visual fatigue may result in headaches.

- Strabismus: Long-term use of prism glasses may exacerbate strabismus issues.

Therefore, it is generally recommended to wear prism glasses only when necessary and to have regular follow-up appointments.
I hope this information is helpful to you.

Reply Date: 2024/04/26

More Info

Understanding post-cataract surgery vision changes can be quite complex, especially when considering the various factors that can affect visual perception and clarity. Based on your questions and the context provided, let’s delve into the potential causes of your symptoms and explore possible solutions.

1. Perception of Magnification in the Right Eye: It is not uncommon for patients to experience differences in perceived image size between eyes after cataract surgery, especially when an artificial lens is implanted. This phenomenon can be attributed to several factors, including the power of the intraocular lens (IOL) used, the curvature of the cornea, and the overall refractive status of each eye. If the IOL in your right eye has a different power than your left eye, it could lead to a noticeable difference in how images are perceived, which may indeed affect binocular vision and fusion. This disparity can cause discomfort and visual disturbances, making it challenging for the brain to merge the images from both eyes effectively.

2. Effect of Frame Size on Visual Comfort: The fact that you find comfort in wearing smaller framed glasses could be related to how the lenses are positioned in relation to your eyes. Smaller frames may limit peripheral distortions and help in stabilizing the visual field, making it easier for your brain to process the images without the added complexity of peripheral vision issues. This could explain why you do not experience the same fusion problems with these glasses. It’s essential to ensure that any new glasses are properly fitted and prescribed based on your current vision needs.

3. Assessment of Binocular Vision: Hospitals and specialized eye clinics often have equipment to assess binocular vision and fusion capabilities. Tests such as the Worth 4 Dot test, stereo vision tests, and other assessments can help quantify how well your eyes work together. If you are experiencing significant issues with fusion, it would be beneficial to discuss this with your ophthalmologist, who may refer you to a vision specialist or orthoptist for further evaluation.

4. Prism Prescription and Long-term Effects: When it comes to prism glasses, they are often used to correct misalignment and improve binocular vision. However, the need for prisms can change over time, especially if there are underlying conditions affecting eye alignment or if your vision changes. It is not typical for prism prescriptions to increase indefinitely, but they may need adjustments based on your visual comfort and any changes in your eye health. There is no direct evidence to suggest that wearing prism glasses increases the risk of developing other eye diseases, but it is crucial to have regular eye examinations to monitor your overall eye health.

In summary, the visual changes you are experiencing post-cataract surgery can be attributed to several factors, including the differences in lens power, the effects of the artificial lens, and how your eyes work together. It is essential to maintain open communication with your eye care provider, who can guide you through the process of understanding these changes and help you find the best solutions to improve your visual comfort and clarity. Regular follow-ups and assessments will be key in managing your post-surgical vision effectively.

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