Tecnis Synergy toric IOL surgery week ago worsening vision

Eye care
1

Hi,
I had IOL implant surgery 8 days ago. IOLs are Tecnis Synergy toric lenses. Model ZFW100.

Right eye +22.5 diopter, cylinder 1.00 diopter
Left eye +22.0 diopter, cylinder 1.00 diopter

Day of surgery, expectedly extreme haziness, massive halos, glare and starburst. I went home and rested. At night I could read small print, albeit hazy.

Day after surgery, amazing close up vision from about 35cm. Distance vision quite good. Was feeling good and confident surgery was a success.

I saw doctor three days after surgery. Vision had deteriorated a bit, which doctor stated was likely due to some inflammation and healing. I was given a score of 20/20 vision, but I struggled to read the letters as they were hazy/fuzzy and blurry.

It is now eight days since surgery and I have noticed each day since third day after surgery that my eyesight has gotten worse and worse. Today, I can only read my phone screen at a specific distance (about 35cm) and anything closer and further away is blurry. My distance vision is now really bad and very blurry. I cannot stand looking at distances as there is just nothing I can properly see. I am getting distressed.

The doctor on Monday said fluctuating vision is normal and to be patient. But, this is a continual daily deterioration. I am on a regime of drops - antibiotic, anti-inflammatory 4 x times a day. I wear eye patches at night, not rubbing eyes, not getting water in eyes, using lubricating drops. I am resting my eyes alot.

Has anyone had similar experiences like me and if so did it resolve? Just seems like my recovery is going backwards.

2

From what I have read, you may have an exaggerated inflammatory response. It may go on for another week. If it continues beyond that, or if you have pain or redness, or more symptoms, see your cataract surgeon right away. If you happen to live near an eye hospital that has a 24 hour Emergency Room, that is another option for you. Maybe someone else here will chime in.

3

I had poor vision after surgery where everything looked fuzzy and straight edges look zig-zaggy. It was dismissed at first until it got worse and I insisted on have it looked at again. It was cystoid macular edema (which was easily treated and resolved in mu case with more steroids). This doesn’t sound like what you have though as you didn’t mention any distortion, just blur. Also you are still on steroid drops I assume, which should prevent or at least minimize CME. In any case CME is easily ruled out with an OCT which is a machine they (or even some optometrists) would have in their office. Could also be corneal swelling maybe (cornea edema)? I don’t know. I do think it will improve though. You are still in the very early days.

4

I was told about 95% of recovery from the surgery occurs by 3 weeks and 100% by 5-6 weeks. Probably a bit early to be getting worried if the surgeon is saying everything is ok with the lens.

5

Thanks David. I am taking Maxidex (Dexamethasone) steroid drops 4 x times day and Ilevro (Nepafenac) drops 1 x time before bed. Also lubricating drops when needed.
Tenth day today and vision is still blurry. I suppose what has thrown me off is that the day after surgery my distance vision was good and could read a sign 450 metres away quite clearly. Now that sign is a big blur and I cannot even see the words on the sign. So from good post op vision to deteriorating vision is strange.
I might give the clinic a call this week. Thanks for info.

6

I also experienced CME. On the first eye, I had 2 days of great vision, then everything got blurry with a clear area in a tunnel that might have been a few inches across at 10 feet. I had no distortion, just blur. Optometrist blew me off with “I don’t know what that would be.” (He also never dialated my eyes to look. I’ve since changed doctors.) The surgeon’s office just said “see your optometrist.” Went to my retina doctor after about 5 weeks, and sure enough, CME. I’ve read that it’s a lot more common than is diagnosed, and in most cases just clears up on its own or with the steroid drops, but it’s something to keep an eye on. (My second eye also got it, and had blurriness and a loss of depth of field.)

I also have diabetic retinopathy, and I’m still fighting the edema after almost 2 years. I had to start anti-VEGF injections due to the inflammation, and of course the off-label cheaper treatment doesn’t work for me, so I’m getting about $3600 of injections every 4-6 weeks. Thankfully my insurance is good.

Again, I want to stress that most people have it clear up with no issues.

