Blurry Vision After Cataract Surgery

Blurry Vision After Cataract Surgery

If you have already had your cataract surgery but aren’t happy with your final vision, then you may have additional eye conditions present that need treatment to improve your vision. While there are many reasons for blurry vision outside of the topics presented here (for example macular degeneration and diabetic retinopathy), we will focus on the reasons for blurry vision after cataract surgery which can generally be improved with treatment.

An Overview of the Cornea

Background of the Cornea

To understand why some patients have blurry vision after cataract surgery it is helpful to understand a little more about the anatomy and function of the cornea. The cornea is the clear, front part of your eye that you look through. A healthy cornea helps focus light so you can see clearly. There are 3 main layers in the cornea called the epithelium (outermost layer), the stroma (the middle layer) and the endothelium (the innermost layer). All 3 layers must be clear for you to have good vision. In some patients, the cornea can become cloudy or scarred leading to blurry vision.

Layers of the Cornea

  • Epithelial layer (Surface of the eye): The surface of the eye depends on a healthy tear film to be smooth for good vision. If the surface of the eye is dry (poor tear film) or damaged (corneal abrasion/scratch), or “lumpy bumpy” from corneal dystrophy you may have eye pain and blurry vision.
  • Stroma (Middle layer): The stroma makes up most of the thickness (about 90%) of the cornea. A healthy stroma is clear but it can become cloudy from swelling (cornea edema) or develop scarring or deposits in the cornea (degeneration or hereditary changes).
  • Endothelial (Innermost layer): The endothelium is made of thousands of tiny pump cells that remove excess fluid out of the cornea. This pumping is essential to help keep the cornea clear. Without the pump cells, the cornea becomes swollen and cloudy. The pump cells in this layer can be damaged by age, injury, inflammation, eye surgery, or disorders such as Fuchs’ corneal dystrophy. Damage to these special pump cells can cause poor vision.

Blurry Vision from Map Dot Fingerprint Corneal Dystrophy

This condition goes by many different names including Anterior basement membrane dystrophy and epithelial basement membrane dystrophy. The name Map Dot Fingerprint is very helpful because it describes the reason for the blurry vision. In this condition, the surface epithelium layer of the cornea looks as if someone imprinted their fingerprint on the surface. Like a smudge mark on your glasses, the changes in the epithelium of the cornea can lead to blurry vision and less commonly recurrent eye pain. This condition can be treated by a corneal polish procedure in the office and which restores the clarity of the vision for many patients within a few weeks. Typically, the glasses prescription will change or you may develop the need for glasses after the polish procedure.

Blurry Vision from Dry Eye Disease

Having effective treatment of dry eye disease is important prior to cataract surgery. Any eye surgery typically makes dry eye disease worse, though typically this goes back to your baseline about 4-6 months after surgery. Dry eye can present with an irritated, scratchy, sandy feeling in the eye however it does not have to cause pain. For many people, dry eye disease causes blurry vision or inconsistent vision that becomes blurry with certain activities like using the computer or iPad or while reading. This is because a tear film that doesn’t have enough oil will evaporate too quickly. Without a smooth tear film coating the surface of the cornea, your vision will be blurry. There are many good treatments for dry eye today such as HydroEye and Lipiflow and preservative-free artificial tears. We treat dry eye disease with a systematic approach. If dry eye disease is the reason for your blurry vision, we can help diagnose it and formulate an effective treatment plan to improve your comfort and the clarity of your vision.

Blurry Vision From Corneal Edema or Fuchs' Dystrophy

Sometimes after cataract surgery, the cornea can become swollen or edematous which gives it a gray or hazy appearance. This can cause blurry vision and sometimes eye irritation or eye pain. The mechanism behind this is based on the poor function of the inner-most layer of the cornea, the endothelial cells. These delicate endothelial cells have a specialized function to pump water out the cornea continuously helping keep the cornea clear. Just as a boat taking on water will sink, if the pump cells stop working the cornea takes on too much water it swells. There are many conditions in which these endothelial cells can become damaged or stop working such as aging, prior eye surgery, as well as genetic conditions like Fuchs’ Dystrophy. Cornea edema also causes glare and poor contrast sensitivity. In severe forms, cornea edema can progress to painful blisters and put the eye at risk of infection. As a center of excellence for Fuchs’ Dystrophy and corneal edema, Tailored Eyes is proud to offer the full range of options for restoring your vision. We can evaluate your cornea for corneal edema, and if necessary, help you pick the right corneal rejuvenation procedure to maximize your vision.

Blurry Vision from Posterior Capsular Opacification

The Intraocular lens (IOL) or lens implanted in your eye during cataract surgery is supported in place by a capsular bag. This bag helps maintain the lens position. In some patients, the capsular support bag can become cloudy which can lead to blurry vision. Some patients will report seeing streaks or halos around lights, glare, or as if they are looking through a “dirty shower curtain.” These changes tend to worsen over time and can progress quickly (over a few weeks to months). Some patients worry that their cataract is coming back. Today, this opacification can be quickly treated in the office with a YAG laser. The laser is used to create a small opening in the posterior or anterior lens capsule. This allows light to pass through the eye once more without distortion. The procedure is typically painless and takes only a few minutes. Often the vision recovery is rapid. We can evaluate you for PCO in the clinic with a dilated eye exam and if needed, can schedule you for the office laser procedure.

Blurry Vision from Cystoid Macular Edema

This condition leads to the blurring of your central vision because of central swelling in the retina. For this condition, the vision is good after cataract surgery but then becomes blurry later. It is a painless condition that often presents about 6 weeks after eye surgery as a generalized fog or central blur. There are several medications such as caffeine and steroids that can increase the risk of developing this condition as well as general stress and high blood pressure. To diagnose this condition we typically perform a dilated eye exam and will capture a retinal OCT scanning image to look for microscopic pockets of fluid in the retina. If macular edema is present, we will develop a medical treatment strategy with you as well as make a referral to a retina specialist if needed.

Summary and Next Steps

In summary, if you have had cataract surgery and are unhappy with the quality of your vision afterward, come to Tailored Eyes for a blurry vision workup. Together, we will formulate a plan to maximize your vision potential. Click the link below to register or make an appointment or call 941-499-1570.

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