Questions about 2nd YAG procedure
Posted , 16 users are following.
Following my recent catarract surgery, my eye surgeon carried out a capsulotomy on both eyes as I was experiencing halos and flickering (PCO severity was 2 out of 10). However, since the YAG procedure, I now have lots of glare and long streaks of light at night which is making driving impossible (the halos and flickering is still there). I read that enlarging the opening may remove the big starbursts of light. I am concerned that this may not help and could lead to other issues such as ghosting images.
Has anyone got experience of having additional YAG that could help me with the following questions:
what was your experience after the 2nd YAG procedure, any complications
did increasing the size of the opening in the lens capsule help with your symptoms (especially with the starbursts)
Any thoughts or comments would be much appreciated.
0 likes, 38 replies
ara21947 jen601
Posted
Hi Jen, I dont have an answer for you but wondered how soon after your surgery did he do this? What is your surgeon saying about the increase in symptoms after he performed what should have reduced them?
jen601 ara21947
Posted
Hi there,
YAG was 3 months after my surgery. My eye surgeon said give it time to settle and I have an appointment with him in 2 weeks' time.
RonAKA jen601
Posted
I am afraid I can't help you with any actual experience with IOLs. I am just at the research stage of choosing one to be implanted. My understanding is that there are a couple of somewhat common issues which may be causing your issues. First is posterior capsule opacification, and it seems to be an issue in up to 45% of implants.
"Posterior capsular opacification (PCO) occurs when a cloudy layer of scar tissue forms behind your lens implant. This may cause you to have blurry or hazy vision, or to see a lot of glare from lights."
Some lens materials and lens designs seem to be more resistant to it than others. Here is one comparison. From what I read one YAG treatment in most cases is successful, but perhaps not always.
The other issue could be positive dysphotopsia, which is much less frequent in occurrence, but may be under reported.
"Positive dysphotopsias (PD) are most often characterized by persistent bright rings, flares, arcs, halos, and flashes that most often appear when light is coming into the eye from the side, such as the oncoming headlights of another vehicle."
This effect seems to be more common in lenses with sharp edge design which are used to prevent PCO. It is less of a problem in round edge designs. Not sure there is a surgical cure for PD though. It seems that most resolve themself over time or the user just gets used to it...
What lens are you using? What is the surgeon attributing your issues to?
jen601 RonAKA
Posted
Hi Ron,
I have Eyhance monofocal lens ICB00, which is supposed to reduce glare and halos. As the starbursts of long streaks of light were not there before YAG, my surgeon is saying let it settle down. I have an appointment with him in 2 weeks for a full check up. Hopefully I will know more then.
john56935 jen601
Posted
Hi Jen, I had worse glare after my YAG and was going to ask my doctor about widening the opening too but i thought YAG would reduce glare not make it worse--maybe someone else has done that and will post about it. I am curious how you like the Eyhance lenses--do you have them set for monovision or if they are both set for distance, how clearly can you see things up close before they get blurry and how clear is your distance vision? I wish they were approved here in the US as some on here would consider it to balance out the concentric rings that many experience with EDOF lenses like Symfony.
jen601 john56935
Posted
Hi John,
They were set for monovision, which hasn't worked as well as predicted. My experience of the Eyhance lenses is that it is not a panacea. Even before the YAG, I had halos and flickering in my LE. I understand that it can take a period of neuroadaptation for these PD symptoms to become less noticeable. Overall, I can see clearly in the distance and need glasses to read my phone and ipad. As these are monofocal lenses, I didn't expect perfect vision and expected glasses for near vision.
kwilson2019 jen601
Posted
Hello Jen601, I have a Panoptix in right eye, 4 months, not done left yet waiting to see how right eye progress'. I have extreme star burst, streaks, flares also. Physician has suggested YAG also, as to stretch, wrap the bag capsule around the IOL as said by physician to reduce the star burst streaks. I thought the YAG removed the capsule as your physician states upon 2nd YAG procedure. Would like very much to know how your next procedure goes.
jen601 kwilson2019
Posted
Hi kwilson2019,
Yes I will keep you updated.
derek40125 jen601
Posted
Hello Jen:
Please report back after you see your surgeon. I had YAG on one eye in November (22 months post surgery). I didn't even notice the PCO but he said it was there and a really trivial procedure.
