Drawings of my positive dysphotopsia with Tecnis ZKB00

Hi there, Just figured I'd share what I was (am) seeing with my Tecnis ZKB00 +2,75 lens in my non-dominant eye, with a worsening cataract in my dominant eye that has it measured at -2.5 correction needed (and pretty dramatic light effects with the cataract too...but these drawings are what I saw with just the "fixed" eye looking). I was quite frustrated for weeks and so I drew what I was seeing (couldn't take a picture or a screenshot of it!). So I've attached the images I drew over the first few weeks, in case it helps anyone compare to what they are seeing. My visual acuity is fantastic with that eye, but the light effects include when I look at the stars and moon. :( FYI, since people may be curious... I am considering options for the second eye, will likely get monovision for distance (or maybe just a touch undercorrected if I think I'll keep this multifocal in). If that settles these light effects down, I may stay put with that combination because I might be able to get by daily tasks like grocery shopping and phone checking without reading glasses...and just need one-sided readers for long periods of near work. If I still get halos when I look at the moon and stars, then this multifocal will have to go and I'll go for monovision of some sort. Hope this is helpful. It would be fun/interesting if others wanted to doodle what they are seeing and post them in the comments...1000 words...

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I should probably put some words in here that will help future searches, so here goes...

halos glare night vision starburts ghost images side effects

Thank you for posting those images. They will be very helpful to others in the future. I'm interested to see if this lessens for you over time. Hopefully it will.

I see halos around headlights and some other similar light sources that are similar in size to what you are seeing. However, I don;t see them around starts/moon or many of your other circumstances and they aren't intense enough to impact my ability to see other objects.

Thanks for sharing. In a few days I will know, if the Zeiss Lara does the same, but I am not worried though, maybe a bit naive, but at least not worried :-) Or maybe I am not worrying because I really can not see that well on white paper with my cataracts, so I am having a really hard time seeing your drawings anyway :-)

In Denmark it has been quite some years since the bifocals were used, here it is either trifocal or edof, or monofocals off course. The Lisa trifocal came 7-8 years ago, and I think no one have used the bifocals since that.

In fact many get the trifocals here without having cataracts, just because they have presbyopia and wants to get rid of the glasses - i guess they would think twice, if they saw you drawings....

thank you for sharing this with us. i wish i would have thought of this when i complained of ghosting images before my exchange of restor 2.5 len...it was tilted when implanted during surgery. i kept telling the dr what i was seeing and he didnt want to believe me, saying the surgery was a success, etc. i finally went to another dr who saw the tilted lens and also saw that the wring lens type was used for my specific needs. when the exchange was complete, the ghosting disappeared!

but like the tecnis, the restor 3.0 has 12 concentric rings, and i see them all the time if i pay attention. around any light source, or water droplet. I find it fascinating, and i also check to make sure i can see each seperation in those rings. I'm assuming when its time for YAG those 12 concentric rings will blur together.

i also need a large amount of light in the blue spectrum to see very clearly...20/20. dr says stay in the 4k-5k blue light spectrum. cloudy days and low light definitely make things more challenging. ive changed light bulbs throughout the house to accommodate this need. some florescent lights still give me a problem, especially if the ballast is flickering.

Found these images, search for -

My intraocular lens experience David Taylor, Stevenage, England

Do they look like that for you Tamarind?

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I'm assuming when its time for YAG those 12 concentric rings will blur together.

The rings are on the IOL so I am not sure YAG will fix that?

Hi Julielyn my concentric ate part of the Symfony design so assuming I will still see the distinct rings even after YAG which may not be in too distant future for LE as I suspect I have PCO bow in that eye.

i meant the blur...i realize the 12 rings are part of the design, hence why we are able to see clearly at different distances

Interesting digital images. My concentric halos do have some radiant lines but they are not nearly as crisp or thick as those on the upper image.

I don't really have what the lower image shows...my starbursts have spikes that are closer together and finer. That's not the effect that bothers me, probably because it's bright enough that I just look away. They're actually kind of pretty.

The halos might be pretty to some but they pull my eye away from the crystal clear dark objects so all I tend to see is those friggin' halos. I have to deliberately make myself ignore them and concentrate on looking at the clear dark surroundings. Then I'm always impressed at my visual acuity. But it's a lot of work and "positive thinking".

The ghosting is annoying because most times I can't tell that it's not real. So I am concerned that with two of these, I'd lose all basis in reality for intermediate or distant objects. Up close, the ghosting and halos disappear optically. Through binoculars, for example, the world looks astounding.

i think people call those fine speckles radiating with the halos spidering. And yes, I have that too.

