Complications and Side Effects from IOLs

Posterior Capsular Opacification

Posterior capsule opacification (PCO), or “cloudy lens capsule” occurs in approximately a third of patients who undergo cataract removal and intraocular lens implantation. It is less common than it used to be, due to significant improvements in intraocular lens design that actually inhibit the process of PCO formation. If you do develop PCO, it is easily treated with laser surgery, either in your ophthalmologist’s office, or at an outpatient surgery center.

This condition results from clouding of the posterior capsule, which can lead to a decrease in best-corrected vision. You may have some early PCO that does not significantly affect your vision. Similar to the way cataracts are managed, if your cloudy capsule is not bothering your vision, it can be left alone. If you are having difficulty due to decreased vision resulting from your cloudy capsule, you can undergo a yag laser capsulotomy (YLC), in order to improve your best-corrected vision. As with cataract surgery, there is a short healing period, after which you may be fitted with new glasses.

The procedure takes approximately 5–10 minutes, and once the posterior capsule is opened with a laser, your PCO will not recur. On uncommon occasions, this can be associated with retinal tears and detachments, so it is important you alert your doctor if you notice worsening vision, flashes of light or floaters after this procedure has been performed. Older style lenses were also susceptible to dislocation following YLC, but this is uncommon with today’s improved lens designs. Most patients who undergo this procedure will notice improvement in their vision a day or so after the procedure is performed.

Lens Dislocation

Lens dislocation occurs infrequently and may not cause you difficulty. If your lens becomes decentered, it may change your glasses prescription, but you may continue to see just fine with an updated prescription. On rare occasions, your lens may dislocate into the vitreous cavity, although this is rare with the newer generation lenses. If this rare complication occurs, the lens can be removed by a retinal surgeon, after which you can usually have a new lens placed in your eye.

Iris Capture

Occasionally, part of the lens may rotate forward and catch part of the iris. Most patients are asymptomatic when this occurs, but if you develop inflammation or blurry vision, you may undergo a simple lens re-positioning procedure, or possibly a lens exchange. Most patients do very well after these procedures.

Glare and Halos

The premium IOLs may cause glare and/or halos due to their refractive properties, which allow you to focus at more than one distance. A small percentage of patients with monofocal lenses report these symptoms, but they are not typically associated with this style of lens. Most patients are not significantly bothered by these symptoms and find the trade-off between glasses independence and glare/halos acceptable.

Loss of Contrast Sensitivity

This refers to a loss of the ability to distinguish fine detail or subtle differences in color and/or background, and is associated with certain types of premium IOLs. Most patients tolerate this well, but if you require extreme detail resolution, a premium IOL may not be a good option for you.

Loss of Accommodation

Accommodation is the process that allows you to focus from distance to near, and at each distance in between. So, if you are young enough, and retain some ability to focus from distance to near, you will lose that ability after surgery unless you select a premium IOL. Many older patients who undergo cataract surgery have lost much or all of their accommodative ability, so this effect is less obvious for those individuals.

Dysphotopsias

This effect comes from the edge of the IOL. It usually manifests as an arc-shaped shimmer in the peripheral or side vision. This is generally very well tolerated, and usually resolves after several weeks or months following surgery. It is uncommon for this to cause long-term complaints.

Inflammation Inside the Eye

This was much more common with older lens designs. Occasionally, if a lens becomes dislocated, it may rub against the iris and cause inflammation inside the eye. If this occurs, the lens can either be repositioned, or replaced. Each of these procedures is very successful in treating this uncommon condition.