Non surgical management of starburst dysphotopsia 6 months after cataract surgery

I see starburst rays of light from headlights, streetlights...even the full moon. I can't drive at night because of this. I see it around lights at home also but night driving is the worst. I also have a diagonal ray in each eye...sometimes called Maddox Rod effect and had the YAG laser treatment in the right eye which eliminated the wrinkle that apparently causes that but it did nothing for the starbursting. I tried brimonidine drops with no improvement. My doctors do not want to consider a lens exchange because the surgeries were considered successful in all other ways. Although I am in the minority, I have seen other accounts of people who are having the same experience so it's not just me.

Ok really odd to have this much with a standard IOL but we are all unique and notice things in our own ways.

I won’t get into all the possible issues with the Panoptix just see if anything that I did helps you. My story is https://patient.info/forums/discuss/to-panoptix-or-not-to-panoptix-that-is-the-question--791385 read it if you have a few hours.

My advice is really simple steps that helped me.

At night when driving normal ppl don’t look into oncoming headlights but people with IOL’s seem to test things out by looking into oncoming traffic. For me the road in front of me is clear so I keep my eyes on the road where I am driving and don’t look into oncoming traffic. I never looked into traffic before the surgery.

Same goes for streetlights there is no reason to focus on them or test what they look like. They are there to light up the road so focus on the road.

I am in no way trying to diminished your complaint I too have the same but actually more of these type of issues with the Panoptix. I am just trying to say how I have made the negatives not bother me as I really like the 20/20 vision from 16 inches to infinity it is worth the spiderwebs, halos, starbursts, ghosting. Remember nothing will replace your natural lens any replacement lens is going to have its issues you just have to find ones you can live with.

You mention neuroadaptation it is a big part of it but only works when you focus on the positives about your vision. Do you see clearly? Driving your car at night with just you and your headlights do you see good? I would think so unless your Dr really missed the mark. If you do see good in general you have to change the way you look at things. Instead of driving and thinking about everything that does not look right focus on what looks right.

Like I was saying unless your Dr totally messed up and missed the mark with plain IOL’s you should have clear distance vision. If not say so because then maybe you do need the correct IOL and a new Dr.

Right now as I am typing this it is totally clear with no glasses and it is very sharp. But if I drift my thinking there it is the ghosting of all the letters, they are no longer sharp but have a ghost image around them. This is the way my IOL works many images of the same thing at different focus points only one is in actual focus. If I allow myself to see them all it is not clear but I have learned to tune out everything except the clear one. My Dr said this to me what your eye sees is actually everything projected onto the retina and that is a total mess. It’s your brain that sorts this all out and gives you the final picture. I have found this to be very true especially at night. If I let my mind see it all I see so many spiderwebs of light, halos, starbursts, it is like a crazy light show. At first, I thought I cannot ever drive this way it was so bad. Now at night in the rain, glaring headlights, fog, low contrast situations, I have no issues. My wife who has both her natural eyes and proper glasses often asks me how you can see to drive I can’t even see the road. But I see just fine I am very pleased now with my results but at first, I thought the only answer was a lens exchange I though how can I ever live with this.

The moon well with a Panoptix and all the rings just like any light source I can see all 26 images if I want to. See the Panoptix has 26 rings each one brings a different distance into focus. The brain needs to let you see only the ones that are in focus and ignore the rest. So if I want to I can see the moon with 26 rings or really any light source with 26 rings even this laptop and the type. But when I just think about what I see clearly the others disappear. So I only see one clear moon and one of each star in the sky now.

This really works as many people with monovision have proven. This is where one eye is set for near and the other far clear vision. So if they have their left eye set for near and the right for far and they close their left eye something close like a laptop is totally blurry. But with both eye open like magic everything is totally clear. The brain automatically tunes out the blurry image of the other eye and even varies it from near to far and the person does not even notice anything just clear vision.

You can always get a second opinion to make sure you really got the correct IOLs and that everything looks good to put your mind to rest and just double check that he or she did you right. But as long as your surgeon gave you the correct lens and did not do anything wrong it’s really just up to you to learn how to see clearly.

But to say it again there is value in a second opinion in any case. I think you should really get one just to make sure your Dr did a good job and that there is not some other issue that your Dr is missing or does not want to say. Don't wait see what someone else says what will it cost hopefully just the copay so just do it.

Thanks for all your input. It does appear that it is boiling down to finding a way to deal with it. It bothers me that so many people have problems with night driving, especially with the newer headlights, and that there are just no solutions. I regret that I didn't wait until my cataracts were worse to have the surgeries. I couldn't see well driving at night before the surgeries but it was better than being non functional.

Do you see it with both eyes separetly? Do you think you can live with that and still be active at night?

both eyes are affected so probably not

Did you try miotic drops and no improvment? Do you have sometimes issues during a day? What is exactly your problem? Long streaks of rays coiming from every light source? Is it static or keep changing depending on lighting conditions?

I see starburst rays of light from headlights, streetlights...even the full moon. I can't drive at night because of this. I see it around lights at home also but night driving is the worst. I also have a diagonal ray in each eye...sometimes called Maddox Rod effect and had the YAG laser treatment in the right eye which eliminated the wrinkle that apparently causes that but it did nothing for the starbursting. I tried brimonidine drops with no improvement.

How old are you? It's quite important.

I got a second opinion and that specialist did not recommend a lens exchange. I have Acrysof IQ SN 60 WF. His only thought was to try scleral contacts. He said there would be no guarantees with a lens exchange. It seems unlikely that scleral lenses would be covered by insurance and they are quite expensive if they even worked at all.

Can you see arcs or halos as well?

Generally those who are not qualified for IOL exchange do not recommend it.

Starbursts are my major problem. I have the diagonal light ray in the left eye that hasn't had YAG. The right eye diagonal seemed to go away with YAG.

So you've got statburst in both eyes or not? What about arcs and halos? Visable or not?

1. Scleral lens won’t help.
2. Let me tell you from my terrible expirence - when you start asking for non surgical options, you re basically reffering to some kind of magic. I did the very same thing as you but now I know there's no solution except miotic drops (which doesn't work in your case) and IOL exchange. If you reject this option, you will have to live with that. Perhaps you will get less focused on the issue years down the road, but it doesn't mean you won't see it.

Thank you for your candor and for sharing your experience.

You're welcome. Are you able to drive right now or your issues are too severe to drive/live at night (mine are) ?

No halos?

Can't drive at night safely if around any other traffic. Starburst is what I experience. I had haloes before the surgeries and had the surgeries to get rid of them. Now they are replaced by starburst. NOT an improvement.

What surgeries did you have to "get rid of the halos"? Also what IOL lenses do you have?

.

The reason I ask is that conventional laser surgery for refraction correction can cause the starbursts.

.

Interestingly one of the causes of starbursts is said to be high order aberrations. These are different that the lower order aberrations like myopia and astigmatism. And while Lasik is potentially a cause of them, more sophisticated Lasik is also promoted to be a cure of high order aberrations. They use an instrument called a wavefront aberrometer to measure the imperfections in the cornea and then use that data map to program the Lasik to remove them. It is called Custom Lasik, or Wavefront Guided Lasik, and sometimes Topography Guided Lasik.

.

It is expensive, but if you were to go to a Lasik clinic that has the more sophisticated measurement capability and the laser that can used it, it possibly could be a solution. Some clinics do a free assessment and should be able to tell you up front if higher order aberrations are an issue and if they could be corrected.

i just meant removing the cataracta was supposed to eliminate haloes. Which it did but now have starburst. Acrysof IQ basic lenses set for distance.