Starburst around all lights at night after cataract surgery

That is the problem Doctor 2 says it is the corneas not being smooth and having an asymmetric astigmatism so she referred me to Doctor 3 he disagreed with be diagnosis. He stated that the yag opening needed to be bigger and maybe the pits that were created in the lens by the Yag were the problem. He referred to Doctor 4 who was in his practice and he stated that I needed LASIK surgery. So I decided to seek a final decision with Doctor 5 today and she stated the above which puts me back at square one with no answers because of finally aspect that continues to add up Honestly she is just grasping a straws to rule things out like everyone else.

Thank you! I am so

sorry for you. I will keep you in my prayers too😊

Thank you. I will keep you in my prayers.

I had my six week check up.  He agreed when I asked about the arc that yes the arc that I see in my peripheral vision on my right eye is Negative Dysphotopsia.  He said that the circle around circle, around circle that I'm seeing in headlights, street lights etc. is the lens itself.  I know nothing about these lens' other than the card that I received with the implant.  The card itself says ACRY Sof IQ Restor UV with blue light filter (that tells me nothing).  But he said that the circles around circles and halos beyond is the lens itself. This is all associated with my RIGHT eye.

He has also scheduled me for a Retina specialist to check the eye just to be 100% sure there is no tears in the Retina because if you have a tear in your Retina it could also cause those type of flickers.  He feels there is not anything wrong in the Retina but just wants to be extra sure.

His advice to me is that I should wait for at least 6 months to see if my eye adjusts to any of this.  I do have to admit that as time passes some of these flashings/flickers and blue dots have subsided considerably, however, they are still there.  He said that also the brain has to work with all of this and I do know from reading a lot about all of this that it is true that our brain has to create a path (so to speak) back to the eye.  To put it in laymen's terms the brain has lost its path and needs to create a new one.  I was in agreement with that when we discussed these issues thanks to some of the reading that I have done.  

His other suggestion is that after 6 months I could have the implant removed and put a new one in.  The implant that I got I paid extra money out of pocket because health care would not pay for it since it was an implant that would enable me to see far, computer/TV distance and close up.  So if I do have it removed and replaced that could possibly eliminate the rings around the lights and the arc but he felt I should wait for a while. I agree, I'm not even sure if I want to go through surgery again, it was an unfortunate experience.  

When they removed my Cataract on my LEFT eye, my Iris and my Pupil came OUT!!  And had to be stitched back in.  I had a black eye for a month a very big purple/blue/black eye that extended 2" below my eye, it was a real nightmare.  This was supposedly caused because the Cataract was so think and they had a hard time getting it off. And...once again, I paid extra out of my pocket to have it lasered because it was so bad....thank God I did that or who knows what would have happened to my eye.

So all in all everyone, I will continue to be patient and pray and have hope that this can all be resolved without another surgery.  

You will ALL be in my prayers....our eyes are EVERYTHING to us.

Thanks Rene, 

I, too, have been very discouraged. I also had the multifocal lenses inserted.  It was in Sept, so I will just wait a few more months and hope for the best. There is something wrong with my left eye so I am seeing the Retina doc next week. BTW, I visited my optometrist to have glasses made up for my new vision. The glasses are antiglare and coated for computer work. They are also progressive lens. A complete waste of money!  I see much better with my $15.00 readers. I like my docs, but no one, no matter how skilled can actually look out of our eyes and know how we are seeing.

Hi Rene,

I have many of the same symptoms you do. I had a multifocul lens placed in my right eye 7 weeks ago. The starburst, halos, circles, glares are huge and blinding at night. I also am unable to see at intermediete or close up levels even though I paid extra for this. 

I see your post was several months ago, so I'm wondering if these symptoms have improved for you over time. Can you let us know if you have found a solution?

Thanks!

I had both eyes done 5and 4 weeks ago with expensive out of pocket multi focal.

Pros distance is fantastic, colors and clarity great.

Cons: can't read anything other than large print clearly. Can't see computer as I had expected. Thought it would be as good as monovision contacts before surgery. Doctor said this is disappointing for him as well but is trying restasis drops to see if dry eyes improve and help close up vision. He doesn't think further lasik will make vast difference in my case.

Halos are big problem also but think I can learn to live with that.

Are my expecta

Were my expectations too high? Would regular lenses have been good enough without throwing out 4000.00? What is you opinion?

