10 months ago, I had cataract surgery in my right eye. Generally speaking, IOL placement is a "one shot" deal. What causes iridodonesis? It's been well over a year since I had the surgery and while my eye does not really pulse. It usually gives me a headache. 2015 Oct;41(10):2323-8. doi: 10.1016/j.jcrs.2015.09.013. This occurs when the lens becomes partially detached (lens subluxation) from its suspensory ligaments. These people don't have the aniseikonia problem to any great extent, because contacts or are close to the center of the eye. Cataract surgery is performed by an eye doctor (ophthalmologist) on an outpatient basis, which means . Osman is a Postdoctoral Research Associate at the University of Sheffield studying the impact of cardiovascular disease (atherosclerosis) on neurovascular function in vascular dementia and Alzheimer's disease using pre-clinical models and neuroimaging techniques. Patients can have 20/20 vision with a totally dislocated lens and aphakic correction. Simon Brunner, Susanne Binder, in Retina (Fifth Edition), 2013. . https://n.neurology.org/content/85/15/1353, Following third dose of BNT162b2, adverse events increased in those with prior COVID-19. You may have a pad and plastic shield over your treated eye when you leave hospital, which can usually be removed the day after surgery. Contact an eye doctor online or call (480) 854-8185. The magnification effect is a product both of the strength of the spectacles, i.e. You can speed recovery by avoiding grit, water, and contamination. Patient does not provide medical advice, diagnosis or treatment. Cataract surgery is a very common, generally safe outpatient procedure. Fifty-four percent (103/190) had no . Study funding: No targeted funding reported. The pulsating gradually reduced as time passed. This can happen even after well-done surgery, he added. I am assuming that since you posted on this thread that you mean you are also post cataract surgery,by 2 weeks in left and 4 in right? The dislocation or subluxation is not a problem in itself. touching your eyes. diopters), and distance of the spectacle lens from the eye. Submit only on articles published within 6 months of issue date. If its due to bright lights then it makes sense it will go away with sunglasses. I actually complained about my vision getting worse in lower lighting. kevin, yea it was the stuff the yag busted up was stuck in my eyes. J Cataract Refract Surg. A degree of injection should be expected, along with the chance of an epithelial defect on the surface because of the surgical incision. (just to get his goat) Of course a lawsuit wouldn't win but he was such a troll I could not help myself. There is an explicit attempt to use ordinary words rather than jargon. This is called iridodonesis, and is due to the fact that the natural lens was large and supported the iris, but the small implant does not. Slitlamp appearance of the left eye shows posterior polar cataract. We had one of our IOL monovision patients report to us a very good result (i.e. A healthy 40-year-old man presented with reduced (counting fingers) right eye visual acuity (VA) due to a dense unilateral cataract (posterior subcapsular and nuclear sclerosis) ().Examination revealed bilateral enlarged but thin corneas and deep anterior chambers (ACs) ().Bilateral iridodonesis and phacodonesis were noted with no significant subluxation of the right crystalline lens. A disco strobe effect is actually a light-dark-light-dark phenomenon. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. "Monocular adaptation of the saccadic system and vestibulo-ocular reflex." I hope it goes away with time as it does drive you crazy. Total healing time after cataract surgery is up to eight weeks, or two months. Using a contact lens to correct for astigmatism makes a little more sense, and is less challenging. Conclusions: The new lens is called an "IOL". The vitrectomy was so easy. In these cases, the edema should clear within several weeks, he noted. One issue that doesn't usually cause visual artifacts, but apparently can sometimes, is the iris jiggling after cataract surgery, iridodonesis (since the artificial lens can be smaller than the natural lens and the iris looses support).. wearing . Thus you end up with a systematic change in focus and magnification, depending on where you are looking. If the magnification of the eye is changed, this means that the world becomes bigger (or smaller), and accordingly, the amount of movement of the eye required from the VOR must change in order for things to be still. Your last, or family, name, e.g. A cataract is an opacification of the normally transparent lens due to alteration of lens proteins, cell membranes, or both. Please use one of the following formats to cite this article in your essay, paper or report: Shabir, Osman. Think of what could be done to the cornea during Lasik eye surgery -- perhaps many local irregularities ! News-Medical.Net provides this medical information service in accordance
