I am depressed about glistening effect of Alcon intra ocular lens.

i have monofocal lens. My pupil in that eye is large and it makes it more visible to everyone. many people asked me about this sparkle. it looks like a diamond eye or terminator eye. i can myself see it in mirror everytime. Now my doctor has no experience with synergy lens and she doesnt know if that cosmetic appearance is true about that lens. I am just so worried because of this look and dont go to any gatherings any more.

I have also tried pilocarpine drops for pupil to make it smaller but that didnt work well for me. I got excited after i heard about synergy lens. but nothing happened

One possibility is that what is being seen by others is a form of positive dysphotopsia. It is most often reported as an issue to what the user sees, not what others see. It is aggravated by a large pupil and is not easy to solve. Silicone lenses may be better than acrylic lenses like the Alcon and Tecnis, but they have other disadvantages. My frank thoughts would be to be very thankful that the issue is not affecting your vision, and not worry about what others may see or think. In doing a bit of research you should probably avoid a multifocal lens like the Synergy or PanOptix and stick to a monofocal. That may be like jumping from the frying pan into the fire. Here is an article to google to get a bit of info on dysphotopsia. What you are describing sounds a little like negative dysphotopsia where light from a sharp angle to the eye is being reflected off the square edges of the IOL. Both the Alcon and Tecnis lenses use square edges to prevent PCO. It can also be aggravated by higher index material, which makes the lens thinner and possibly set further back in the eye. Both Alcon and Tecnis materials are high index, although the Alcon is slightly higher. High index material allows a thinner lens which makes insertion easier.

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Review of Opthalmology Dysphotopsia: Not Just Black and White

Thank You so much for your time. everytime I try to be normal someone will point out that my eye looks strange, like diamond or terminator eye. Then again I get conscious. But you are right that I dont have any other issues with my eye. Your message really gave me hope and courage I needed. I might have more problems with multifocal lens. I will try to focus on positive side. Thank you so much

If you poke around reading the threads on this site you should find ones talking about positive dysphotopsia, and the issues they have with vision. That may be helpful in alleviating your concerns, as when it affects your vision it can be bad.

Here is a thread to look at. But, take note that many of the issues (halos, flare, spiderwebs) described in this thread are really issues caused by multifocal lenses, not true postive dysphotopsia which is caused by the lens edge reflections.

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https://patient.info/forums/discuss/iol-exchange-positive-dysphotopsia-726497

ok im checking it.

thank you so much.

The other issue that seems to be reported occasionally in social media is a "cat eye" reflection effect which is said to visible to others. It is claimed to be cause by the higher refractive index of the material used by Alcon. I have an Alcon lens and don't see, and can't create any such effect. I can't find sources other than social media that say it even exists. But, you seem to see it.

Ron if you watch Dr. Shannon Wong's new video on YouTube called Synergy v Panoptics at the 30:10 mark he not only acknowledges this cosmetic effect but he even shows it. As the person moves their eye around you can see a brief flash of the Alcon IOL reflection in her left eye. It's a real thing. Yes it's purely cosmetic (no effect on the patient's vision) but it's not a myth.

What I have been looking for is a research type report on the issue with some explanation of what causes the effect, along with some statistical data on how often it is seen and in what specific lenses. So far I have not seen anything like that. I found one report that showed multiple very small reflections in the eye that probably are only visible with a slit lamp examination by an optometrist. The article claimed it was a method to determine if the lens in the eye was a natural lens or an IOL, in situations where the patient doesn't know -- dementia or the like I guess.

what you experience is called diamond eye. it is different from glistening which has been a defect in the alcon iol material as reported in the past. it is not known if it is still an issue as it take some time to develop. the wong video someone mentioned shows the damages lens.

if you have no other visual issues then you have a rich man's problem.

