Shadows after Cataract Surgery
One of the common things that people don’t know about cataract surgery is that it is possible to see “negative dysphotopsia” afterward. This is essentially a shadow caused by the edge of the optic. During a cataract surgery, a substitute/artificial lens is placed in the eye to replace the natural crystalline lens (which is what we call a cataract once it starts to become cloudy). The cataract/natural lens is obviously removed during the surgery. The lens implant is made of an optic, which is the part that the patient actually looks through, and haptics, which are “legs” that hold the lens implant in place. The optic doesn’t fill up the whole space where the cataract previously was, which is why the haptics are needed to hold it in place. Since there is a size difference, it is possible for light to pass around the optic of the lens. Another consequence is that light can hit the edge of the optic, which can cast a shadow onto the retina. This shadow then causes the “negative dysphotopsia,” which is usually a dark crescent shaped area seen temporally (to the side of the eye that has had surgery, i.e. off to the right after right eye cataract surgery and off to the left after left eye cataract surgery). The good news about this dark area is that patients don’t always continue to see this forever after their cataract surgery. Essentially, the brain adapts so that the area becomes much less noticeable or hardly noticeable in many cases. So, if you’ve had cataract surgery and you see a dark area off to the side, don’t worry! You’re in good company, and it will probably get better on its own.
I had cataract surgery almost a year ago. The day after the surgery a brownish shadow appeared in the corner of my left eye. My eye surgeon didn’t know the cause and said to give it time. He even had me examined by a retina specialist. Upon my last visit to my eye surgeon he told me that a “wrinkle” had formed in my eye where the cataract was removed and this was causing the shadow. He said this is highly unusual and to keep giving it time. It has not improved and I’m very concerned this will be there always. What do you suggest for this condition?
I’m sorry for the late reply to this post. I somehow missed this comment. In any case, if a person does have a temporal negative dysphotopsia, there are some things that can be done. For example, for the right patient with the right lens implant, there is a technique called reverse optic capture that can help. Sometimes, if it is really a huge nuisance and the patient feels that they cannot live with the temporal dysphotopsia, an exchange of intraocular lens implants can also help. Obviously, these techniques are only useful in the right patient, so the judgment of the proper solution for a particular situation can only be made after a complete eye examination and office visit.
I had cataract surgery yesterday. Last night and still today I have a dark cloud that covers all my vision like looking through a dark veil. I’ve read that some people have this in their periphery vision but mine is a total darkness. It’s as though not enough light can enter my eye. I had my other eye done three weeks ago and all is well with that one. Should I mention this to my doctor when I see him again next week? Thanks for responding.
Obviously I do not have a professional relationship with anyone posting on this website, and I do not know that much about any individual’s particular circumstances. I can only tell you what I would generally do if I were in similar circumstances. If I had a dark cloud that covered all my vision in a post surgical situation, I would call in to the office to describe the symptoms to the practice that knows the actual clinical situation. I would not wait until my scheduled appointment to inform the office. Let me reiterate that this is generally what I would do in a situation as described, because I obviously cannot comment on any particular case on a website.
Dear Dr. Shalwala,
On 4 Sept. 2019 I had cataract surgery/removal in both eyes. Since then, and up to now March 2, 2020, I still have these ‘crescent’ shaped black ‘strips’ which are very annoying indeed. Would you be so gracious to tell me what’s going on, if these annoying black strips will, IF ever, go away or what can be done? Would this be considered a ‘mishap’ on the part of the surgeon?
In advance I do thank you for your time!!!
Rose C.
Rose,
The crescent of negative dysphotopsia can persist for many months before it improves, so there is certainly still a chance of improvement even after five or six months. However, there is also a reasonable chance that it will persist. There are some things that can be done to improve negative dysphotopsia, but the best solutions tend to be surgical. Temporal dysphotopsia is a completely normal finding after very well done cataract surgery. I would definitely recommend anyone with persistent temporal dysphotopsia-like symptoms to discuss them with their surgeon.
Best,
Ajay
Have you seen this about slightly moving the lens?
https://www.youtube.com/watch?v=cPlg4FfE0kk
Shirley, reverse optic capture is sometimes a good solution to negative dysphotopsia. This gets a bit technical, but certain lenses have thicker edges that are hard to anteriorly prolapse out of the capsulorrhexis without irritating the overlying iris. Also, the size of the capsulorrhexis has to be appropriate to achieve reverse optic capture. Still, it is sometimes a good solution, and sometimes other surgical solutions are appropriate. Thank you!
I’m trying to verify that after oil implants, I see a shadow around letters on a page. The greater the color contrast, the more I see it. White letters on a dark red background seems to present the greatest shadow
Autocorrect changed iol to oil
Jay,
There are many reasons that one might see a shadow around letters when reading after cataract surgery. One of the simplest reasons would be a need for reading glasses. If seeing shadows around letters is a sufficiently vexing issue, I would recommend discussing those symptoms with the surgeon.