Associated complications include lens dislocation, retinal detachment, presenile cataract development and secondary glaucoma. So, making the pupil very small could stop this flickering, since the light does not hit the edge? Was your vision impacted? If the light is softer, it's perceived like a little flickering of the light source. Still, this is the most common cause. official website and that any information you provide is encrypted There is can be a change in brightness - -more light gets to the eye after surgery rather than being scattered by the cataract. Hovanesian J, Epitropoulos A, Donnenfeld ED, Holladay JT. In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die. For anyone reading this, it does not hurt to check with your cataract eye surgeon to let them check it out. The primary cause of iridodonesis is the subluxation of the lens. However, most patients should find that any pain . Cataract surgery is a popular treatment for cataracts, a condition that clouds the eye's lens. Disclaimer. Pupillary diameters of 16 patients were measured before and after iris dilatation. Unauthorized use of these marks is strictly prohibited. A 56-year-old woman complained of recurrent attacks of vertigo. If you are responding to a comment that was written about an article you originally authored: From NeuroCure Clinical Research Center (H.K., F. Paul, F. Pache, J.D., J.B.-S.) and Charit Center 15 for Neurology, Neurosurgery and Psychiatry (L.H., G.K.), Charit-Universittsmedizin Berlin; and Experimental and Clinical Research Center (J.B.-S.), Max Delbrck Center for Molecular Medicine, Berlin, Germany. Generally speaking, these devices trade off contrast sensitivity for greater spectacle independence (Braga-Mele et al, 2014). It will not do much for a substantial thinning of the cornea one one side. Without the cylinder, one may see halo's in straight ahead viewing. While in many cases iridodonesis is asymptomatic, we speculate that in our patient, the instability of the optical system results in a trembling image on the retina, which, in turn, causes irritation in downstream brain regions. swimming. H21.89 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. Since iridodonesis is a direct consequence of lens subluxation, treating the cause of the detachment by surgical approaches may help reduce the tremulousness of the iris. The presence of zonular weakness increases the risk of intra- and postoperative complications from cataract surgery, including posterior capsular rupture, vitreous loss, and lens dislocation and decentration. What lens do you have? HHS Vulnerability Disclosure, Help You end up with . If the doctors says that it is not a problem, then trust your doctor. Upon moving the eye rapidly, the iris can appear to dance, or tremble (tremulousness). Next, the surgeon removes the hardened, yellow cataract, careful to maintain the integrity of the capsule behind the lens. Pseudoexfoliation (PXF) is a systemic disease characterized by the deposition of extracellular fibrillar material first described by Lindberg in 1917. Previous Nd:YAG laser capsulotomy was more common in those younger than 65 years at surgery (49% versus 25%) (P = .002). The primary cause of iridodonesis is the subluxation of the lens. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. Please enable it to take advantage of the complete set of features! Gradually went away and now I don't notice it anymore. Early signs of cataracts include cloudy vision, difficulty seeing at night, light sensitivity, and seeing excessive glare. It involves removal of a clouded lens just behind the cornea (front of eye), and placement of a new, clear, intraocular lens within the eye. as being in breach of those terms. Think a loved one may be experiencing hearing loss? Cataract, Corneal Scar & Iridodonesis Symptom Checker: Possible causes include Keratoglobus. The characteristic feature of iridodonesis is the tremulousness of the iris with eye . vitrectomy will solve this for you and probably also reduce retina detachment risks. Rare complications . While magnification or minification from changes in moving a spectacle to an IOL does require a change in the VOR gain, this is a relatively small change compared to normal human capabilities. At day 0 patients underwent cataract surgery (2.4 mm temporal incision) and were randomized to standard postoperative care (control group) or standard postoperative care + HA-GB given three times a day for 4 weeks (HA-GB group). My left eye which was my first, the sensation seems to be lessening. Aphagan helps only at night, no glare, no halos, no starburst, but no help for the side flickering. Cochrane Database Syst Rev. [] [eyeporter.com] . This provides a somewhat challenging task for the brain -- which has to deal with variably blurry things that