I paid 3,300 for this lens. The plans were to pay another 3,300 for the lens in the left eye. I too am wondering why I paid extra. I only have clarity at distance when I wear a contact lens to correct the astimatism that was missed. With this contact lens in, I have NO intermediate or close (without the contact lens, I have very limited intermediate - blurry).  I'm wondering if we were better off saving our money and getting a mono lens. I don't think your expectations were too high. The reason we chose these lenses is because the company claimed they would allow us to see clearly at all three distances AND starburts, halos, glares were VERY rare.

Thanks for getting back to me. I'm wondering how many people have this experience?

Me too.

re: "were very rare"

Its unfortunate if someone claimed the issues were "very rare" with a multifocal, since although most people don't have such halo&glare problems, they are far from rare (though the % is much reduced from older multifocals, newer low add bifocals, or trifocals, do better).  Most people who do have problematic halo&glare issues initially see them fade over the first few months, which is why most studies only report on the incidence at 3 or 6 months since the concern is whether the problem remains long term.  

 The fact that it isn't rare though doesn't change the evidence that most people don't have problematic halos&glare. Unfortunately even if issues were rare, *someone* winds up being the statistic and tends to assume they aren't unique so the problem must be common... even if it isn't. Those with problems  are more likely to post in a place like this than those with good results, so you get a skewed view of the issues. People getting a premium lens should be prepared that there is a small chance they'll have problems requiring a lens exchange, with the benefit being that if it works well you'll have a better range of vision. 

There are over 20 million cataract surgeries worldwide, with the most recent data I'd seen indicating 2.4% of them are with presbyopia correcting lenses (though I don't know the breakout of what % are multifocals), which sugggests > 480,000 people getting them each year, so it only takes a tiny % with problems to account for the posts online about them. Since they moderate links, the place i saw the figure can be found by googling:

"According to Market Scope, presbyopia-correcting lenses only account for 2.4% of total IOLs implanted globally in 2014."

Though it doesn't give any more stats in that article. The % is far higher in developed countries of course like the US and the UK, and those most likely to get a premium IOL paid for out of pocket are those who have internet access and may come online when they have troubles.

People are more likely to have problematic halos&glare than with a monofocal (even monofocals can cause problems, there is no IOL yet that doesn't), but usually they are consistent in terms of providing better near (unlike the Crystalens where a noticeable minority are known not to get much better than a monofocal).  The overhwelming majority of people are happy with multifocals, and most don't have problematic halo&glare issues, and most who do initially see the issues fade over the first few months. 

The lack of  vision at intermediate & near when corrected for distance does sound like something  unusual, and suggests either some other eye problem interfering with vision, e.g. perhaps still healing from the surgery in some way or some other eye problem the cataract was hiding that they haven't found yet, or otherwise it'd   make me wonder if they mistakenly put in a monofocal. The studies I've seen, and the surgeons talking about lenses in the trade literature indicate  that a minority have complaints about multifocals in terms of halos&glare, but a total lack of near isn't something I've seen talked about as being a concern, merely less near then hoped for, so it could be that you are just taking longer to adapt.

Each person is different, it isn't clear if you'd have even worse vision with a monofocal or if there is something keeping you from adapting as quickly as most people do with multifocals. Neuroadaptation can sometimes take some months to get the best quality near vision, but usually I get the impression they have at least some near fairly soon. This sounds poorer than should be expected based on anything I'd read (and I read a lot before deciding what to get, though I went with the Symfony rather than a multifocal). Which multifocals?

A multifocal IOL puts images from different focal points on your retina, the physics  is well understood, there isn't anything that would prevent the lens from doing that job (assuming there wasn't a mixup and you got the wrong lens).  What is less understood is how the brain manages to pick the right image out of the ones its getting. So the issue is if there is some other eye problem interfering with the multifocal image somehow (e.g. an eye problem degrading the quality of vision, which is good enough for the distance image to be made out but not the other focal points), or if you aren't neuroadapting for some reason, your brain isn't picking out the right image, perhaps it will merely take more time.

 

Well, Hello....to everyone!  It's been a while since I've indulged in reading up on any additional information regarding my experience so I'll just give you all an update on my status.  

It's been six months and just about everything is the same, my eyesight, the Negative Dysphotopsia and the Positive Dysphotopsia.  My surgeon suggested that I could have the right eye done again.  This is the eye that has the circle around circle, halo around halo when I look at the headlights or any lights for that matter.  He said that this was reflections coming from the lens itself, the lens that I paid an extra ±$3,000 (of the $5,000 extra I paid out of pocket).  

