I know others have posted about this, but I would be so grateful for some advice or suggestions. I will detail my experiences in quick reading format and state that I did NOT have cataracts prior to lens exchange. I required 2 eye prescriptions and wanted to be spectacle-free.

January 2017 - had trifocal Carl Zeiss AT Lisa IOL's implanted into both eyes. 

Immediately after surgery I had ghosting, giant spider web halo's and loss of visual acuity in low light. These were severe and I was unable to drive at night.

Several months later, the right eye was developing PCO. Vision in that eye was extremely poor.

January 2019 - I visited the surgeon in Prague. He advised he would "polish" the right eye to clean up the cells and advised to carry out an explantation of the trifocal lens in the left, dominant, eye, which he replaced with a monofocal lens, the Alcon Clareon. 

Immediately after the lens exchange, vision was crystal clear in that left eye, albeit there was a tiny, pin head size reflection when looking straight ahead, under bright lights, or when sat in the car.

In the right eye with PCO, vision was still poor and PCO became worse.

May 2019 - I returned to Prague to have YAG on the right eye with PCO. I explained to the eye specialist that I was also experiencing a small aberration, of a pin head size blob of light on the bottom lashes of my left, monofocal, eye, which was only present under bright lights and also when sat in the car.  She said she would carry out the YAG on that eye, too.

It has been a week since I got back and the trifocal eye has resumed all ghosting, halo's and low visual light acuity, but the cloudiness has gone.

HOWEVER, the monofocal eye now experiences huge starbursts, as long as 20 foot, emanating from car headlights and from other light sources, even the flames of a fire. The small ray of  light "blob" I previously saw has now become larger and is present a lot more. It has also shifted position. This is not a "floater".

I have googled and researched as much as I can and I have only seen on this forum a person who had starbursts AFTER YAG. I am absolutely distraught because I cannot drive at night and this limits not only my job capacity, but my quality of life.

WHY would she YAG the clear monofocal eye? Why do I now see starbursts?

WHY is the trifocal lens still seeing halo's, ghosting, etc and will a larger hole done by a 2nd YAG improve them?

Any advice would be greatly appreciated.

Original Post

She YAG'd the right eye because she believed it would remove your symptom. The only reason I can think of as to why that would create a new, more complex visual outcome is if the IOL shifted position somewhat and is no longer aligned with the visual axis. That said, IOLs don't have to be perfectly aligned visually to work well. There is no way to accurately answer your question in this case.

You refer to your left eye as "dominant." Why?

And didn't you post here in the fall or sometime last year about this?

Dear Dr

Thank you for your quick reply. I'm not sure if I posted on this forum before, as I had to sign up to this one today. 

I understand why the right eye with PCO required YAG, but I don't understand why she carried out YAG in the left eye, with the recently implanted monofocal lens, which just had a very small reflective aberration and no PCO. Since she carried out YAG on the left eye, I now see huge starbursts and the tiny reflection of light has shifted position and is larger.

Would YAG normally be carried out on an iol that does not have PCO? I have not received a response from her so far and I am concerned that I will now be stuck with this starburst problem forever.







I have seen many instances where a surgeon does a YAG even when there is no apparent posterior capsular obscuration (PCO). I think it is to remove any question as to whether the posterior capsule is contributing to the visual problems. IMO, if the capsule is clear, don't YAG. However, sometimes the lasered posterior capsular tissue gets "hung up" between the posterior of the IOL and the vitreous face, causing new aberrations. Usually the tissue eventually drops out from the interface and the symptoms are abated. The posterior capsule "remnant" is normally visible to the examiner when viewing the dilated eye through a slit lamp.

Dominance does not normally have a bearing in cataract surgery unless one eye is being prescribed for distance vision and the other eye prescription is skewed towards reading. Some surgeons will alter their IOL powers in such a way to enhance the benefit of a multifocal (tri-focal) IOL. I wonder if that was the case here. In that regard, it is important to know what your present glasses prescription is. Have you been refracted for glasses since your most recent visit with the surgeon?

Dear Doctor

When the trifocal lens was explanted earlier this year and replaced with a monofocal lens, it was described as "set for distance". This is because it was my dominant eye and most people prefer to have it set for distance, which I agreed with.