Interestingly, I am seeing that with my left (still cataract) eye and had never noticed that before. Sometimes I think the brain is interpreting the light scatter from the cataract differently now that it has an alternative light scatter in the right eye.

My cataract is an oildrop cataract, so more central. This creates a lot of (somewhat correctable) nearsightedness and lights turn into blurry Mercedes Benz symbols.

I hope you have NONE of these! I don't think you're naive...you're one of the most thorough people here. Other patients have zero or miniscule halos. It's totally possible to have better optics than I or Sue.An2 do.

My ophtho chose the lens, offered me the Symfony for "less glare" (he didn't really highlight halos) but said more folks needed reading glasses with it.

Perhaps if I had looked myself at the specs I would have chosen Symfony. I have never needed +2.75, only +1. My near vision may be more than I actually need...it's about 30 cm now. (Reading phone with elbows bent to 80°)But I was insistent that I didn't want reading glasses....now that I'm living this, I realize that glasses for longer sessions would acceptable...it's the need to have them for every single glance at the phone or labels that is hindering.

I also told him that I prefer conservative tried and tested solutions. So I conveyed suspicion of new technologies ..perhaps I conveyed that five years isn't very long for a new thing. Again, if I'd researched perhaps I would have concluded differently but I have to accept that life works out...no sense in blaming myself.

Whats so hard about this is one has to make a permanent decision without knowing how it's going to work out. I can change this once, but not twice.

I'm also realizing that the clear far vision energizes me and so despite the fact that perhaps most of my daily life is spent at intermediate and near (as most urban people are), I still prefer to have clear far vision. Maybe I'll feel differently if I get a far lens that really messes up my intermediate.

I agree, I feel the same way, I would not like to need reading glasses for shopping, socializing or writing a text message on my phone, but reading glasses for some tasks at home, at the office and in the garage for the small stuff I can live with. My surgeon thinks that the At Lara (like Symfoni) will do this for me, but we will see. The Lara is relatively new on the marked, and I have had the same thoughts like you, about not wanting to be the test person. But I realize, that after just one year, many thousands already have these lenses worldwide, if the lens was bad I am sure I would have found stories on the internet.

I have heard several stories about the side effects you are having, where people say they went away after 6-12 month, and even between 12-24 month some still get significant improvement, but the first 6 month they never believed the side effects would ever go away. I hope for you it gets better, it is really a difficult choice you are facing right now.

I see starbursts just like the one shown in the first picture, day and night time. Night time is the worst time, a very dangerous situation that I cannot wait to see if "maybe" it goes away The size of the starbursts from end to end are 20+ times the size of the object they surround. My first surgery was in March of 2019: I had one of those Symfony EDOFs removed yesterday and replaced with a monofocal lense. I will have the other EDOF removed in the very near future.Wish I would have gone with the tried and true monofocal lenses.

Hi ann, Thank you for sharing your experience. I wish that both of us were in the percentage of patients who don't have these light effects!

Would love to hear how it is with a monofocal lens, and which one you got implanted...if you are so inclined to share.

With gratitude, tamarinda

Unfortunately, your post didn't come up when I first searched for something on the Tecnis ZKB00, so I started a new discussion: "Ghost Images with Tecnis ZKB00 (+2.75add) Multifocal Lens" I am not totally sure if you are seeing actual ghost images as I am, but will be most interested in what you have to say on this after reading my post.

My left eye suffers from astigmatism and has the Tecnic ZXT225 Toric lens fitted. I don't have any ghosting issue with that lens, only a reduced close focusing range, compared with the ZKB00 (not good enough for reading a book). PS: I have now seen your other post: "Tecnis ZKB00 multifocal combined with a monofocal?"

Hi I previously wore multi-focal glasses - needed for reading and closer/mid vision e.g. watching tv - My far distance/infinity vision was great - I enjoyed scenery such as the mountain range near my home and watched the moon and stars - Loved the night sky. Working in healthcare with glasses was sometimes difficult but for the most part manageable. Since the arrival of our friend Covid however, it has become increasingly difficult, even dangerous on a few occasions. The transition from Spring to Winter was the straw that broke the camels back and such, I looked for advice for laser surgery. I wasn't eligible for that so offered Lens Replacement In December 2020, I had PanOptix Tri-focal lenses fitted in both eyes and 4 months on, i hate them. Pre-op, I was told (and since read several times) my near, mid and far distance would improve significantly. I saw your drawings and the "Halo" drawing from another poster and sadly, I suffer with all of the same and some of what i see if tried to illustrate below. The surgeon only advised of "some" contrast loss and associated halos at night with cars and the like. I can honestly say that if I had any idea how bad this would be, i would never have had the procedures.

