Flickering light with monofocal lenses in both eyes

Eye care
1

Hi all!

I'm 44 years old and had lens exchanged in both eyes. I have mild keratoconus too, so surely irregular cornea but I can see 20/20 on both eyes. I have two different models of iol, in one eye silicone, in the other acrylic, both lens have squared truncated edges and low refractive index, 6 mm of diameter.

After 2 years since the first eye operated and 1,5 after the second, I'm still very sensitive to light and still bothered by a very annoying phenomena several other people here reported. In relatively low lighting I can see a luminous circle or half circle on the opposite side of the light source with some light streaks coming from the light source itself. Since the shape of the disturbance is circle or half circle it has to do with the lens shape: a circle. Probably its edge.

It happens also during the day with very strong lighting (ceiling reflectors), usually inside. 

Since eye does not move 'fluidly' but with tiny jerky movements called 'saccades', the perception of this circle and the light streaks are also jerky, like a flickering caused by the reflected lens combined with saccades. Using a myotic drops like Alphagan, constrict the pupil a little so the annoying presence of edge glare at night disappears. It happens only with off-axis (side) rays, never with frontal rays. With strong light I cannot perceive the edge (circles) but only light flickering, strobe-effect like, because light is strong enough to enter the eye, hitting the edge even with relatively small pupil aperture. 

After 2 years I don't think it will go away. Therapy? No iol exchange, obviously, too risky, and because I have two different model and both cause the same problem. Unfortunately iol with rounded edge that should help to spred reflected rays on a larger area are practically all discontinued. 

Another option is piggybacking a iol with rounded edges in the sulcus, like the Sulcoflex (Rayner). Lately another even more interesting lens was invented, it's called Xtrafocus pinhole (Morcher) and it's based on the pinhole principle. I'm wondering how a lens in the sulcus can deviate the light from hitting the primary lens' edges and stop causing edge glare. Someone had these lens implanted? Any thought?

Thanks in advance for any suggestion or help

Phil

2

Out of curiosity did you have cataracts which necessitated the surgeries or did you have clear lens exchange to improve your eyesight?

Given you are 44 years old your natural lens would have provided far better eyesight than any IOL.  Once removed there is zero accommodation left.  Also given your age your pupils will dilate more in low light conditions versus someone over 60.  As you are aware the IOL is just 6mm in diameter so it’s likely some of the visual effects are due to your pupil dilating beyond the IOL.   As well contrast sensitivity is about 15% less than a natural lens so good lighting to read or see is required.  That percentage is greater with a premium lens. 

It is great you can see 20/20 during the day - many people still have to wear glasses after cataract surgery to obtain that.  If you have good daytime vision, I would not personally do a piggyback lens.  Some of the night time visuals could disappear as you age.

Also out of curiosity what has your surgeon suggested could be the cause of your low light visual affects?

3

Hello! Yes, the lens were implanted for better eye sight. With glasses my sight was not good, only with contact lenses but they could not help much with astigmatism plus I could not tollerate them anymore so the surgeon suggested the iol. He didn't take in consideration my pupil aperture nor the keratoconus and now my sight is surely better but have tons of dysphotopsias, photophobia and floaters too. Contrast sensitivity a bit worse too, true. Probably a poor decision he made. Have you ever heard about the xtrafocus implant? Looks very promising

 

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4

Yes, before the operation I didn't see very well with glasses, only with contact lens and they could not correct irregular astigmatism, so the doctor suggested lens exchange but apparently he didn't consider the terrible combination of pupil size in young people and irregular cornea causing an almost obvious dysphotopsia. Very poor decision for a high-class surgeon, but the damage has been already done.

Halos around lights, glare, starburst, flickering, circles, flashes, multiple images caused by high-order aberrations (keratoconus) and pupil/iol size. Strong straylight from the side, like ceiling reflectors or light on the bed table is the worst.

5

So sorry - must be frustrating to deal with.  It’s really unfortunate the surgeons suggesting this to younger patients only discuss the upside to IOLs and downplay or don’t say anything at all about the negative aspects.

There are drops that constrict the pupil but it’s temporary.  Might be worth a try though especially if having to drive a distance at night etc.  

Night Hawk here on the forums posted a chart of ages with corresponding pupil size. It will improve as you age but unfortunately I don’t think a any other lens will help given all of them are 6mm at best.

6

Thanks you dear! Yes, it's frustrating, because today I surely can see "better" but I lost accomodation, and dysphotopsias are really 10 times worse than before. My surgeon said it's going to be ok but it hasn't. Have you ever heard of Xtrafocus pinhole piggyback lens by Morcher?

7

No can’t say I have heard of that lens.  Will google to read up on it.  Living in Canada we don’t get access to as many types of lenses as other countries (think USA is similar to us that way).  FDA has had stringent approval criteria.

I wish you the best.  

8

Hi there. I am also seeing the edge of lens, I also have a shadow effect in about the 2 o’clock position. I’m 49.  I do believe a lot of this has to do with having younger eyes and we are able to dilate more; beyond the scope of the lens. But an interesting thing came up recently, not only is my lens 1/2 way out of the bag, but there is also a tilt. Have you had your eyes dialated lately to see if your lens is in the correct position?  Even a slight tilt will give us a problem. Hope this helps. And good luck to you 

9

Unfortunately links aren’t permitted on these forums but here is a cut and paste of what I assume you are referring to.  This is new to me and as far as I know not offered in Canada.  What was interesting was these implants are reversible and can provide those with monofocal lenses a chance to gain broader range of focus.  They must be very new on the market - haven’t been able to find any patient reviews.

“A new product from Morcher takes advantage of the pinhole effect to enhance depth of focus and will allow patients who have previously had cataract surgery with a monofocal lens a second chance to improve unaided reading vision if they missed out on the opportunity to have a multifocal lens at the time of their primary surgery.

Morcher Xtrafocus implant

The new implant has a 1.30mm central pinhole and is placed in front of the previously implanted monofocal lens. The pinhole aperture achieves 3D of near focus in the non-dominant eye and aids reading vision. The surgery is performed through a tiny 2.4 mm incision under local anaesthetic and would take less than 10 minutes to perform. It has the added benefit of being reversible with easy removal of the implant leaving behind the underlying intraocular lens in case of dissatisfaction.

Some patients may require additional YAG laser or laser eye surgery to achieve optimal vision. “