Best,
Ajay
I had cataract surgery in June 2017. replacement with bifocal lenses. By March 2018 had shadows appeared over field of vision. These shadows seemed to move. Had YAG laser treatment which improved vision somewhat. In January 2020 had second YAG procedure, after developing worsening vision. Vision improved significantly, but temporarily. It seems harder to read print and shadows persist. What is best course of treatment?
Greg, Obviously I don’t have a therapeutic relationship with you and don’t know what lens implant was used for you. So this is a very difficult question to answer. One consideration is whether the “shadows” that you are describing are representative of opacities in the vitreous cavity. If opacities in the vitreous cavity are the source of the problem, then I would not recommend intervention, as sometimes the risks of the treatment outweigh the benefits.
Dear Dr Ajay Shalwala, MD,
I’ve the same issues as the folks who’ve written above. Left eye cataract surgery done 7/14 – later that same evening and every day since I’ve had what I described to the surgeon a blind spot off to the outer left field of vision like a horse blinder, a shadowy curtain or over lay like crescent of darkness. He rechecked my vision and the health of my retina and told me that for some unknown reason the calculations of my vision didn’t match with the implanted bausch and lomb toric lens for astigmatism and that my eyesight had worsened. He is set to replace it with the corrected bausch and lomb toric lens next week. I asked if the lens may not be appropriate for me because of the blind spot but he really didn’t acknowledge my question or concern yet said no when I asked if he ever heard or read about other people having the same complaint. What more can I ask of him for my appointment tomorrow that would be helpful. I’m concerned this is going to happen again with the left eye and have yet to have the right eye done. Thank you!
Dear Dr Ajay Shalwala, MD,
I’ve the same issues as the folks who’ve written above. Left eye cataract surgery done 7/14 – later that same evening and every day since I’ve had what I described to the surgeon a blind spot off to the outer left field of vision like a horse blinder, a shadowy curtain or over lay like crescent of darkness. He rechecked my vision and the health of my retina and told me that for some unknown reason the calculations of my vision didn’t match with the implanted bausch and lomb toric lens for astigmatism and that my eyesight had worsened. He is set to replace it with the corrected bausch and lomb toric lens next week. I asked if the lens may not be appropriate for me because of the blind spot but he really didn’t acknowledge my question or concern yet said no when I asked if he ever heard or read about other people having the same complaint. What more can I ask of him for my appointment tomorrow that would be helpful. I’m concerned this is going to happen again with the left eye and have yet to have the right eye done. Also, one of the technicians told me that one common complaint that often occurs after cataract surgery is a “droopy eyelid” which would call for a plastic surgeon opthamologist to remove the excess tissue which she says is cause of the crescent blind spot. Is this true?
Dear MC,
Please keep in mind that all of my discussion is generic; they are general considerations that may not apply to your case.
It is certainly possible that one could have a loss of visual field due to drooping of the upper eyelid. Often if there is excess tissue that is overhanging, the actual eyelid position doesn’t need to be adjusted but the tissue can be removed (this is called an upper lid blepharoplasty). If this is the case, there should be improvement if you tape the excess skin tissue up away from your vision. In fact, patients often have taped and untaped visual field assessments to determine whether blepharoplasty will help them.
However, there are certainly cases as described in the original post of temporal negative dysphotopsia, which is related to the intraocular lens implant and not related to tissue overhanging from the upper eyelid. This can happen with a variety of different intraocular lens implant brands and materials.
I had right eye cataract surgery 3/23/21 and I have a ‘shadow’ when I look to the left mostly and my eye feels “full” all the time.
Is this normal ?
Dear Betty,
Please keep in mind that all of my comments are generic and that you should discuss your particular case with your individual surgeon during your post-operative visits.
You have had cataract surgery very recently on 03/23/21 as today is 03/25/21. At this time, your healing process is only beginning, and there may be many slight feelings of discomfort which can include a feeling of “fullness.” There may also be visual changes through the process of healing, so seeing “shadows” to in any direction could easily be part of an ordinary post-operative course. As I said, attending your scheduled post-operative exams is critical in order to make sure that everything is proceeding as it should, but nothing in your description jumps out at me as particularly concerning.
Had a IOL PanOptix trifocal lens put in my left eye. It’s been 4 weeks now. My distance vision has come in pretty well. The mid range and up close reading are not in focus yet. Mid range is not good especially in a room full of objects or poor lighting. Reading my phone is not in focus yet. One thing I noticed is that all the words on a screen, paper or sign have an outlined gray shadow around them making it hard to focus. I also had a astigmastism in this eye where the surgeon made incisions to correct while implanting the lens. It’s been 4 weeks and I’m feeling like I made the wrong decision on the lens just so I could stop wearing glasses. I’m 50 year old male and thought it would give me better quality of life without glasses. I’m stopped surgery on my second eye because if I have the same result then I would technically be blind up close and would need glasses anyway. So should I just get a monofocal lens in my right eye and take my loses with my left eye? Sucks because I paid $3,000 cash for the special lens that insurance won’t cover and it has not been good for my eye. Or is 4 weeks too soon to know what it will do? I also have really big circle halos around car lights at night. I took the lens out of the left side of my glasses and wear them at night to drive. Thank god I still have the glasses lens for my right eye so I can see things when I need to. Any advice or encouragement would be appreciated.