I've read so many negative comments about "another surgery" that I've pretty much opted out of another surgery.  The reason being is because I "can" see, I don't want to take ANY chances of losing any more than I have right now.  I can see computer distance, TV distance but most of the time I need a magnifying glasses to read a recipe on a box etc.  I can see, but I can't see like I used to with my trifocal glasses.  I tried the reading glasses and they simply do nothing for me except I feel like they make things blurry.  So the bottom line is I've decided that I'll live with the Negative Dysphotopsia and the Positive Dysphotopsia, lucky me I get both.  My one eye went through so much trauma I just feel like I need to accept where I am and live with it.  I will never drive in the night, the lights are so exaggerated that I can't see properly. So here I am six months later kinda in the same boat but adjusting and accepting. I've attached a picture of one of my eyes, I STILL have scaring and browness beneath my eye that I don't think will ever go away.  This is one of the reasons I'm opting out of another surgery, it was so painful and so unbelievable.  I realize not everyone experiences something like this and I wish this on NOBODY!  It's getting better but I figure I shouldn't take any more chances.

Well wishes to all of you who have had so many problems as I have and prayers for everyone's speedy recovery. 

Thanks softwaredev for you in-depth response. I think I have made a mistake that I have realize after reading your response. You are indicating that the Symfony is different from a multifocal. I have the Symfony toric lens. Even though it's a toric, I still have astimatism (that we have attempted to correct with a contact lens). With this lens, I was hoping for close, intermediate, and distance without starburst, halos, glows. I only have distance (with the contact lens) and huge starburst, halos, glows. Since you also have the Symfony, did you have any of the same issues I have and if so how long did it take for them to improve? Thank you so much for the time you have spent to respond and I'm sorry I mislabeled my lens.

Thank you for letting us know Rene. I'm so sorry you are still having trouble. I know the emotional toll this can take. I, like you, am very leary of having the surgery redone or any lasik surgery to correct the issues. Hopefully, we can all stay in touch and support each other through our "adjustments." All my best, Sue

Unfortunately residual astigmatism (which might be corrected via rotating a toric IOL, incisions, or laser) can impact things like halo. A decent % of people need  correction for astigmatism after toric lenses in general, e.g. google this:

"Visser 31 considered 22 publications to 2012 that published toric IOL outcomes. The pooled estimate of the 22 studies was quite disappointing with only 43 per cent of eyes =6/9 uncorrected and 71 per cent =0.50 D of astigmatism."

The reason I mention the difference between the Symfony and multifocals is because the optics are different, even if they result similarly in a wider range of vision. Just as an audio tape player or a CD player both reproduce music, they do so differently and the flaws can be different. In this case they both do use diffractive optics, so there is some similarity, but as this article you can google for notes:

"This IOL is frequently called a ‘multifocal IOL’ (MFIOL), which is incorrect. The optics are entirely different, using phase shift rather than constructive and destructive interference. "

The incidence of halos tends to be higher with multifocals since they are partly caused in that case by the presence of out of focus images on the retina from the other focal points of the lens.   The Symfony doesn't have that issue since its not multifocal, but it does share a different issue with diffractive multifocals that can cause some to see halos. There is some light scatter off the edge of the diffraction rings which is usuallly drowned out by ambient light, except at night, which is a different cause of halos. Of course to a patient it doesn't matter what the causes is, but it does mean that fewer people have halo issues.   Regardless, in both cases most people who do see halos initially find their brains learn to tune them out in the first few weeks or few months.

 

Fortunately I had little astigmatism to begin with and didn't need toric IOLs, and only have -0.25D of astigmatism in one eye now, 0 in the other. I am in the minority who continues to see halos with the Symfony beyond the first few months, however they have always been so translucent and mild (I see through/past them) that I've never considered them  a problem, especially since overall my night vision seems  better than I can recall it being in the past. There seems to be less glare from headlights, bright headlights don't interfere with vision to the same degree they did even before I had cataracts (to the best of my recollection). Oddly despite being 2 years postop, I may still be adapting to it since now there are times when I don't see halos around lights where I consistently used to, or they are even more mild.

I had Symfony IOLs  put in both eyes early December 2014 (traveled to Europe to get a better lens, it wasn't yet approved in the US, since at age 52 I figured I might be living with the results for a few decades so it was worth a bit of hassle to get a better result). At an eye exam  a month   ago I had 20/15 distance vision (at least, the line was easy to read and they didn't have one below it), 20/20 (plus a bit) at 80 cm, and 20/30 at 40 cm. For near they didn't have a 20/25 line and I read some on the 20/20 line which suggests its likely I'm 20/25 which would match prior checks where they used a near chart held at my best distance (rather than exactly 40cm) and and I was 20/25 ever since 1 week postop. I had decent distance vision from the start, and it was only the first couple of days where my near and close-intermediate seemed to go in and out a bit, sometimes needing strong readers for computer&phone, but then by the third day it seemed fine, as the 1 week postop confirmed.

