Post Cataract : posterior capsular opacification - speed

Posted by elliott1953 @elliott1953, Jul 16 2:49pm

I had cataract surgery on my right eye not quite four months (16 weeks) ago. While I obtained 20/20 vision in that eye (along with a fold in the capsule that caused a linear glare), my visual acuity was excellent; in fact, my surgeon said it was actually better than 20/20.

Yesterday, I noticed for the first time that my vision in that eye had deteriorated substantially. My vision in that eye is blurry, like a bad cataract, and the vision seems worse than my other eye which is 20/40.

My initial thought was that this might just be posterior capsular opacification (pco), which is apparently a common complication after cataract surgery, although maybe not this quickly.

I called my surgeon's office but won't see him until Aug 1st. I've become quite concerned and had trouble sleeping last night with worry given this development.

I know I was probably a good 'candidate' for pco since I have a wrinkle in the capsule that actually has caused a long linear line at a 45 degree angle on lights in dim settings and in certain conditions during the day; and, in addition, I believe that the type of cataract I had (posterior sub- capsular) may be more prone to pco development.

My question to others who might know or might have had 'pco', can vision drop this quickly. It's frightening. Since I can't get an appointment with my surgeon for two weeks, I hope to see my optometrist by early next week as I am just plain worried.

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tillymack | @tillymack | Jul 31 10:32pm

I have the impression that most surgeons doing yag these days don't use an eye piece. That said, I just found out my dry eye doctor (who also does cataract surgery) does use one. Some have one on hand when needed apparently. I've tried to find out why this is not universally done, but haven't found any discussion in the literature on this point. In contrast, when this issue is mentioned, it's been in the context of improved safety.
Have you asked your surgeon about the rotating starbursts?
How do you like mini-monovision? Do you find that your near eye has clearer vision as well? I currently have one eye for near and one for distance. It's convenient for reading but I was hoping to have both eyes set for distance and to wear readers. I have concerns about developing the maddox rod effect with my second eye so find myself in a holding pattern on that as well. By the way, did you visit another surgeon for a second opinion regarding the maddox rod effect or yag in general?

elliott1953 | @elliott1953 | Aug 1 7:58am

Hi Tillymack, in response to your questions above,

1. I did raise starbursts but it was when my eyes were still heavily dilated and that was the response I got. It's far less bothersome now than that maddox rod effect so, in that respect, it's definitely an improvement. It's not something I am going to bother with at least for now. I wouldn't do another yag over it. And, I haven't, nor do I plan to, see another cataract surgeon over it. In addition to the cataract surgeon, I do have an opthalmologist and a retinal surgeon - both who I see yearly or if an issue arises.

2. I hadn't noticed any decline in the eye with the nearer (mini-monovision) so I wasn't expecting to Yag that eye. I only did so because the surgeon said that the opacification in that eye was similar to the distant vision eye. If I had known about the macular pucker, I probably would have delayed that eye but my guard was down and went with the surgeon's recommendation. I trusted him.

3. I really like the mini-monovision which is what my surgeon had recommended for me. It's excellent. One eye was set 1.25 diopters below the distant eye.

4. I had read somewhere that the maddox rod effect isn't that common and it's to be distinguished from other positive dysphotopsias (halos, starbursts, etc). I guess the decision to undergo your other eye is the degree that your vision is being affected by the cataract. In my case, my right eye had a significant cataract where glasses/contact lenses no longer helped very much. It was therefore time and, while it's elective surgery and wasn't urgent, my surgeon told me that eye tissues can deteriorate with time so that it was advisable to go ahead with it. My other eye wasn't that bad. I still had fairly acceptable vision in that eye and could have deferred that one and maybe I should have. So I guess the decision for you is how bad is the vision in your non-operated eye - a decision you can make with input from your opthalmologist. Best wishes,