Dear Robert,
Please keep in mind that all of my comments are generic and not medical advice specifically directed to your case because I do not have the appropriate data given that I have not examined you.
Based on my experience, the Panoptix IOL is a very popular presbyopia-correcting lens implant in the US currently. It is a totally appropriate choice for someone who wants to decrease the need for glasses post-cataract surgery (given the rest of the clinical situation is also appropriate). However, when I personally discuss these lens implants, I specifically use the language above: “decrease the need for glasses” or “decrease the dependence on glasses.” I want to make sure that I never suggest to anyone that they will be free of glasses or be able to “stop wearing glasses.”
With regard to timing, usually 4 weeks is an appropriate time to wait to determine the effect of the lens implant. However, there are those who believe that, when considering the impact on near vision, the proper effect of a presbyopia correcting lens implant requires both eyes to be done. I’m not suggesting that someone in your position should have the other eye done with a Panoptix, but certainly there are those who would argue that the proper effect can’t be assessed unless both eyes are done.
The Panoptix IOL achieves its effect by “splitting” light; basically the same amount of light is coming into your eye, but it gets focused at multiple different points (compared to a monofocal with only one focal point). Therefore, there will always be out of focus light for any particular distance that you look, which can be the source of blurry outlines/shadows with any text and part of the reason for glare/haloes around headlights. That is a part of the technology, so it is a common issue in Panoptix patients.
Thank you for your feed back. I had a follow up visit a couple of days ago and they took pictures of my eye in depth. Conclusion was that the lens sack had some waves still in it and hadn’t formed around the new lens just yet. Dr. said it takes some time to naturally heal. So we are giving it another four weeks of healing to see what happens. If nothing changes he feels he can go in with a light laser and fix the issue of my haze and also recut the astigmatism incisions to make them stronger. I feel that I can be patient with this process now and see what happens. Thanks for the advice and I have also thought that the second eye will help the first eye in working together more.
I had cataract surgery 9 days ago. Before inserting the new lens I’m aware it was washed. I now see what can only ge described like looking out of a watermarked window. My actual vision is good. I was seeing slightly double print but this seems to have settled.
The water marks dots and lines are driving me crazy as I tend to focus on them and have to actively try to ignore them.
I was told this will settle down but if the lens is ‘dirty’ I don’t see how it will go.
The surgeon mentioned carrying out the yag laser procedure but I’m reluctant in case it’s the actual lens.
Has anyone experienced this?
Dear Tania, Please keep in mind that all of my comments are generic and not medical advice specifically directed to your case because I do not have the appropriate data given that I have not examined you. If there is in fact a defect in the intraocular lens implant, you are right that it will not go away in the long run. However, it is MUCH more common for patients to notice dots, lines, and marks in their vision after surgery that are representative of inhomogeneities in the vitreous jelly. These are often more prominent and visible after cataract surgery due to higher contrast–once the rest of the world looks sharper, clearer, and less dull, the vitreous inhomogeneities stand out much more. Adaptation to this increased prominence is also very common over time (i.e. weeks to months).
I had cataract surgery on December 3, 2020, yet my vision is not clear and I still have negative dysphotopsia. When do you think my vision will be clear, and negative dysphotopsia gone.
Ekeh, Please keep in mind that all of my comments are generic and not medical advice specifically directed to your case because I do not have the appropriate data given that I have not examined you. That said, negative dysphotopsia can definitely improve even between 6 and 12 months post-operatively. The probability of complete resolution is definitely less than it would be with the same complaint 1-2 months after cataract surgery. Different lens implants have different probabilities of causing negative dysphotopsia, and that fact is something to consider. If your vision is not clear, there could be many different reasons, which would require an eye exam to elucidate. In general, I would NOT expect continued improvement of vision/recovery 6 months out from cataract surgery; the healing and post-cataract vision can usually be assessed by 1 month post-op.
I had cataract surgery about a year ago. A J&J lense was use. I see a round to oval shadow a lot. Always when I get up or when I shower. I see it when I’m doing a thing strenuous like yard work. It seems to always be there but under certain conditions is noticeable. It is like rays of shadows that pulsate. My Dr keeps telling me it is an ocular migraine but that just seems like an easy answer and why would it be so continuous. Can you give me some direction. My vision is good in that eye since the surgery. They did have to clean it by laser but that didn’t help. Thank you. B.
Brian, Please keep in mind that all of my comments are generic and not medical advice specifically directed to your case because I do not have the appropriate data given that I have not examined you. Round/oval rays of shadows, especially ones that pulsate, does sound quite like an ocular migraine and not like a typical issue caused by a lens implant. If these symptoms are so frequent, then it is possible that you need to be evaluated for migraines, which can include things like an MRI of the brain. In such a situation, it may be appropriate to see a neurologist to discuss these symptoms.