 

I had the same exact experience.  Paid $$$$ extra.  I see halos, starbursts, etc. at night. I can't see as good as I think I should close up, considering all the extra money I paid.  I can read in the bright sunlight, and I use a flashlight when I want to read at night in bed. (I have a cap that has lights attached to it - that's very funny looking when I'm in bed!).   It's frustrating, but I can see a bird fluttering its wings way up in a tree.  I have floaters that annoy me, but hopefully eventually I will stop noticing them as much.  I am glad I don't have to wear contacts.  That was very painful and very frustrating because I couldn't see anything without a blur.

HI Rene.  I know your post was a long time ago,  but I was just wondering how you are doing since you made the decision to live with the Negative and Positive Dysphotopsia.  I had a monofocal lens put in about 6 months ago and then five weeks later the doctor did an exchange because of a refraction error and I was complaining about the dysphotopsia.  The refraction error was fixed and I was left with both positive and negative dysphotopsia.   I have been to several doctors and another exchange for a silicone lens was suggested. I am afraid about having a third surgery and I would love to be able to just live with what I have and go on but I am finding it difficult.  Just wanted to know how you are doing and if things have gotten better.  I have the beginning of PCO in the lens and know I can not do exchange if I have the Yag done so I feel like I need to make this decision soon.  Hope you are dong well and I would welcome any comments from anyone that has had similar experiences.

It has been a year and a half since I have had my cataract surgery.  I don't know how to get around these comments and questions very well so I'm responding here in hopes that others may see my update.  Finally after realizing that my 1) Negative dysphotopsia - It appears in patients as a temporal crescent-shaped shadow after in-the-bag IOL implantation following cataract surgery.  2) Positive dysphotopsiathe - unwanted images including rings, arcs, and central flashes that become bothersome after IOL implantation.  The surgeons basically didn't give me much hope, other than "you'll adjust" and that's pretty much what I did.  The black arc is still there but I've adapted to it.  I no longer drive in the night because of the "ring around the ring" when looking at headlights or any lights for that matter.  I paid an extra out of pocket $5,000 in addition to what they collected from my insurance for the "best" lens and it's the one that has the negative and positive dysphotopsia.  How blessed am I?  LOL.  Even though I got the best lens and was pretty much guaranteed I would never need glasses, my vision never felt right.  I could never see like I did with glasses, what a disappointment because I thought I'd see better.  So the surgeon's just kept telling me to get some reading glasses.  I tried every type of reading glasses, every strength, cheap to expensive and still could not read very well and things were fuzzy.  I used a magnifying glass all the time, trying to read a recipe on the back of a package or something off of the back of a shampoo bottle, always used a magnifying glass because the reading glasses were not clear for me.  FINALLY after over a year and a half  I went back to my former eye Dr. and explained all of this to him.  He gave me a very extensive exam including one to see if I needed glasses and I DID.  So why after all that time those surgeons never told me that I should do that.  They kept making me feel like I was just a complainer.  When I'd read the letters they'd say well you can read well but I kept saying everything isn't clear, it's fuzzy and not clear.  After my exam from my former eye Dr. he recommended me to get a pair of glasses and a pair with progressive lenses.  I just picked them up this week.  When I put those glasses on I was in awe.  That clarity and crispness that I had been looking for was finally here.  As far as the other problems, they'll never go away, I'll just have to live with them.  But at least I finally am at the point where I can read without a magnifying glass.  The clarity that I now have is unbelievable compared to when I take them off.  So for those of you that are told "just get some readers" maybe just like me, you will need a pair of glasses.  I'm so thankful to my eye Dr., he's the best and I'm very disappointed in the surgeons that never tested me like my eye Dr. did and just blew me off with "get some readers your eyes are fine."  Good luck to all of you who have gone through this horrible experience.  I never imagined I'd have such terrible results after paying for the top notch surgery and lens.  Prayers for everyone for a speedy and complete recovery.  My sight is so precious to me and I will never take it for granted, not even for a second.

I’m glad you have finally found some relief and thdark shadow is not bothering you as much or you have been able to live with it. I am still trying to decide whether to do another exchange.  I’m so afraid like you were that things can get worse instead of better.  I have some decent days where I think it’s tolerable and then I will have bad days when the glare and dark line on the left side are bothering me so much.  I just wish I knew how to neroadapt.