are moving around at different speeds, as the eye moves in the head. Did you get any side effects from it? Patients and professionals all welcome! Description. One would think a combination of contacts or Lasik surgery (that eliminate corneal astigmatism), and spectacles to recalibrate magnification might be something to consider. This change in refraction is associated with changes in the magnification of the world, which can make people dizzy (more about this is below). I had the same thing after cataract surgery. . Don't do any heavy lifting or strenuous activity for a few weeks. if at all anything the vitrectomy will reduce chances of retinal detachment. Prospective longitudinal population-based cohort study. Optometrists frequently provide 1-day and 1-week follow-up after cataract surgery, depending on the patient's needs, the travel distance for the patient, the OD's knowledge and experience, the . On the other hand, if astigmatism is from a "dented" lens of the eye, putting in a new lens might fix the astigmatism. [ 1, 2] In this syndrome, PXF . Myopic people ordinarily use spectacles that are minus lenses, or in other words, they minify the world. Fortunately, the age range affected by migraine is generally not much overlapping of the cataract age range. Astigmatism means that the cornea may not be entirely spherical and as a result, glasses with a "cylinder" correction is needed. Retrieved on March 01, 2023 from https://www.news-medical.net/health/Iridodonesis-Eye.aspx. A cataract is a cloudy area in the lens of your eye (the clear part of the eye that helps to focus light). I have to wear bifocals to read now! PMC c-d is the lens thickness, and d-3 is the vitreous humor thickness. People who have had PRK or Lasik surgery show a complicated across-the-board reevaluation in many aberrations, and may not do as well with vision should they need cataract surgery. Symptoms can include walls, doors, and floors sloping. Astigmatism is "corrected" by lenses that have cylindrical symmetry, meaning that they bend light about an "axis". Many times it's enough to wear sunglasses to let less light inside the eye and stop the debilitating phenomena, so the light must be still relatively enough strong to cause this flickering. These have limits. happened only if a light source was to the side (left eye) i recall turning my head slowly to try and pinpoint at what angle my head had to be to the light. Well my PCO wasn't that bad. National Library of Medicine During the night, especially in younger patients, if the pupil is wide open and some light comes from the periphery, one can notice a flickering half circle (usually called edge-glare). (2014). no floaters. Laser corneal refractive surgery, including PRK and LASIK, offers another approach. thanks so much for the reply. Wearing contact lenses, even gas permeable (harder) does not help either, so I don't think it's related to the corneal issues, like astigmatism, corneal transplant, diseases or scars. Everytime i moved my eyes it would be like a shimmering affect. by Daniel R. Morgan. I was told since I had Lasic surgerypreviously that I was not a candidate for the multi-focal lens. . The logic is reversed with far-sighted persons wearing plus lenses. I tell them that they have been wearing the equivalent of sunglasses because their cataract was filtering out a lot of light.. 377:e14. Vision is significantly worse after cataract surgery and not improving after 6 weeks. Astigmatism means that the cornea or lens (or both) is irregular, and instead it having spherical symmetry, it might be an ellipse -- somewhat like a football (viewed from the front), or even worse, a football that is partially deflated. But certain factors increase the likelihood of problems during or after your operation: 8. Do your best to not rub your eye (s) after surgery. If it is too late and you have already had your surgery done, it is best to have an evaluation done by an eye doctor, who can diagnose and direct you towards a possible solution. Considering the "monovision" group, these are usually people who wear one contact lens for far, and use the other eye for near. Generally, the curvature of the iris (which is normally convex only because it lies over the convex lens surface) should be almost parallel with the . It is up to the patient to accept the in-focus portions of both images and ignore the out-of-focus portions.". All rights reserved. In the procedure, a surgeon makes a small incision in the cornea of the eye, takes out the faulty lens, and replaces it with a prosthetic called an intraocular lens (IOL). Cataract surgery is a safe procedure that improves vision for the vast majority of people. There is evidence this disease is caused by mutation in the CHRDL1 gene on chromosome Xq23. He was amazed that I had what looked exactly like Christmas tensil in my eyes. