starburst symptoms after yag surgery-

I have had yag surgery and now I have starbursts at night, from car headlights, streetlights and traffic lights.

My doctor looked twice, two different appointments,  and said there was no problem. His assistant said that the eye might still be healing, inferring that after total healing the starbursts would disappear. The yag surgery was performed about 9 months ago. I called Baush and Lomb  , the expert said that particular lens , a hydrophobic , mono-focal lens , has no history of starburst or glare symptoms. 

Does anyone have any insights. I am trying to find a Yag machine salesman, who might have some ideas. 

I

Original Post

I've seen tons of patients following laser capsulotomy and this is not something I normally hear from patients. Starbursts are actually present, IMO, in every IOL patient's vision but not all patients appreciate their presence. When the posterior capsule has clouded over it may reduce clarity significantly and the startbursts become less evident. Removing the cloudy posterior capsule will sharpen the vision, allowing the starbursts to once again be noticed.

Every manmade optical device has some unwanted visual side effects. The only thing close to perfect is the natural eye in a youthful state.

Yes? 

I was told by Bauch and Lomb, the product specialist said there is no history of any glare , including starbursts with this particular lens. She is the complaint expert. So , to repeat, you say this is "normal"? , I can tell, from  looking at a very tiny like in a totally dark room, that there is a problem with the focal setting , it seems to be off a slight %. I see a semicircle hologram, and the  source of light is a rectangle , long on the sides and short on the top and bottom. That is a the actual shape, but , in the total dark , I see a T  on it's left side, not a rectangle.

the "hologram" is just appearing out side my eyes , to the left , complete semicircle. I know this is an illusion. This is a problem.

The enVista IOL material is hydrophobic acrylic.

 

Bausch $ Lomb MX60 +28.00

2017 -10

OT12.5mm        

OB 6.00 mm

Please help me understand the actual problem , the Doctors' statement that there is no problem and the Bauch and Lomb rep, who says this particular lens has been completely researched and has never shown any glare symptoms, including Starburst.

 

No,The Dr. Said there was no pronlem. I asked if a second yag surgery, might correct the starbursts. He said the first ine was correct  So ,no I didn't ,I never got an explanation as to why I have this Symptom. I read on a website that if the hole is not large enough starbursts might occur. Two doctors said the hole is large enough but I think ,at night when Dilated for darkness, the hole is a little small. My feeling is the lens moved a very slight bit off. Could scar tissue do that? I see more light ,but the direct vision for print has become a little out if focus, unless I stare. My doctor set the monofocal lens at computer distance. I  am fairly happy with my daytime vision ,but not night time ,especially when driving. Thank  you so much for looking in to this. I don't want Bauch and Lomb

to do a formal inquiry yet. I really like my doctor 

"Two doctors said the hole is large enough ... "

The capsulotomy should be about 5.0 mm in diameter.

"My feeling is the lens moved a very slight bit off. Could scar tissue do that?"

The clouding of the posterior capsule does tend to tighten up the capsule but if the IOL was centered to begin with it usually won't shift position. If the IOL did shift position then any doctor can see this on examination. I very small shift is usually no problem.

"I  am fairly happy with my daytime vision ,but not night time ,especially when driving."

Your profile did not include your year of birth. Younger patients have larger pupils. If your pupil dilates more than the IOL diameter (which is usually around 6.0 mm) then you will experience light getting around the implant and that can cause significant glare effects.

There is a way to test this. Have your doctor give you some Alphagan (used to treat glaucoma). Alphagan has a mild side effect of preventing your iris from dilating as much in low light. If using a drop or two of Alphagan (and waiting thirty minutes) relieves your unwanted low light vision problems then the dark adapted pupil size is part of the problem. Alphagan can be used whenever you might have to drive at night. It is safe to use.

Hi Doc, You asked how old I am. I am 72 years old, sir. The starburst and the glare has improved since my yag surgery 9 months ago. With a divided highway the problems is not problematic. On a two lane street at night, the feeling is Unconfortable, to say the least.

The beams shoot out across my lane and I have to look very closely to make sure there are no pedestrians behind the beams of light. I had the cataract surgery, The glare is severe enough for me to be unhappy about the result. What are you telling me about getting a second Yag procedure. You suggested  Alphagan, instead of another Yag surgery? I read that a too small hole will cause glare, You are stating that a too large hole will cause glare. How does getting another yag procedure add up , with what I have told you so far?  I just can't get my head around the fact that Bauch and Lomb reps say there is no glare associated with this particular lens, The doctor says there is no problem, I am feeling uncomfortable with all this, to say the least. Please give me your best guess as to why I have glare and starbursts at night. P.S. I am very grateful for your time and kind attention.

"I read that a too small hole will cause glare, You are stating that a too large hole will cause glare."

It's very hard to know what is going on by description alone. If the IOL is reasonably centered then my only guess is too large a pupil when driving at night. Never seen a patient with a small pupil diameter have a problem. Try the Alphagan before driving at night and see if it helps. 

"How does getting another yag procedure add up , with what I have told you so far?"

 I was just referencing your profile about whether someone had entertained the idea of having a second YAG. Patients don't get second YAGs unless the first YAG was too small and opening. If you have 4.5 to 5.0 mm opening then that should not be a problem.

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