ESA, all I can say is I did adapt to the black crescent, but this August will be 2 years since my surgery.  I explained to my eye Dr. that they said I could have the $5k lens removed and I told them no I was not going through another surgery for fear something would go wrong again.  He said if he were me, he would NOT go through another surgery either, he agreed that every surgery is a risk no matter what.  Not sure how long it's been for you but I do feel that the amount of time helped me adjust to the black crescent.  It's there but I'm used to it.  As far as the glare, the many halo's and rings around the lights, I will never adapt to that.  But it's intense in the dark, not as much in the light.  I hope you find the right answer as I did.  Maybe it's not the answer I wanted but I'm able to live with it and I am ever so thankful that I can "SEE" I'm so thankful for that.

Rene, My first surgery was August 23.  I have never worn glasses before and the surgery left me with too much near vision and not enough distance.  I also had dysphotopsia. The doctor agreed there was a refraction error and wanted to do an exchange.He was not concerned about the dysphotopsia  as much.  The exchange was done September 27.  I was much happier with my distance vision but noticed glare, flickering, and the dark shadow immediately after.  Both lenses were Monofocal.  It is now a little over five months and there is no improvement.  I have been to another doctor who suggested the exchange to a silicone lens which he feels with its lower refraction would help me.  He does lens exchanges and complicated surgeries for people from all over the world.  I am still on the fence with this decision.  On my last visit to my original doctor he said there was the start of PCO.  I am scared of YAG because of all the things I have read about more glare etc.  I have also been to a retinal doctor who said I had a very mild epiretinal membrane.  I think YAG can make that worse.  I would not do any surgery unit i spoke to the retina doctor again as I do not know how that impacts things.  I have been to many doctors and I am still getting opinions.  In the meantime I am trying to live with it and hoping the PCO that I can not see yet does not get any worse yet.  I am wondering how much time I have.  I know once I do YAG there is no going back, although one of the surgeons I have met has done exchanges after YAG.  I feel like I can live with the dark line/shadow but the glare and flickering is a lot harder to deal with.  Wish I could neuro adapt!

ESA, I will say some prayers for you.  Honestly, I lived on prayers, I had no idea such problems could occur.  I feel the surgeons should be responsible enough to inform you of all of the ifs, ands or buts and mine did not.  Even though I would have still gone with the surgery, at least when all of these problems came up I would have had some knowledge of them and not thought "Gee when this is done I'm going to see better than I've ever seen." Because that was what I was told.  I went to very reputable surgeons very well known and top notch.  As a matter of fact, this is no lie, I felt like I diagnosed myself.  I went through all this horrible stuff and found this forum to find out from other people it happened to them.  I got advice and terms that I looked up MYSELF and when I went back for my checkup I'm saying "Do I have Negative and Positive Dysphotopsia?" Only until I asked them and explained my own searches and definitions did they then say yes, that's what you have.  The surgeon did offer me to do the surgery over again and then he said he thought I should wait for 6 months to see if any changes came about and then after the 6 months passed when I brought it up he acted like he never said it.  I wasn't even going to opt for a replacement anyway, but he totally disregarded that he ever said that and my husband was in the room when he said it.  Also, this is something else that happened to me at the end of last year which was 14 months after my surgery.  I got a flash of light and it was like a large floater that was bluish.  So I called for an appointment.  The next day I woke up and it was like a big black circle was in front of my vision.  If I looked at my keyboard, I couldn't see any of the white letters on black keys.  Everything had a black screen in front of it.  If I looked in the toilet (as I used it as a test) at the clear toilet water, it looked like the water was BLACK!  So they determined that it was a giant floater which fell off of my eye.  They said our eyes are made of a gel like substance and they weren't sure if it would ever go away.  OMG, I can't tell you how horrible it was.  I cried so much and prayed so  much because I only have one good eye and that's the one that has had all the problems.  The other eye is a lazy eye so my right eye (the good one), I was totally dependent on that eye to see.  My left eye is basically pherofial vision.  They said there was nothing that could be done.  For THREE months I had that and then after three months it went away.  So when I went back for my exam he said it will never go away it just "settled" down and is not in front of my vision so to speak.  I can still see it sometimes very faintly but basically it's pretty much gone.  I can only attribute all of the positive progression that I have made to my prayers and the grace of God.

The last thing you experienced is a Posterior Vitreous Detatchment. I also experienced one a week after my first operations. It is another known side effect of cataract surgery. My other eye went a year ago, not connected to any surgery, its just an age thing, so likely would have happened any way eventually (I'm 58). It is a shock when it first happens, but you eventually get used to ignoring it. RNIB have a useful page explaining it. http://www.rnib.org.uk/eye-health/your-guide-posterior-vitreous-detachment-pvd/posterior-vitreous-detachment-PVD