I had small, but not bothersome halos before the procedure (which were an expected artifact of the IOL I chose). However, post YAG, I have huge starbursts, like you that are massive and quite annoying. It's not keeping me from driving at night, but I have to concentrate so much more closely.
On my follow up he said that he already did as large of an opening as he could. I'm going to wait until I'm at 6 months and then go back, but at this point, about 3 months post-YAG I haven't noticed any decrease in the size or intensity of the starbursts.
jen601
Posted
My latest update:
I have just been back to see my eye specialist. They carried out further tests and scans, which were all fine. He said give it time for the neuroadaptation to settle down. I do hope that with time it will improve.
sabine92988 jen601
Posted
Hi Jen, I hope your symptoms have improved by now! I have the exact same issues that you describe after a YAG 3 months ago in my right eye. In April, I had a lens exchange with the Tecnis Eyhance IOL which I chose because it is a monofocal and it was supposed to induce less problems with glare, starbursts etc. Which proved true as, after the lens implant, I did not have any starbursts at all, not even small ones. But after the YAG procedure this July, I now have huge streaks of light emanating from most light sources at night, even candles, most bothersome are car head lights which makes night driving impossible. I had similar issues after lens exchange in my left eye in 2018 (with a EDOF/multifocal lens implant, the Zeiss AT LARA). My surgeon at the time (who has sadly retired by now) enlarged the YAG in a second procedure, which improved my symptoms so the starbursts are now thinner and less noticeable, and I do not notice them around every light. I now have an appointment next week to have the YAG enlarged in my right eye as well, and I hope that my issues will at least be reduced so they are not as bothersome.
jen601 sabine92988
Posted
Hi Sabine, unfortunately my symptoms have not improved and my consultant did not know what caused it. Prior to IOL replacement procedure and YAG, I did not need to use eye drops but have been suffering from severe dry eye symptoms after that. Does anyone else suffering from this issue?
It is good to hear that your second procedure had helped. How much was the enlargement? Hope your appointment next weeks goes well.
sabine92988 jen601
Edited
Hi Jen, many thanks! Sorry to hear that your symptoms have not improved. Could it be that the YAG opening that was made is a bit too small relative to your pupil size? I have large pupils in mesopic conditions so my surgeon enlarged the YAG opening to around 5mm, which improved my issues with glare and starbursts after the YAG. This is also described in the following article which I found quite helpful: https://crstodayeurope.com/articles/2018-julaug/size-matters/ I hope the YAG enlargement in the right eye next week will help as well, will report back. All the best, SAbine
jen601 sabine92988
Posted
Hi Sabine, thank you for the link, much appreciated! Hope all goes well for you. I look forward to your update. Take care. J
sabine92988 jen601
Edited
Hi again Jen,
an update on my recent posts: my YAG enlargement was postponed to Tuesday this week so the surgeon who originally did my lens exchange and the YAG enlargement in my left eye could do it (he's only working in the UK sporadically). He said that my YAG opening had been made using a cruciate pattern and has opened to a diamond shape, but that the edges were probably still in my visual field as I have rather large pupils, so he enlarged the opening further with a few strategically placed laser shots. It's still early days but I can already see the difference, my vision seems generally clearer and I don't seem to have as much glare. At night, I now see no starbursts at all around some lights, only small halos, other light sources still induce starbursts but they seem significantly smaller, fainter and much less debilitating. So all in all, the second YAG procedure has definitely brought a noticeable improvement and I hope that this will get even better with time. I also wish that my experience will be helpful to you and others suffering from huge starbursts after a YAG. Good luck and have a lovely weekend!
jen601 sabine92988
Posted
Hi Sabine,
Thank you for the update. I am glad to hear that your 2nd YAG procedure has helped. Hope this will continue to improve with time. Do you mind me asking the name of your surgeon who carried out the enlargement? Hope it is ok to post it here and if not, I would be grateful if you could send this in private message.