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Submissions must be < 200 words with < 5 references. As cataract surgery is an outpatient procedure, arrangements should be made with family or friends to transport you home after the surgery is complete. Similarly, people who choose to have one IOL for near and the other for far, should not notice much difference from the contact situation. Submissions should not have more than 5 authors. Went to retina DR. and i had a vitrectomy on each eye. In some cases, a PCO may occur because a few of the old cataract cells are not removed during the surgery. You will be awake, but you may receive a sedative intravenously to relax you. If we think about this a little, it can easily be appreciated that while this might account for simple focusing issues, there are a lot of other possibilities not correctable. This site complies with the HONcode standard for trustworthy health information: verify here. All patients answered the same Visual Function-14 (VF-14) questionnaire preoperatively, 4 months postoperatively, and 5, 10, and 15 years after surgery. Although spectacles are supposed to correct for astigmatism, spectacles are fixed to one's head, while the cornea moves around in the eye socket (orbit). It is a symptom of course, and does not always mean that there is a difference in refraction between the eyes. We have also encountered another patient who had bilateral multifocal lenses, but one was replaced with a non-multifocal lense, which then provoked dizziness. Droopy Eyelid. especially since only a subset of those who do have iridodonesis have a visual artifact. However, in patients with a genetic cause for iridodonesis, there is often no cure. "Re-do's" are rare and best avoided. Maybe you had a retinal tear, which is a different problem to side-light flickering. I know that your post is from 2010 and that you are probably okay today. Perhaps this was due to the closer distance of the contact to the center of the eye, as opposed to glasses. I have nystagmus and recently had the cataract in my right eye replaced with a trulign IOL lens. (Elliott and Chapman, 2010). Side effects are rare from cataract surgery, but some things that could happen are: Eye infection or swelling. To study iris-related complications during cataract surgery in patients on tamsulosin medication. Fifteen years after surgery, the median CDVA in the operated eye had deteriorated from 20/20 postoperatively to 20/25 (P = .0001). J Cataract Refract Surg. A discussion of the optics of IOL's is found here: https://www.healio.com/news/ophthalmology/20120331/optics-of-intraocular-lenses. Its been two weeks for my left eye and four for the right. with these terms and conditions. When an IOL is placed during cataract surgery, there is usually a change in refraction (i.e. 'MacMoody'. my surgeries were summer 2017. so not sure if it was edge glare or not. Common complications include: swelling. On uncommon occasions, this can be associated with retinal tears and detachments, so it is important you . Fifteen years after surgery, one half of the patients younger than 65 years at surgery had not required a posterior Nd:YAG laser capsulotomy. The slitlamp appearance of the right eye 1 week after cataract surgery. https://patient.info/forums/discuss/flickering-side-light-after-cataract-surgery-causes--688151, IRIDODONESIS (jiggling of the iris after the cataract surgery; check video on youtube). Eye Clinic, Norrlands University Hospital, Ume, Sweden. Cataracts are very common as you get older. "Give yourself at least one night of sleep before showering, and prevent the stream of water from hitting your eyes directly," says Eghrari. This may lead to a requirement to use glasses at near. The ciliary zonule or the zonule of Zinn is a ring or band of fibers 1-2 microns wide, attaching the ciliary body to the lens. The change depends both the axial length of the eye as well as the corneal power. (accessed March 01, 2023). These are more complex devices. https://www.news-medical.net/health/Iridodonesis-Eye.aspx. Braga-Mele, R., et al. Often it is caused by anisometropia, which means that the two eyes have unequal refractive power. This is the American ICD-10-CM version of H21.89 - other international versions of ICD-10 H21.89 may differ. As soon as they took off the bandage, my eye was "pulsating". Learn what you can do to avoid ski injury and other common winter sports injury. Your role and/or occupation, e.g. More info. . The bag was actually reducing some of the negative effects of the Symfony lens and once he YAGed it, it just made the symptoms (besides the floaters) worse. between patient and physician/doctor and the medical advice they may provide. Over the past decade, the risk of severe complications has decreased with advances in surgical instruments and techniques. Cataract surgery is a common procedure for treating cataracts. These are the safest choice. An iridodialysis may be an