Flickering light in eye after Cataract surgery

Eye care
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I am so thankful to have found this discussion.  

I too had catract surgery on my left  eye 2 months ago (Aug 5, 2015) and have experienced this "jittering" sensation ever since.  It's more prominent when there is a bright light source coming from my left and it's very frustrating when trying to read or make rapid eye movements.  To make it stop, I have to close that eye and let it rest or I have to put my hand to the left side of my face to deflect the light for the jittering to subside.  I also have to avoid sitting anywhere there is a bright light source coming in from my left.   When out in the sun, I have to wear the wrap around sunglasses due to the light sensitivity and I don't notice the "jittering" as much.  

Because I had an astigmatism in that eye, it was recommended to go with the TORIC Lense and not a standard lense for the best results.  Unfortunately, my surgeons office make an error in assessing my eye correctly for that and now I have to wear my old prescription glasses to see distances and drive.  After paying the extra money (INS does not cover the TORIC  lenses and the cost is almost $3K) to have the corrected distance vision.....I'm not a happy camper.  

My surgeon has a huge successful business here in the DFW area and was highly recommended so I felt I was in good hands.  I go back today for another follow up because of the "jittering" problem and to see what they are going to do to correct my distance vision.    On my last visit, I was told my eye was healing perfectly and they could not explain why I was experiencing this "jittering".  

Apparently, I am the first one to complain about this kind of situation.

 

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The flickering issue sounds like it is fairly rare so some surgeons may never have encountered it. I would try to see if you can get your surgeon to reproduce lighting so that you see the flicker to see if that will help with diagnosis.  If you read this before going to your appointment, if you hadn't read through all the posts above, I'd suggest having him check for what seems to be my issue, the iris jiggling, iridodonesis, which varies the stray light coming in through the iris. (more likely if you were highly myopic before surgery and have light colored eyes). In my case I caught that on video.

The fact that it seems to be tied to stray light coming in from the side is one thing that suggests to me it might be the iris in your case (it sounds like there are likely multiple vague symtoms which can be described as "flickering" so I suspect that not everyone posting here has the same problem).

However I'd also  suggest making sure the doc takes at least one look at your eye before dilating drops, or that they use a non-cycloplegic dilating drop, to see if the issue might be your capsular bag jiggling due to loose zonules,  pseudophakodonesis, which is another possibility.  

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I'm happy to read that I am not alone with the flickering/flashing in my left eye after cataract surgery. I had the right eye operated on several years ago with no issue.  I noticed the flickering soon after the doctor removed the patch just yesterday.  I was ready to call him in a panic, but will wait and hope for some improvement over the next days, but will be ready with questions when I see him in a week.

64

Personally I would go back to the consultant and push more. I had one who I had to coax information from. I did not have the flickering but 10 months later I still have a shadow at the edge of the left eye, that I had a cataract operation on. It's very irritating and distracting when I drive or am in open spaces. I have been told, and read on the net, that it should have gone within 3 months. Others say it takes longer for the brain to eliminate it.

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The shadow at the edge of vision is a far more common issue than flickering it seems. Common negative  dysphotopsias like the shadow usually go  away in the first few months. However they  may not go away by themselves, and if they do then  how long it takes them to go away varies greatly depending on the person. Unfortuntely no one can give you a concrete answer on if/when it'll go away. There are various approaches to treatment for it that are considered after the first 3-6 months (though some wait a full year), from lens exchange to a piggyback IOL.  Any decent surgeon should be aware of negative dysphotopsia issues since they are reasonably common, but many haven't encountered the flickering issue.

One potential cause of the flickering issue is the lens being loose in the bag initially, which will usually go away in the first few weeks as the lens heals into place. If its still around after 2 months then the cause is likely harder to pin down.

In my case my flickering issue is improving at a glacially slow rate still at 10 months postop, but I still notice improvement so I'm hoping adaptation will solve the issue. I havent' heard of anything that can be done if it is the iridodonesis (iris jiggling) that is the issue, and there are added risks (and question of how much help it'd be) suturing it it is loose zonules, and if its either of those lens exchange is likely not going to help.

 

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After one conflicting opinion after another about what to do, if anything about the flickering, I finally decided to have a piggyback lens inserted in my left eye. The doc felt it was less risky than a lens exchange.