Many thanks for your help. Hope you have a nice evening.
sabine92988 jen601
Posted
Hi Jen,
no problem, I had my lens exchange and subsequent YAG with Professor Jan Venter at Optical Express in London. He is a brilliant surgeon but semi-retired now and living most of the time in his native South Africa, so he is not always available in the UK. But I think most surgeons should be able to do a YAG enlargement as it's not usually a difficult procedure. Good luck and have a lovely evening as well!
ahmed03162 sabine92988
Posted
Hi Sabine , was the lens exchange done before the YAG PCO or did Prof Venter replace the lens with the hole in your lens capsule
thanks in advance
sabine92988 ahmed03162
Posted
Hi Ahmed,
yes, the lens exchange was done before the PCO and the YAG. As far as I know, replacing an IOL is possible even after a YAG but more difficult.
All the best
DMarie2020 sabine92988
Posted
Yes, that is true. The 2nd opinion I got told me today that he could not recommend replacement of the lens as it may not solve the issues and cause other complications. I am moving forward with another opinion, because he also has "no idea" why the symptoms worsened after the YAG. So, I see this is going to be a long road to find a doctor who at least knows and acknowledges positive dysphotopsia.
Hubby is against any further surgery, but unless he can see what I am experiencing EVERY night (and in low light), he cannot possibly understand why I would consider taking the risk of a lens exchange. I had a good cry today after my appointment. Only my 4th "breakdown" in the 9 months I've been going through these visual disturbances. It's easy to overlook during the day, but night time is just awful.
sabine92988 DMarie2020
Posted
Dear dsgreen5, so sorry you have to go through this, I know how demoralising these symptoms can be! I agree that lens replacement may be the most risky strategy to reduce symptoms, and that they may persist even after the exchange and even with a monofocal IOL. From my experience, the starbursts could be due to the shape and size of the YAG opening, so an enlargement may make things better, but i If there is another cause for the glare effects, then it may not. In my case, the edges of the YAG opening were still in my visual field so light rays were scattered causing severe starbursts around most lights. Making the cruciate/diamond shape opening slightly bigger by cutting into the edges helped reduce the symptoms, so that I now see starbursts only around some light sources, like oncoming car headlights. Sometimes, I see starbursts initially but then they diminish or even disappear when I look at the light source for longer, I guess this may have to do with my rather large scotopic pupil contracting the longer I look at the light. Generally, my symptoms have not disappeared completely after the YAG enlargement but have become much more bearable. My surgeon says a YAG review is not requested or done very often as these symptoms are unusual after a YAG, but in my case it was worth insisting as the enlargement has definitely helped. So maybe it would help to find a surgeon who may be willing to do a YAG review and enlarge the opening, if possible. Anyway, I wish you all the best and good luck!! Hug from London
DMarie2020 sabine92988
Posted
Thank you so much for your input. I appreciate you. I will definitely enquire about increasing the YAG opening with my next "opinion" consult. I don't think I see the edges of the YAG, but who knows. What I do have is more floaters and "blur blobs". What I have noticed is the closer I get to the light source, the starburst goes away. It also floats between an X and a laser light show. I don't care what the "experts" say, that is IOL related. I've always learned so much online from people actually going through a health situation. Much more than I ever learned from actual doctors. Very sad.
Khaled01094 sabine92988
Posted
hi can i please know who is your Surgeon?...i have bad starbursts glare at night had many tests and Scans seen a few Consultants and they dont know what is causing it ..
sabine92988 Khaled01094
Posted
Hi Khaled, my surgeon was Jan Venter at Optical Express London. He usually lives in South Africa and has partially retired now but is available for consultations in the UK from time to time. I don't know where you are located but you would have to enquire with Optical Express UK if he is available.
Just to repeat that my symptoms have not completely disappeared, I still get large starburts from oncoming car headlights and some other sources, but smaller light sources are often ok.
Hope this helps and good luck!