Hello again, and first I want to say that I'm sorry your PD has not resolved. My main complaint is an annoying constant light show. I am going on almost 5 months post surgery from my second eye and the flickering, mostly when indoors around artificial light has not resolved. I did get a 2nd & 3rd opinion and they said it is Positive Disphotopsia and that if neuroadaption doesn't happen in 3 months then a ROC o IOL exchnage is the solution. My ophthamologist said yesterday that I could try ROC (reverse optic capture) and it that doesn't work do a lens exchange. Not thrilled with multiple surgeries, especially if no guarantee. I am fine outdoors. I need to figure out this flickering first because my doctor also wants to make sure the lens is not moving (Phacodonesis). His exam and 2 other DR. say it is not but the video I have looks like it is or is it just a refection of light bouncing off the square edge of the Panoptix lens? I can't post link but if you search lottemeiners1.wixsite with .com at end you can see it.
If It just takes time to resolve than I am willing to do that vs any interventions but also am sensitive to the optimal timing to do any surgery, especially an IOL exchange. My Dr. says that needs to happen sooner than later (2-6 months).
I think what is happening for many (3 %) who have the latest material for these lenses, acrylic, is that it is highly reflective and causing light splatter when it hits the lens. Especially if it is a square edge lens with rings like my AcrySof IQ Panoptix Lens. LE is a topic. I think there is a misalignment issue of the alpha angle of our eyes and optical angle of the IOL lens. I did not have a pre-op Corneal Topography w/ iTrace to evaluate so I would ask for this in the future. BTW 3 doctors assured me that I had the perfect surgery with a very centered lens and perfect refractive power. That is maybe the missing link because the lens may need to be aligned differently according to your Corneal Topography vs. centered. One size does not fit all.
Here are articles that explain that more. Again can't post links but google:
How to Reduce Higher-Order Aberrations
Understanding spherical aberration
USING ANGLE ALPHA IN PREMIUM IOL SCREENING
Positive Dysphotopsia After Toric Trifocal IOL Implantation
Can't Get No Satisfaction: Post-cataract Surgery Dysphotopsias
I have tried the Vuity drops like you with same results. I was interested in the contact lenses you tried but sounds like that wasn't helpful. I am also trying drops that dilate my eyes because when I get dilated in the Doc office the pulsating vision goes away. I have tried with my Doc's advice OTC, Naphcon A which dilates your pupils slightly and it does offer some relief. Again, for me all is good outdoors on a bright sunny day when the light is not coming in at an angle but is overall and my eyes are dialated. Another thing that helps is to occlude (block) one eye, either eye, and the pulsating vision goes away. I have tried wearing a patch but then all gets blurred because I nee both eyes to focus.
I think Time healing option is a caveat, Optic capture a crap shoot and from most specialists I have talked to, IOL explant/exchange the consistent solution that would solve PD. All say they would also use a silicone lens, like Bausch + Lomb L161. It has rounded edges, less prone to developing PCO and is not reflective like acrylic. For me unfortunately it will be giving up the Multi-Focal I have for Mono - 1 distance. Not happy about that because I do see 20/30 in the doc office and outside. It becomes a quality of vision decision for indoors when it becomes vision that pulsates and is in soft focus. I cannot see peoples faces clearly, read street signs and text has a soft blur around it.
I have talked to many specialists and will list them here as well as informative forums I have visited;
Dr Fram, Advanced Vision Care
Dr. Robert Bailey, Wills Eye Center
Dr. Safran, NJ
Dr Foster, Eye Center No. Colorado
Dr. Olsen, Moran Eye Center
Forums to google:
Patient.Info - Panoptix Experience
Patient.Info - flickering-sensation-after-cataract-surgery
I hope this helps. I am happy to answer any more questions. It is hard to navigate this eye world as a novice but vision is so important, that I keep digging through the weeds. I wish I had done this much research before a procedure that I was told by so many, including my DR., would give me perfect vision.
Thank you for all of your valuable research and insight. You refer to yourself as a “novice”, but you seem more like an experienced cataract surgeon!
Background: I’m longtime myopic and I’d employed monovision for many years with contact lenses. Had retinal surgery in left eye in 2018 and it prompted quick development of the cataract. In 2019, they implanted the distance vision Alcon SN60 and I experienced, almost immediate PD AND clouding of the posterior capsule. I, also, had significant floaters in that eye. My Vitreo-retinal surgeon, in whom I have fairly high confidence, advised a concurrent FOV and PCO which I had done. He believed this procedure could also help the PD. However, that surgery took care of the floaters and cloudy capsule, but was no help to the PD. And, since posterior capsule is now gone, an attempt at IOL explant/implant is of prohibitive risk to many surgeons.
I appreciate all of your site and doctor references and will check them out. Doctors that I’ve seen in my Pittsburgh area are not in favor of IOL exchanges. I had good communication with Dr. Safran, and he seems to have considerable, positive IOL exchange experience.
At this point, it doesn’t seem there are any easy answers to improve my left eye PD. It’s been 2 and a half years now and I hope age-related pupiler reduction and neuradaptation will give me incremental help.
As this right eye cataract has advanced, I need to decide on the lens and power to select for best ongoing vision. With the shortfalls of my left surgery, it is not a simple decision! Again, thank you for your wonderful input and let me know anything else you find out!