After a one week scare following the surgery with the incision leaking eye fluid (maybe because this was the 3rd surgery on the same eye?) the doc was finally able to stop the leak with "bandage contact lens". The good news, the surgery seems mostly to have stop the flickering, The bad I now have worse glare from bright objects from both sides (going across my vision) particularly at night and in a dim environment and it did nothing for the rays and halos, which are as bad or worse than ever. And overall my vision seems worse, both in the distance, up close and even at computer distance. The doc says he has absolutely no explanation for the glare from the sides.

Now I'm 2nd guessing that I should have opted for a lens exchange. The doc now feels any kind of additional surgery (particularly the lens exchange, with the Trulign now so "imbedded" after almost a year) is too risky. He said the Trulign is "frozen" not moving at all. I still don't have a clue why it didn't move/accommodate/work anything like it was supposed to.

The secondary cataract is getting worse, but the doc wants to wait before doing the laser treatment to deal with that and of course, once that's done, from what I understand, it that really means no more possible surgeries on that (my left) eye.

Meanwhile the cataract in my right eye, that I've been putting off doing about, while all the confusion reigned about the left is getting noticeably worse.

All the upsetting conflicting input which cause so much indecision aggravated my chronic insomnia, which is now so bad, it's taken on a life of its own, taken a major toll on me.

Have to say the fateful decision to have the surgery last year, the decision I made about the lens, and what's happened since, as "minor" as the eye problem may seem compared to other bad things, diseases etc that could be happening to me at 73, at this point seems to have been a completely unexpected negative turning point in my life.

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Hi Linda,

I am a cynic when doctors tell you that "you are the first one" or that "I have never seen that before". I had a dark shadow on the left of my left eye and was told that it would go. I then learnt that this does go for many people but sometimes it takes a long time. 10 months later I am still waiting and hoping that the shadow will disappear! 

Many doctors and consultants have not yet faced the reality of people being able to check things out by sharing experiences as on this site.

Good luck with your "jittering" and be persistant!

68

Thanks for the info.... after this complication I have done a lot of research on my own.  I saw my surgeon earlier this week and we both concluded  that what I am experiencing is positive dsyphotopsia.  This is caused by the IOL that was placed and there's no easy answer as to why.  After I told him I had been doing some extensive research on my own, he opened up and discussed some of the issues on a more indepth level.

As expected, my eyes have healed without any complications.  I had the right eye done 3 weeks after the left eye with no complications whatsoever.  Our hope is that the condition will resolve on its own, as often times it does.  The next step is to perform Lasik on the Cornea to correct my distance vision in my left eye as the IOL did not give the results that we expected.   

In my research I discovered that the acrylic lense (which was what my surgeon chose) has a higher incident for the dsyphotopsia problems.  Silcon lense with a rounded edge and lower refractive index seems to have fewer incidents of this problem.  

This shimmering or pulsating light (jittering as I call it) is called scintillations and it's caused by back scatter from the IOL combined with short eye movement.  It's seen more often in high refractive index IOL's.  Interestingly, the size of the IOL is not the problem.

For now I am trying to keep a good attitude and deal with the annoyance of the this "jittering" that I experience daily.  I will continue with my own reseach and discuss all my new finding with my surgeon.  I would encourage others who are experiencing these same symptoms to use the internet, research and educate yourself and present your finding to your surgeon.  He/She will take notice, because at this point you've proven you are not crazy and the symptoms are real.

 

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From my research, the shadow you are describing may be what is called negative dysphotopsia.  Have you read up on this?  Theres lots of information on the internet.  

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Thanks Linda, I think you are right and I have read a lot about it. Of course my consultant never used the word! Next time I see him I will be more assertive and let him know that I understand the problem, and just need a solution. He is hoping it will just go. So am I!

 

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The phrase "positive dysphotopsia" is broad generic description of a class of unwanted problems, not a specific explanation for what it is in a particular case. The suggestion it is due to back scattter is a specific explanation, a hypothesis, which may be the  potential explanation for some (to avoid sending the post to moderator by including a URL, if you search for "Demystifying Dysphotopsia" the first hit will be an article explaining it from the Jan 2005 Review of opthalmology. That is an old article however and lens designs  and materials have improved).

In my case the iris issue seem more likely, the phrase "flickering" is vague and broad enough to encompass symptoms with different causes.  Actually newer acryllic lenses tend to have newer edge designs intended to cut down on things like dysphotopsias, I don't don't know what model lens you went with.