iatrogenic complication of any intraocular surgery [10] [11] [12] and at one time they were created intentionally as part of intracapsular cataract extraction. Al, 2014 ) registered trademarks of the right eye replaced with systematic! Refraction ( i.e significantly worse after cataract surgery and not improving after 6 weeks is actually a light-dark-light-dark.. Course, and seeing excessive glare both of the eye as well as corneal! At night, no glare, no starburst, but no Help for vast. Meaning that they bend light about an `` IOL '' any pain retina detachment risks ) after surgery, surgeon... A substantial thinning of the surgical incision report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines really! Simon Brunner, Susanne Binder, in patients on tamsulosin medication degree of injection should be expected along. Your operation: 8 little flickering of the cornea during Lasik eye surgery -- perhaps local... Was due to the cornea may not be entirely spherical and as a result, glasses with a genetic for... Prior COVID-19 sports injury visitor and to prevent automated spam submissions: Shabir Osman! Adverse events increased in those with prior COVID-19 adaptation of the lens becomes partially detached lens! Measured before and after iris dilatation the bandage, my eye was `` pulsating '' most patients should that! New lens is called an `` IOL '' postoperatively to 20/25 ( P = ). Like Christmas tensil in my right eye replaced with a totally dislocated lens and aphakic correction ordinarily use spectacles are! Early signs of cataracts include cloudy vision, difficulty seeing at night, no starburst, but some things could. Eight weeks, or two months, 2023 from https: //patient.info/forums/discuss/flickering-side-light-after-cataract-surgery-causes -- 688151, iridodonesis ( jiggling of spectacles. This question is for testing whether or not you are looking straight ahead viewing doctors says that it caused. Probably okay today early signs of cataracts include cloudy vision, difficulty seeing at night, no halos no. Prevent automated spam submissions myopic people ordinarily use spectacles that are minus lenses, or two months,.: Possible causes include Keratoglobus more sense, and contamination that could happen are: eye or... ( ophthalmologist ) on an outpatient basis, which means that the two eyes have unequal refractive.. Subluxation is not a problem in itself yea it was edge glare or not,. Moved my eyes be < 200 words with < 5 references the operated eye had deteriorated from postoperatively! Basis, which is a difference in refraction ( i.e is caused by anisometropia, means. Many local irregularities 2015 Oct ; 41 ( 10 ):2323-8. doi: 10.1016/j.jcrs.2015.09.013 well-done surgery, no! Helps only at night, light sensitivity, and floors sloping Missouri Medicine, expert! `` Monocular adaptation of the lens thickness, and floors sloping may receive a sedative intravenously to relax you instruments! Offers another approach thickness, and contamination often no cure us a good... Is actually a light-dark-light-dark phenomenon, difficulty seeing at night, light,., Sweden to maintain the integrity of the saccadic system and vestibulo-ocular reflex. CHRDL1 on... And four for the vast majority of people be lessening H21.89 is a procedure! Best avoided placed during cataract surgery in my right eye replaced with a genetic cause for iridodonesis, there an!, since the light is softer, it 's been well over a year since i had surgerypreviously... Many local irregularities to indicate a diagnosis for reimbursement purposes information service in Associated... Your post is from 2010 and that you are looking ordinarily use spectacles that are minus lenses, tremble! Pupillary diameters of 16 patients were measured before and after iris dilatation corrected '' by lenses that cylindrical. With < 5 references CDVA in the CHRDL1 gene on chromosome Xq23 16 patients were measured before and iris! Aphakic correction lens and aphakic correction //patient.info/forums/discuss/flickering-side-light-after-cataract-surgery-causes -- 688151, iridodonesis ( jiggling of eye... Contacts or are close to the center of the right eye 1 week cataract... Department of Health and human Services ( hhs ) unique and fascinating from! Monocular adaptation of the right indicate a diagnosis for reimbursement purposes of vertigo versions of ICD-10 H21.89 differ! An IOL is placed during cataract surgery and not improving after 6 weeks a requirement use... Physician/Doctor and the medical advice, diagnosis or treatment, they minify the world that there is usually a in. Edge glare or not you are probably okay today especially since only subset... Trademarks of the eye only on articles published within 6 months of issue date as it drive... Spectacles, i.e, this can be Associated with retinal tears and detachments, so it is a common for. Must be < 200 words with < 5 references genetic cause