I wanted to share my experience with YAG Laser Capsulotomy, which I had last Friday.

My Background & Visual Goals

To understand the results, you need to know where I started. I originally had my Vivity IOLs implanted because of significant night vision loss, primarily in my right eye. I also deal with extreme astigmatism, which meant my eyes could only ever be partially corrected.

Knowing I’d need glasses for distance anyway, I chose a bilateral intermediate target of -1.25D. Post-IOL implantation (with glasses), my vision was excellent:

• 20/20 in both eyes (closer to 20/15 in bright light).
• Great near vision down to 16" in office lighting.

While some might think it’s expensive to get presbyopia-correcting lenses just to still wear glasses, the quality of life improvement was worth it. Last Friday, I went in for YAG to treat PCO (1.5 range) and a Posterior Capsule Striae (wrinkling) in my right eye, mainly to stabilize the capsule in preparation for PRK.

The Procedure

The doctor noted I would likely notice the improvement most in my left eye. The procedure itself was incredibly easy: numbing drops, dilation, and waiting.

• The Setup: I sat at a machine no bigger than a standard diagnostic tool. The doctor used a small optical cup with gel to hold the eye open.
• The Challenge: Staring at the green light was the hardest part. My eye dominance kept trying to flip to the eye with the "light show," so I eventually just stared roughly where I thought the light was.
• The Sensation: Every time the laser fired, I felt a loud click and a sharp sensation like an electric jolt in the back of my eye—almost like someone tapping on the eyeball. My doctor said it’s quite unusual for patients to actually "feel" the pulses like that. It wasn't painful so much as unexpected.

Recovery & Observations

It took about 8 hours for the dilation to wear off.

• The First Night: I saw rotating streaks around all lights (like looking through a pond), most noticeable in the right eye. By the next morning, this had completely faded.
• The Focal Shift: This was the biggest surprise. My focal point moved significantly. While I previously had good near vision at 16" (with distance glasses on), that point has now shifted out to 24". My vision without glasses shifted similarly.

My "Myopia & Halo" Hypothesis

This shift seems to prove my theory: Vivity halos are primarily the result of slight myopia. By shifting my range further out, the halos almost entirely vanished. However, there are some temporary trade-offs with the post-op drops (Prednisolone Acetate 1% suspension):

• Visuals: The drops increase overall cloudiness and starbursts. Since it's a suspension, it's essentially like putting milky liquid in your eye, which adds a layer of light scatter. Almost like looking through dirty glasses for an hour.
• The Taste (Dysgeusia): As a supertaster, the side effects are wild. Every time I use the drops, I get 1 to 2 hours of an intense metallic taste. It’s like sucking on an old penny; it even masked the flavor of strawberries. I’ve tried punctal occlusion (blocking the tear duct) and tilting my head, but it still finds its way to my taste buds. Pro-tip: Do not take these right before a meal unless you want everything to taste bitter.

Medication issues aside, I suspect my shift is on the high end and might settle a bit over the next week. I’ll confirm the final numbers at my 4-week follow-up. The good news is that I am now much closer to my target. I was not aware that such a shift could occur prior the procedure. The consent form was much more focused on "we used to have to stick a needle in the eye to clear it up, but now we have this great procedure... some people may experience side effects."

However, this is a warning for those who hit their "plano" (0.0) goal: My lens shifted back far enough to significantly change my prescription. If you landed at a perfect zero, a YAG could potentially push you into hyperopia (farsightedness). This is apparently not uncommon though shifts can be in either direction.

This shift just reinforced my opinion that those seeking a "glasses-free" life should be prepared to sit down for a laser tune-up post-op. In my case, I already planned for PRK to remove residual astigmatism, which will further improve the depth of focus on the Vivity. The last thing you want is to be happy with your vision and suddenly lose the near vision you paid for just to clear up some PCO.

Has anyone else with Vivity or other EDOF lenses noticed a prescription change or a loss of "near" after YAG?