The index of refraction varies depending on lens model and might be a factor, the Tecnis silicone lenses are 1.46 which isn't much different than their acrylic lenses at 1.47, though the STAAR silicone is lower at 1.41, especially compared Alcon acrylic at 1.55. (the data came from an article titled  "defining excellence in iol optics" which is the first google hit, in the Dec 2014 supplement to Eyeworld).

Although piggyback lenses seem to be promoted more for negative dysphotopsias, I have seen references to them as being effective in some cases of positive dysphotopsias, as might a lens exchange if you are sure enough of the cause that you think a lens with a different material might make a difference. 

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Hi All

I have found it reassuring (but shocking at the same time) to find I am not on my own suffering these effects after lens replacement surgery on my right eye.

Its only a couple of days since I had surgery and fingers crossed things will improve. Some of you have asked about lens types and I thought it may be useful to give you details of mine as I still have the card along with the various drops Im using. My lens is a bifocal one, a LENTIS Mplus ref LS 313 MF30 whatever that means. I have had extra issues as I suffered from sarcoidosis as a teenager that caused same scaring (and a partial detatched retina in the eye not yet done). Afetr hearing your experiences I will be hanging on as long as possible before going ahead with the other eye. Once again thanks for sharing your experiences. Its good to have that support. Wishing you all a speedy recovery. thanks

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hi Rady

I wonder if your eyes have improved?

i had surgery 2 years ago. i had conbined surgery to both eyes. I had a vitrectomy and cataract surger to my right eye and then two weeks later had the same to my left eye.    I still suffer dreadfully from flashing and flickering from all light sources.   the light effects me whether it is direct or indirect. any movement of my eyes cause these dreadful side effects of nausea, dizzyness, flashes and flickering and light sensitvity.   I have searche extensively for a diagnosis and there are two possiblilies either the implanted lense is slightly unstable or the ligh is ouncing off the edges of the implanted lenses.   Both solutions invilve further surgery.   Does anyone have any further news

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It is also possible your zonules are loose and the capsule is moving, with the lens inside it. Psuedophakodonesis refers to an artificial lens moving abnormally  which parallels phacodonesis which refers to a natural lens jiggling abnormally (though I've seen a few spelling variations of those terms, depending on whether c or ke is used and sometimes "doneses" isntead). I'd seen references to doctors saying that with some patients they can clearly see the natural lens move without dilation, but that with most dilating drops they can't. I assume then the same is true of an artificial lens.

 If you read the posts above you'll see that I suggest having the doctor check your eyes either without dilating them, or dilating them with a non-cycloplegic. Most dilating drops are cycloplegic, in addition to dilating the pupil they also cut off accommodation. Even in those without accommodating IOLs the eye still tries to accomodate, which tightens the zonules and can lead the IOL to jiggle less than it normally would. 

If the issue is light reflecting off the edges, some people report good luck with a 2nd piggy back lens being added to cut down on that, or a different size and shaped lens. 

It seems useful or them to pin down whether the issue is the lens or capsule jiggling, since that of course would suggest a different treatment like suturing or glueing the lens in place. Adding a 2nd lens or replacing the existing one likely would merely make things worse if the issue is the capsule being loose.

You'll also see above that my case seems most likely to be due to iridodonesis, the iris jiggling, and while thats not usually going to be the issue for most people, its useful to rule that out if possible. Unfortunately I haven't heard of any productive treatment for iridodonesis.

75

I, too, have been suffering with a light-induced flickering in my eye post cataract surgery.  I have also come to realize that the flickering occurs whenever the eyeball moves (while exposed to light), and it is amazing how very often the eyeball moves.  It is as if the "edge" of the lens is catching the light and reflecting back into the eye. My surgery was performed three months ago and unfortunately the symptoms remain. I am wondering if we can find any common denominators among us who have these symptoms in an effort to try to understand why it has occured.  I had radial keratotomy performed about 30 years ago and the lens that was implanted was the Crystalens IOL.  Anyone else have RK and/or Crystalens? The surgeon who performed the cataract surgery said it might be occuring because of the RK scars and she has suggested implanting a piggyback (sulcus) lens under the Crystalens, adding that it may or may not help but would be worth a try. For many reasons I won't go into I will never go back to her again, so also looking for a second and possibly third opinion in the Seattle area.

