Last year in March at the well established Pepose Vision Institute here in St. Louis. I had a $6,000.00 RX Sight LAL (Light Adjustable Lens) 20.0 D implanted be Dr. Pepose, in my left eye and immediately developed ND.

The following procedures have been done to my poor butchered left eye since then. : /

- a Reverse Optic Capture was performed at WashU. This diminished the shadow and transformed it to a blurry area of light non focused by the IOL. It’s like the frame on an eyeglass lens effect only it moves with the eye.

- Next a YAG capsulotomy (bad idea) that Dr. Pepose stopped mid procedure to reexamine the eye with slit lamp and then finished, subsequently the posterior capsule was not opened enough, confirmed by Dr. Gira at Ophthalmology consultants, inducing glaring light streaks.

- another YAG capsulotomy at Washington University in St. Louis to open up posterior capsule more and more evenly to correct the light streaks created by not making a good opening that was large enough - that had been done by the brilliant Dr. Jay Pepose who again, originally convinced me I needed cataract surgery in the first place, even though my real issue was vitreous opacities, aka floaters.

- Next Vitrectomy, to clear up the floaters and clouds in the eye - which it had to begin with, before cataract surgery with a crystalline natural lens that was not very clouded, in an eye with >= 20/20 acuity - but was told the vitreous opacity (floater cloud) was cataract. Post YAG’s I developed PVD (vitreous detachment) which increased the floaters. I also have right eye with cloud floaters. But the acuity is 20/15. Both eyes had LASIK 12 years ago.

- Next YAG pitting of the edge to ostensibly diffuse light from edge of the silicone RX Sight lens was tried twice with some minor improvement the first time and the second time made it worse than before producing arcs across from oblique light sources.

- Next and lastly on March 22 this year the RX Sight LAL was now explanted and a new Lucia 602 was implanted in the sulcus, behind the iris - as I was assured that would most likely be the final solution for the peripheral photopsia.

- Post last surgery developed corneal edema that went on for 3 weeks. That finally cleared up which brings the photopsia back into front stage.

The eye is now in worse shape than before surgery. The lens power was dropped from 20.0 Diopter to 19.0 because it was moved to sulcus. I have lost distance, and central acuity. Back to glasses for good distance vision and depth perception. I'm an avid tournament ballplayer that has now struggled mightily for the last two seasons to stay off the bench.

I now have floaters in the eye again, some pitch black ones that are most annoying. Worst of all I still have left peripheral blur/blob from left sourced peripheral light hitting my nasal retina.

All of the solutions they try seem to be hacks, yes hacks, that do not address the core issue, that of replacement lenses at 5-6.5 mm diameter that simply are not nearly the same diameter as the natural lens which is 9-9.5 mm. Current replacement lens optics in use are smaller in diameter than the natural lens. There are many light ray tracing studies that clearly model the issue of oblique peripheral light crossing the eye to the nasal retina, passing across the lens and emanating either from the edge of the lens light or bypassing the edge of the lens and hitting the nasal retina. The current state of FDA approved lense in the United States seem to be way behind. There are perhaps better lenses that perform better available outside the US. I'm going to see at least one or two more doctors, perhaps Dr. Safran in New Jersey, before I decide whether or not to go abroad for help. It's extremely disheartening to feel like I'm living in the third world of ophthalmology.