7

I contacted the clinic and spoke to one of the eye specialists there. I explained the symptoms I have experienced post surgery - day after: clear vision both near and distant, then each day after that deterioration of vision with everything very blurry now, other than close up reading like on my phone (even laptop use is very hard and I have to bring it right up close).
She said it sounds like it may be an issue where post-op, the capsule can tighten excessively and pull the lens implant forward causing a refractive error.

She said it may resolve, but if not, I will need laser corrective surgery to correct the refractive error. As they like to ensure the eye has fully healed, it is usually not done until several months post-surgery. She said it may be the case I may need prescription glasses as I am now very short sighted, until laser surgery. I was booked to return overseas and not due to return here for up to 9 months.

So basically looking like a real disaster. I am really struggling because when I look beyond reading distance I feel instant eye strain, it’s like putting on someone’s glasses that are a very strong script. The blurriness is unbearable.

Weirdly, I do get brief spots of clarity where amongst the blur, I can sometimes make out a car registration plate number. Night-time the vision seems a bit better. Halos around street lights are like huge round cobwebs and other lights just jut out massive glare.

I used Chat GPT to articulate more about this condition:

Experiencing anterior capsule contraction syndrome (ACCS) in both eyes simultaneously is relatively uncommon, but it can happen. ACCS is a potential complication that can occur after cataract surgery or intraocular lens (IOL) implantation. It is characterized by the tightening or contraction of the capsule surrounding the IOL, which can lead to visual disturbances.

‘When the lens capsule contracts excessively or becomes wrinkled, it can cause the implanted lens to shift or move forward, resulting in refractive changes and compromised vision. This can lead to a loss of distance vision and a focus on near objects.’

Causes:

• Similar surgical techniques: If the same surgical technique was used in both eyes, it is possible that a similar healing response occurred in both eyes, leading to ACCS.

• Pre-existing factors: Certain pre-existing conditions or predisposing factors, such as underlying inflammation or anatomical characteristics, may increase the risk of ACCS. If these factors are present in both eyes, it could contribute to the simultaneous occurrence.

• Surgical environment: Environmental factors during surgery, such as the use of specific instruments or equipment, could potentially affect both eyes and contribute to the development of ACCS.

8

did u have laser surgery?

9

No. I saw one of the specialists today and she said I will likely need laser surgery because I need a corrective script post IOL surgery. Eyes have dropped from 20/20 to 17/20. She explained that because the lenses only come in 0.5 diopter increments, those like me fall in the middle who need a 0.25 D adjustment. Laser will be needed to do that. Laser will only be done when eyes fully healed from IOL surgery.

10

that doesnt sound right. 0.25 refractive error should not be noticeable. was she able
to clear your vision with glasses?

11

Also few if any places will do LASIK for a 0.25D adjustment. I don’t think LASIK is accurate enough to reliably achieve such a tiny adjustment.

12

Especially if you want to move in the more myopic direction.

13

Maybe I recalled part of her conversation incorrectly, but she definitely mentioned something along the lines that because my intraocular lenses only come in 0.5 diopter increments, then there are people who will not get perfect focus until they have additional laser surgery.
During the eye examination she adjusted the slides so my vision was clearer, but even then it was still not completely clear. She said giving me glasses prescription now was too early.
I was given some cheap +0.5 glasses but they made it worse. So for now I just need to wait and try to muddle through with my blurry eyes.

14

It feels like my blurry vision is way more than 0.25 diopter refractive error. Really confusing.

15

the +0.5 may explain the blurry vision. you may have ended up far sighted (hyperopic). sometimes it can happen.

16

Yes, it is too early to get prescription glasses as your eyes are still healing and changing. The standard full recovery time is 5 to 6 weeks.
.
It is true that IOLs come in increments of 0.5 D (and even more for cylinder corrections), but this is measured at the lens plane. At the cornea plane where eyeglasses corrections are normally measured the 0.5 D steps are reduced to about 0.38 D steps. So, not 0.25 D steps like eyeglasses, but not far off. I would suggest standard practice is that Lasik is not necessary to get 20/20 vision, unless the surgeon misses the expected outcome by more than 0.5 D.