The surgeon told me that I would require glasses for reading and computer work after the explantation of the trifocal to the monofocal. However, even before the monofocal was implanted, I still required a reading prescription of +1.75 for each eye with both trifocal lenses!

I was not tested for reading after YAG and I have not been to see an optician at home, in UK yet. I am using +2 reading glasses, which work fine.

The monofocal lens is still perfectly clear day and night, however, the starbursts around anything bright now hinders driving again, particularly as the trifocal lens in the right eye is very poor in low light situations and has halo's and ghosting.

The "blob" in the mono lens is not apparent all the time, it is in  certain lighting situations and peripheral vision. It seems to be when I am (passenger) in a car and under bright lights, like shopping malls. It seems it is like a reflection??

If the monofocal did not have this aberration, it would be perfect and I wish I had had the other trifocal lens explanted and replaced with a monofocal  and then Yag'd for PCO. I wouldn't have the ghosting and halos, or problems with visual acuity in low light.

I do not know what options I have left, now both eyes have had YAG. I would love to hear from anyone who has had explantation AFTER a YAG, or to be pointed in the right direction of a qualified eye surgeon in UK, with this experience, if possible.

PS I am 54, female, no health or eye disorders and did not have cataracts, I just wanted to be spectacle free of having to have 2 prescriptions.



Setting the left eye for distance IMPLIES that the right eye is skewed towards reading. In most cases, patients with multifocal ("trifocal") implants still require reading glasses because multifocal IOLS do not (CAN NOT) provide perfectly clear vision at all distances; it is optically impossible. If the right eye is somewhat underpowered for distance and the left eye slightly over-powered for distance - this can leave you with a frustrating refractive imbalance. This is why I asked if you have had a recent (post-explantation) refraction done. This may clear up some of your vision problems. I say "some" because the multifocal IOL can still create some unwanted haloes.

I can't explain without examining you why the monofocal IOL is causing an aberration. There may be residual tissue from the YAG that is hung up behind the IOL (this tissue usually gravitates down and out of view over time) or some other vitreous tissue interfering with your vision. It is impossible to know.

Explanting the remaining multifocal IOL is another option but the power of the replacement monofocal IOL should be set for DISTANCE like in the fellow eye.

The problem with all refractive surgeries is the inability to deliver true glasses-free vision. While this may be desirable the outcome is always subject to the limitations of optical devices inherent in the laws of physics.

Dear Doctor

I had the YAG laser procedure carried out on both lenses last week. I did not have refractive laser surgery. This has never been mentioned to me.

YAG was required on the right eye with PCO. That eye still has the trifocal lens and all the aberrations associated with that type. 

The left eye with the monofocal lens did not have PCO. It was a very tiny intermittent pin head size "reflection". It was not debilitating. However, the eye doctor decided to perform YAG on that eye, too, to get rid of it, but now I have the huge starbursts emanating from all lights, so the YAG on that eye has caused these.

The monofocal lens allows me to see exceptionally clear from arms length and beyond (although not for reading, of course). Because i also have a trifocal lens in the right eye, with BOTH eyes I also have the ability to read some print and I can read text on my cell phone, some labels on shop products, although only casually.

You are right - the multi/tri focal lenses do not make you spectacle-free.  My vision was worse, overall. Unfortunately you trust to be given the best advice and truthful outcomes. This did not happen to me.

My eye doctor has failed to respond to my email. I am so grateful that you have taken time out to reply.

Hi Doctor

For anyone else reading...Yes,  I had RLE on both eyes in January 2017. I didn't have cataracts, I just wanted to be spectacle-free (I had 2 separate eyeglasses prescriptions).

Because I did not like the  tri focal lenses and was unable to drive due to haloes, ghosting and poor visual acuity in anything other than sunlight, I had the left tri focal lens explanted and a monofocal lens implanted instead.

The right eye with the remaining tri focal lens developed posterior capsule opacification, so required the YAG laser to correct it. The cloudiness went, but the haloes and ghosting are still there. 

My concern is the monfoocal lens, which received YAG to remove a tiny pinhead size speck of light I experienced, visible only in overhead lighting and in the car, has now got gigantic starbursts around lights.

I will have to spend for ££££ on a consultation with a UK eye surgeon to establish what has happened to this lens. I can't afford to keep going back to Prague, paying for flights and accommodation. 

I hope ayone reading this will think long and hard before having RLE and certainly multi focal lenses.




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