Here are my current issues:

  • Halos and glare both day and night.
  • Starbursts and glare at night - The moon looks like a bright white smudge in the sky.
  • Lateral rims - Can see dark shadows of lenses in my periphery - worse when i look there.
  • Mid and far distance is permanently blurry - Cant see faces in front of me and no more stars or mountains. (The blurred vision mid and far distance seems to be "stuck" there - That's never
    changed post-op - It's as if my eye just makes no attempt to focus further than eight feet).
  • White ghosting on pretty much anything with any brightness e.g text, signs, doors or other objects. Often the edges look highlighted/shimmery and sometimes it's far worse with metallic silver objects.
  • Feeling as if there's an element of double vision but not sure.)
  • General loss of definition on pretty much everything near or far and because of contrast loss, its difficult to do anything in poor light and that includes during the day not just at night. As soon as i have decent illumination it improves.
  • Intermittent nausea with eye aches - left and right and frequent headaches - More when
    watching TV or being outside because imo I'm constantly blurred and such, trying to
    constantly focus on things. I'm sitting about 12 inches away from the PC screen to see it, I haven't worked or driven since
    the ops and my passion for movies and gaming has taken a kicking as well.

Despite the surgeon advising both ops went perfect, I had quite bad inflammation in my left eye. As far as I'm concerned it was from the op being difficult as it took longer than the right and the surgeon clearly had more issues siting the lens etc. I had eight weeks of steroid drops and antibiotics which eventually helped. To date I've also had three post op exams and despite clearly conveying I am unhappy, it's always the same comments i.e they're happy with my progress. I'm back at hospital in a fortnight so we'll see what happens and I'm not looking forward to it by any means. I am angry, frustrated and no doubt depressed with all this not to mention having virtually no money coming in since December. Both ops were financed from savings so no fall back position except the thankful pittance I presently receive from welfare for sick payment. I am also a bit scared as I don't know if this will improve or is the best it'll get. One thing that is obvious however, is that most people aren't being told about all the side effects or complications and when suffering from them, just seem to told - It's normal, to be expected and it'll improve in another month.

Thanks and good luck ;)

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I so feel for your situation and so sorry your surgeon advised clear lens exchange (basically cataract surgery) as an alternative to glasses. people who are young have much better vision than someone of normal age for cataract surgery. some of your issues sound like your pupils are dilating beyond the IOL and reason you see the rim. Despite that you should be able to see better than you do. Was the power calculation accurate. How is your distance vision?

I would ask more questions of your surgeon and if not getting answers seek a 2nd opinion

Hi Thanks for your reply ;) I was wearing multi-focal glasses pre-op and elected to get the Multifocal IOL obviously after a consult. Sitting now in normal light my pupil size is about 5mm which i think is average for me? The lateral rim is really annoying and was actually one of the things i disliked about wearing glasses...In fact I'd often remove my specs in order to not see them at the side and give me a rest kind of thing. The IOL "rim" is terrible as the closer i go to something to look at it, I can actually see the lenses moving in from the sides to ?focus - Like being in a pair of binoculars!

Re power calculation - no idea (terrible with numbers but I have been wondering) and my distance vision is bad - Mid and far to infinity is just blurred - lacking definition and detail in any light.

This really angers me. I am so sorry that your doctor talked you into getting a lens exchange when it was not needed. As someone who has gone through cataract surgery, I would never suggest this to someone. Anytime I read it online, I tell them not to do it. There are just so many risks to having cataract surgery, especially with multifocals (I have one in my right eye and got a monofocal in my left due to the negative side effects). All of those amazing things you read about cataract surgery in the waiting room pamphlets, online etc... most of it's not true. It's all hyped up to get you to choose their IOL.

I feel your frustration with going into follow up appointments and they tell you it went perfectly. If you've experienced the negative side effects of these lenses, then you know how hard it is to deal with. You look out of your eyes every waking minute. It's hard to just ignore it. But keep in mind its also been 2.5 months. Your eyes are definitely still healing and they will be get better in some regards. It doesn't make sense that your range of vision is that bad though. It sounds like they got the IOL wrong. What has the doctor said about that?