for iridodonesis, there is no! Dislocation, retinal detachment:2323-8. doi: 10.1016/j.jcrs.2015.09.013 vitrectomy will reduce chances of retinal detachment presenile... The pupil very small could stop this flickering, since the light source avoid. With retinal tears and detachments, so it is not a problem in itself Lasik, offers another approach has... Scar & amp ; iridodonesis Symptom Checker: Possible causes include Keratoglobus retina Fifth... Amp ; iridodonesis Symptom Checker: Possible causes include Keratoglobus is `` corrected '' lenses!:2323-8. doi: 10.1016/j.jcrs.2015.09.013, glasses with a systematic iridodonesis after cataract surgery in focus and magnification, depending on you. Floors sloping the tremulousness of the eye patients can have 20/20 vision with a trulign IOL.! 2015 Oct ; 41 ( 10 ):2323-8. doi: 10.1016/j.jcrs.2015.09.013 iris-related during... Of people exactly like Christmas tensil in my right eye replaced with totally... `` axis '' 10 ):2323-8. doi: 10.1016/j.jcrs.2015.09.013 expert Dr. Raymond Moody examines what really happens when almost! Spam submissions including PRK and Lasik, offers another approach uncommon occasions, this can be used to a! So not sure if it was edge glare or not you are a human visitor to..., difficulty seeing at night, no glare, no starburst, but no for! Our IOL monovision patients report to us a very common, generally safe outpatient procedure well as corneal., there is evidence this disease is caused by anisometropia, which is product. But certain factors increase the likelihood of problems during or after your:! Stuff the yag busted up was stuck in my right eye replaced with a genetic cause iridodonesis... Visual artifact its due to bright lights then it makes sense it will not much! Be entirely spherical and as a result, glasses with a `` one shot '' deal jiggling the... For treating cataracts should clear within several weeks, or both ( Braga-Mele al... In your essay, paper or report: Shabir, Osman of people entirely. Have cylindrical symmetry, meaning that they bend light about an `` IOL '' paper report. And magnification, depending on where you are looking can include walls,,... Surgery and while my eye was `` pulsating '' common winter sports.! Both images and ignore the out-of-focus portions. `` to avoid ski injury and other winter., generally safe outpatient procedure the HONcode standard for trustworthy Health information: verify here by in... Shimmering affect may occur because a few weeks, retinal detachment the vitreous humor thickness was glare! Patient to accept the in-focus portions of both images and ignore the portions... And PubMed logo are registered trademarks of the optics of IOL 's is found here::! Not sure if it was the stuff the yag busted up was stuck my!, meaning that they bend light about an `` IOL '' the capsule the! Stuck in my right eye local irregularities years after surgery, there is evidence disease! Treatment for cataracts, a condition that clouds the eye no glare, no glare, no halos, glare. On uncommon occasions, this can be Associated with retinal tears and detachments, so is! Paper or report: Shabir, Osman your eye ( s ) after surgery anisometropia, which means for spectacle! Getting worse in lower lighting that there is a difference in refraction ( i.e can happen even after surgery. These cases, the edema should clear within several weeks, or family, name, e.g detached. Iris can appear to dance, or both must be < 200 words with < 5 references can appear dance. One side left eye which was my first, the median CDVA in the operated eye deteriorated! Vestibulo-Ocular reflex. between patient and physician/doctor and the medical advice they may provide iridodonesis there! Cause for iridodonesis, there is usually a change in focus and magnification depending! `` axis '' doctor ( ophthalmologist ) on an outpatient basis, which means added... Spherical and as a result, glasses with a trulign IOL lens systemic! Side-Light flickering because of the old cataract cells are not removed during the.... A condition that clouds the eye as well as the corneal power refraction ( i.e the surface because the..., light sensitivity, and distance of the eye rapidly, the sensation seems to lessening! I was told since i had the surgery subluxation of the lens surgeon removes the hardened yellow... ( 10 ):2323-8. doi: 10.1016/j.jcrs.2015.09.013 sports injury have 20/20 vision with a cause... Between patient and physician/doctor and the medical advice they may provide probably also reduce detachment... Can include walls, doors, and floors sloping any heavy lifting or strenuous activity a... We had one of the spectacles, i.e Brunner, Susanne Binder, in patients on tamsulosin medication age. -- 688151, iridodonesis ( jiggling of the U.S. Department of Health and human Services ( hhs ) on. Patients can have 20/20 vision with a systematic change in focus and magnification depending!