All of Alcon lenses have a high refractive index of 1.55 so you will always have the diamond eye if you use Alcon. Tecnis has a lower refractive index around 1.43-47. No diamond eye. The closer you can stay to the natural lens of 1.41 the less likely you get diamond eye. Glistenings are accumulations on a lens over time that may or may not affect vision.

if you exchange your lens ask what the refractive index is. Remember, all of Alcon's lenses have the ability to produce this effect.

There is little research because the majority of cataract patients are elder and less likely to complain/notice/be in multiple frequent social situations. As far as quality control, it is low on the totem pole of concerns for surgeons so they likely dont bother to warn patients. Or maybe they arent aware of it because patients arent informing them for reasons - see above. As younger patients continue to receive cataract or lens exchange surgery i suspect this will become a more well known issue.

wow really

you should see my eye and there are many videos on youtube showing that reflection.

i asked my doctor and she said she doesnt have any experience with new synergy lens and she said that is multifocal lens which might give me other problems. Mine is more visible because of large pupil in that eye.

I know you are right. everytime when someone tells me that my one eye looks unusual and shining more than my other eye that is when i get conscious and find it hard to make eye contact. But im trying to be thankful and positive. thanks

I agree with you. Doctor always tells me that im young and under 40 thats why im more concerned otherwise this effect is normal. I asked her so many times in start that what can I do to get rid of this she said nothing can be done and she also prescribed me pilocarpine to make my pupil smaller but that doesnt work for 2-3 hours in my case and i was scared to use it so much so left it. I hope there is any mono focal lens that doesnt have this cosmetic problem as doctor said multifocal is not good for me.

I think you are making some over simplified assumptions about lenses that are not correct. Probably close to 50% of the lenses in North America are Alcon. Perhaps 40% are Tecnis. I don't think it is reasonable to say all Alcon lenses are bad. It is kind of like saying all Fords are bad vehicles and all GM's are good.

I was watching BBC news today and noticed that the lady doing it had 4 or possibly 5 reflections in her eyes. I suspect there must be 4-5 studio lights that reflect off her eyes. I have a very large HD TV and this is quite easy to see. Another announcer on another channel had three reflections. I suspect neither were old enough to have IOL's.

Reflection is one thing and when there is diamond eye exactly like cat eye that shines in dark it looks scary under different light conditions specially when you have large pupil.

I did not say all Alcons are bad. I said all Alcons have a high refractive index and will have the diamond eye effect in most people.

That is NOT the reflection to which is being referred here. It is an internal reflection that causes the entire lens to glow.

The Alcon lenses which have been around for a decade or more have all used the same hydrophobic acrylic material; Restor, AcrySof, Vivity, PanOptix. All same refractive index. The very newest Alcon material, Clareon, is said to have zero glistenings, has the same refractive index. If it was a real problem I would expect Alcon would have fixed it years ago. Tecnis also uses hydrophobic acrylic but with a slightly lower refractive index. Both are higher than the natural lens at <4.00.

Ron, I am not sure what else to tell you. The diamond eye complaints from patients are not due to glistenings, they are due to the high refractive index of the lens, which creates an internal reflection when the light hits at certain angles. It is not visible to the patient unless looking in the mirror. It is outwardly visible to the public. Clareon will have the diamond eye effect as well if it has 1.55. As you might have seen, more patients here are posting their experiencing - I believe one posted a photo of her eye demonstrating the issue. Tecnis does not create the diamond eye because the refractive index is lower and closer to the natural lens.

Ok. Believe what you believe. I give up.

Absolutely true. I have Alcon Acrysof IQ and have seen that weird "diamond eye". My husband noticed it first. I didn't until one day I was looking through a large mirror and saw the reflection. If that was the only issue I had with these lens, I would be happy. Unfortunately, that is not the case.

what other issues do you have?

Glare/flare, halos, streaks/starbursts.

that is positive dysphotopsia. you probably have large pupil.

glistening is a defect in the lens. gets worse time.

the cosmetic reflection like cat is called diamond eye.