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As you can see by looking at my prior posts in this discussion, I had very annoying flickering as well as other visual annoyances: halos, rays and glare, following my cataract surgery 15 mos ago using a Trulign lens, the astigmatic correcting version of the Crystalens. In addition to all the disturbing visual stuff the IOL seems to be frozen in place (not moving as it was supposed to) so I see clearly only at one distance (about 2 feet).

I had 2 2nd opinions without a definitive diagnosis, but some sort of concensus seems to be that the lens was too small a diameter and light is, as you say hitting the edge and or getting behind the lens, causing the halos, rays etc, but no one had really any explanation for the flickering (or glare).  While the doc (#3) was not optimistic doing a piggyback (with a larger diameter lens) would do anything for the flickering, he thought there was agood chance it would reduce or do away with the other visual BS. After much teeth knashing I finally opted to try the piggy back last Sep. The result (just the opposite of the doc's expectations), the flickering stopped, but the other visual abberations were just as bad, the glare worse and overall my vision seems a bit worse, but with my secondary cataract geting worse and worse  it's hard to say for sure.

I too am in Seattle and have not really been happy with any of the 3 docs 've seen. Having been procrastinating for the past few months about doing anything else (about the secondary catarat, that is getting the YAG procedure done or the other eye with worsening cataract). But by coincidence have an appointment next week with a woman doc who supposedly has experience with the newer lenses. There don't seem to be a whole lot of docs that use the newer lenses, so I'm wondering whether by chance it's the same doc you're not satistfied with.

If you would be willing to share at least the name of the organization where she works, that would be most appreciated. Alternatively if you're willing, we could discuss our situations/experience via email or phone. Let me know, my email: [email removed]

Emis Moderator comment: I have removed the email address as we do not publish these in the forums. If users wish to exchange contact details please use the Private Message service.

http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

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Right eye cataract done 10-22-2015. Female 55 

from the day after surgery before I removed the patch I feel the brightest yellow burning in my eye

Diagionised on day 4 with Negative dysphotopsia and possibly positive dysphotopsia. Along with extreme pure light, jitteriness and flashing light all the time

this is enough to make you go crazy

on the bright side I had eye muscle surgery at the age of 5, and have never been able to see out of both eyes at the same time. And now with the right eye getting so much light it is allowing me to use that and see better with my left eye. So Stereovision after 50 years is quite beautiful, and confusing.  

I just wish the jiggling light and the blinding pure washed out contrasts would go away.  

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55 year old female. I had my right eye done 10-22-2015. IOL mono focal lens  AcrySof SN60WF from Alcon, which includes the Natural blue light blocking and UV filtered.  From the first morning I felt like extreme yellow light coming in my eye. The flickering when I move  my eye has never stopped. Had glasses made they dyed the lens blue then purple, and just because I did not want to look like a freek, they tinted the left lens too but not as dark. I went into a store today and could look at groceries on the shelfs without covering my eye or wearing a ball cap. Light flickers does not go away for me, but I notice when I'm driving my head is slightly turned to the right so the negative and positive ND is not popping up   With the black crescent off to the side and I had 20/20 vision. Now 20/30.  Everything is blurry from 12' away and gets worse the farther away. And I've slowly replaced light bulbs in my house with cool colored bulbs, and I have to keep the drapery pulled when sun is out, and I spend most of the time inside until evening when the sun is not so brite. And I've added tinting on my car windows It's been life style changing. But no one can figure out what to do, and I'm not letting anyone touch my left eye until it either goes away, or ???

 People with dark colored skin, now appears reds and oranges, light colors are all faded together or bleached out. We have snow on the ground and it is so bright, when I close my eyes at night, i see spots like someone had used flash bulbs and took my photo all day. 

what Dr told me ND is the most complained about thing after IOL implant that does not get recorded in the file, because most of the time it goes away and they hear it so much, he ignores it. Sad statement 

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Id find another doctor fast check the internet for patient reviews on doctors before you settle for one.    Find a specialist before you have no vision left. 

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Find another doctor fast.   Look on the internet for patient reviews of doctors and their ratings and pick a good one.   That doctor sounds crazy.  He's just making money on all these surgeries, an eye can only take so much.   I wouldn't be having another surgery with that doctor