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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3343
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I had cataract lens exchange surgery March 15th. A crystalens

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I had cataract lens exchange surgery March 15th. A crystalens implant (January 23rd) was exchanged for a monofocal lens (near distance) due to severe negative dysphotopsia. Unfortunately there have been complications with this second surgery. They include dry eye, which is improving. Vitreomacular traction ( some better - the breaks in the lines on the Amsler grid are getting fewer and smaller) and severe glare. The glare has not changed since the day of the surgery. It is such a problem that I close that eye when I drive at night. There has been absolutely no change or improvement. Two car headlights almost merge into one and the glare is so large it obscures vision in almost my entire visual field. Any idea on the causes or remedies?

Doctor DanB : Hello and thanks for your question. Are you available to chat?
Customer: Yes
Doctor DanB : How are you treating the dry eye?
Customer: Systane. I work an 8 hr day outdoors. My eys get a lot of wind/sun exposure.
Doctor DanB : How many times per day are you using the Systane?
Customer: Not really on a schedule. Maybe twice a day.
Doctor DanB : When there is significant dry eye that is not being treated adequately, the dry eye can cause significant glare as well as other symptoms. It sounds as though you may benefit from much more aggressive treatment. Let me elaborate...
Customer: Please do.
Doctor DanB : When there is significant dry eye, I recommend doing the artificial tears at least 4-5x/day. In addition, if this isn't enough, you may need to use a lubricating eye ointment 1-2x/day (at least at night) to further lubricate the eyes. Furthermore, if your dry eye is not responding to this treatment, it may be necessary to start a drop called Restasis, which helps cut down on the inflammation associated with the dry eye from surgery. Does this make sense?
Customer: It does. Except.........that the glare was there from the very first time I looked at a light when I first opened that eye after surgery. I wasn't outside. It wasn't even night. I was just in the recovery room looking up at an overhead light. Whamo - glare. And the glare pattern is precisely the same today - completely unchanged from the day to this. The dry eye is improved. The glare not one iota.
Doctor DanB : Has your doctor indicated that the dry eye is improved or are you saying this based on your symptoms having improved?
Customer: Just me based on less haziness and less sandpaper feeling.
Doctor DanB : I see. Those are logical conclusions to come to. However, there can still be significant dysfunction of the tear film (a more clinically correct term for dry eye syndrome). Of course, I can't say, without examining you, whether you have significant dry eye still happening, but this is something that needs to be ruled out and treated more effectively if it is. In addition, if there is any residual inflammation in the eye from the surgeries (only your eye doctor would be able to tell this for sure), then this can contribute to glare. Vitreomacular traction, causin retinal distortion, can also contribute to glare, but as that has been improving, I would expect this to be less and less of an issue in that regard.
Doctor DanB : Other things that can cause glare include persistent haze or swelling in the cornea and/or the shell that holds the lends implant becomiing cloudy or hazy
Doctor DanB : In the end, though, these are things that your doctor would know about and I wouldn't necessarily be able to diagnose them from our conversation.
Customer: Hmm. The Doc seemed a little upset that I was having this bad a glare issue. He did just kind of casually mention one thing as a possibility - fold or wrinkle of some sort in or on the back of lens? - but not like he was certain of that. Just kind of blurted it out when I explained the type and severity of the glare. He hasn't given me a prescription for glasses yet, which I need, because of all the problems. I just want two things - en explanation and hopefully a fix for this glare thing and a pair of glasses that will let my eyes work together. I was supposed to have cataract surgery in the other eye but suddenly that is my GOOD eye. No way I having anything done to that eye. I will be more aggressive with the systane. It does help. But I'm a landscape designer/installer. This is the busy season. Long days in the field. Long nights at the drafting board - with one good eye.
Doctor DanB : It sounds like you're going to have a rough haul of it with all the work you have to do; I have had patients with similar symptoms who have had some relief from using a laser to break up the fold or wrinkle in the capsule that holds the lens implant. That may be what is going to help you, though I do expect some improved relief from glare by increasing the systane and perhaps using lubricating eye ointment. I would try to have this discussion about the laser with your surgeon, especially if he/she is at a loss. Do you have any other questions about this?
Customer: So there is a possible fix? Can this fold or wrinkle actually be detected by the Doc or is it just based on the patient's description of the symptoms?
Doctor DanB : Yes, this can possibly be helped by that laser. The fold , wrinkle, or cloudiness of the capsule is something that should be plainly evident to your surgeon on exam.
Customer: Oh, that's a relief. Whew. I will be more aggressive in using the systane. I have no more questions. You've helped a lot. I really like, respect and trust my eye surgeon, but getting all the answers from him isn't easy. I will definitely have a frank discussion about the glare and remedy. One more thing, would this have to wait until the vitreomacular traction fully resolves because I understand it may not resolve or that it could take years or even get worse.
Doctor DanB : No, this will not have to wait until the VMT resolves--these things can be addressed now.
Customer: That's very good to know. I really have no more questions. Thank you so much.
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