Interestingly, not one doctor has come to that deduction. It's very scary that these are the professionals we are entrusting our eyes to. That should be been an easy deduction BEFORE moving forward with a YAG. I am going to have to find someone who knows what they are doing which is quite the undertaking even in a city as big as Atlanta. I'll need to call around and ask specifically for a doctor who is familiar with positive dysphotopsia. I recall on one visit the Opthamologist checking my pupil size and finding nothing troublesome.

I know this is common complaint with Multifocals, but I have a Toric. Could this have happened with a standard lens?

Have you tried pupil constricting drops such as Pilocarpine?

I had a weird reaction to Pilocarpine , and the MD said that he it's not ideal for longterm use. I do use Brimonidine, intermittently, when I have to be out for extended periods, at night.

Let me sum it up. You have Alcon Acrysof IQ monofocal and you're expirencing Postive Dysphotopsia, e.g. streaks, halos, glare, starburst. You sometimes use Pilocarpine or Brimonidine and both relieves your sympthoms completely for a few hours. Am I right?

Alcon Acrosof IQ Toric (for distance)

I would not say the Bromonidine relieves my symptoms completely. It helps. It increases the glare, but reduces the streaking.

I have noticed this once time looking in the mirror. My husband also noticed it. I'm not sure how often it happens. It also was my left eye.

I wonder if increasing the Brimonidine dosage might yield better results. Current dosage is 0.2%.

Wait, wait... Is that YOU who see starburst and halos or you mean you have external reflections that don't bother your vision, but are troublesome as a cosmetic issue?

I believe 0.2% brimonidine is already a higher dose. The prime purpose of this drug is to reduce interocular pressure from glaucoma, but it does constrict the pupil as well. There is a new drug in the development pipeline that may help called Brimochol. To my knowledge not available on the market yet.

Not quite sure I understand the question, but I see starbursts, flares, halos, streaks, etc in low light, indoor lighting, streetlights, off headlights at night. Even my NEST gives off a X blue shadow in my house. Basically, every light source is affected to a lesser or greater degree. Of course, the streaks are obscured during the day (except today when it's overcast and raining), but the halos and starbursts are still evident.

Doc has mentioned replacing with the B&L silicone, but after reading some of the reviews of this lens, I will have to seriously decide whether I want to go through that still end up in the same place, or worse.

Have you had you vision tested by refraction to determine if you have any residual uncorrected sphere or cylinder (astigmatism)? It may be possible that the lens is tilted or has rotated out of position.

Ok, so my question is, when you have these issues in low light, do they disappear when you look at some bright spot light or e.g. your mobile phone?

Yes. My optometrist found some residual astigmatism and I do have glasses that I wear for distance. It does help when watching TV. Doesn't correct any of the glare or streaking, etc.

It sounds to me that these visual disturbances are not likely to be be caused by glistenings or high refractive index of the IOL. It is more likely to be some issues with the lens position in the eye or from astigmatism. A study was done which compared the incidence of pseudophakic dysphotopsia (PD) between the lower refractive index Tecnis ZCB00 (1.47), and the higher refractive index Alcon Acrysof IQ SN60WF IOL (1.55). Both are high refractive index lenses and the difference is not that significant. The study found the satisfaction was higher with the SN60WF to be slightly higher, but there was no significant difference. Their conclusion:

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"In conclusion, we show that increasing refractive index with these two IOLs did not increase the incidence of PD, nor did it decrease overall visual satisfaction. Selecting the best IOL for cataract surgery based on the degree of refractive index appears to be of minimal importance in optimizing post-surgical visual outcomes, at least with these two IOLs."

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You can find the full report by googling this.

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Refractive index and its impact on pseudophakic dysphotopsia

Bryce R Radmall,1 Anne Floyd,2 Zack Oakey,3 and Randall J Olson4

Thank you for the information. The position of the lens has been checked by two doctors and both determined that the positioning is good. However, I am going to get another opinion here in the near future.

One of the best measurements of your eye to determine if there are issues is the old fashioned refraction test - which is better 1 or 2? Your resulting eyeglass prescription will tell you what the residual sphere and cylinder is in diopters. It will not diagnose PCO though, but an optometrist should be able to easily see that with a slit lamp examination.

The residual astigmatism was 0.75 / 0.5. One doctor told me that was "negligible", which I do not agree with. I believe I had a slit lamp test done.

That is not a large amount of astigmatism and kind of on the borderline of what becomes significant in my opinion. My first eye done ended up with -0.75 D cylinder, and I really don't see much impact from it. On the other hand my second eye which I do not have an accurate number on yet was expected to be -1.0 D cylinder, and I do see an impact. I suspect it may be more than 1.0 D when it actually gets measured.

What about my question?

Sorry, for the late response. I had to think about this one. If I turn on say my bedroom ceiling fan light or my kitchen light, I get streaks emanating from the bulbs. The street lights, car lights are the worst for the glare and streaks. Don't really notice with my cell phone, but I do recall looking at someone on their phone in bright light and seeing the glare/streaks bouncing off their phone.

Well, I just wanted to establish whether you have edge glare issues or something else. Because when you look at some source of brighter light, it causes your pupil to shrink. Same thing is done by Pilocarpine or Alphagan. So I was curious whether your case is pupil-size related or not.

FWIW I do have what I would call a true positive dysphotopsia effect in my right eye which has an Alcon AcrySof IQ lens which has been in place for about 1.5 years. After 10 months with absolutely no issues, I suffered a PVD event. At exactly the same time I started to notice flashes in my right eye under very specific conditions. It is always with my eyes open, at night or in dark places, and when there is a bright light off to my left hand side. It is always a very brief flash in a curved arc just within my peripheral vision on the right side of my eye. Most times it goes from the top right to the bottom right of my vision, but can also reverse in direction. I can make it happen repeatedly when the light source is in the right position by just turning my head slightly from right to left. It is exactly like what I would expect from a reflection off the edge of the IOL to look like. Since it only happens in dark situations, I suspect it only happens when my pupil is fully dilated.

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I have had the eye looked at by three optometrists and my eye surgeon. None of them will endorse my theory. They just keep saying that it is flashing caused by the separation effect of the PVD. They say the eye's only way to respond to this is by showing it as a flash of light. My response is that if it was internal to the eye then I should see it with my eyes closed. Then all I get is a blank look from them. They simply do not want to admit that it is positive dysphotopsia. And because there is little that can be done about it, I just accept it now as a given. It is a bit annoying at times but nothing more. It does not affect my visual acuity. I tested recently at 20/15 in this eye. My theory is that the PVD somehow cause the IOL position relative to my pupil to change, and now under the right conditions the edge of my lens "lights up".

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The Clareon lens that has been in my other eye for 4 weeks now has not done anything like this so far -- fingers crossed I hope I do not get the PVD in it as well, although statistics would indicate it is probable at some time...

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Long story, but this is why I was asking about astigmatism, and sphere refraction as an issue to explain the symptoms described by @DMarie2020. They do not sound to me like typical positive dysphotopsia.

If Pilocarpine and Alphagan help her, it's typical Positive Dysphotopsia.

I guess that is one of the issues with positive dysphotopsia. Only the person that has it can see it. There is no way for the surgeon or optometrist to see it, unless they personally suffer from it. There is no way to photograph it that I know of. There are just theoretical speculations on what causes it.

So....? Is it any better when your pupil gets smaller?

It is somewhat better. Most of the streaks are replaced with more glare/flare around the light sources, which is more tolerable at night-time.

So I guess light streaks dissaper when you look at bright light sources (= smaller pupil)?

During the day is better. However, they are still visible in the overhead lighting in my house.