Starbursts, Halos, Glares, etc before surgery.. Better now with new IOL?
Posted , 18 users are following.
So everyone talks about the halos, glares, flares, starbursts that EDoFs and Multifocals can cause. However did most of you not have these issues before lens exchange?
I have those issues now with my cortical cataracts and astigmatism. Starbursts are what bothers me the most, it is "moderate" but I can still drive. I am hoping no matter what IOL I choose, it will get better. If it gets better than I will be happy, but any chance it could get worse?
Could anyone share their before and after surgery experience?
Thank you
1 like, 68 replies
coppp
Posted
Hi Everyone,
I ended up getting a Toric Monofocal set for distance (Alcon Acrysof IQ ). Left Eye Post-Op 7.5 weeks, I have yet to schedule my RE.
I am a bit bummed that my starbursts and glare around street lights, car lights, etc did not get any better. Well it's not the same, the diameter of the effect around lights maybe got smaller by 20% but there are times there are some of the streaks of the starburst efftect that are really long.
One of the main reasons I got a monofocal was to decrease these effects. The effects look a little different but still moderate.
So if it wasn't my cataract lens that caused this, it must be something else within my eyes. I do have residual astigmatism . I originally had -2.7cyl of corneal astigmatism and Rx astigmatism of -1.25. My Rx astigmatism during my 3weeks postop was at -0.75cyl.
Could it be my residual astigmatism? Do I need to wait longer than 7.5 weeks? I was hoping after I am done with eye drops it would be better but it's still the same. I stopped Ketorolac after 2-3 weeks, then my steriods preds 1.5 weeks ago.
Guest coppp
Posted
Hi
Sorry to hear that, I understand why you are not satisfied.
Before surgery I did not have starburst, but I was blinded a lot by lights in the dark.
8 weeks ago I had the Zeiss Lara (similar to Symfony) in my left eye, that lens makes starburst.
3 weeks ago I had the Zeiss Trifocal in my right eye, that lens do never make any starburst, it makes some small halos instead.
I had toric 3.0 iols in both eyes, and there are 0.25 astigmatism left in both eyes.
The starburst from the Lara have fainted quite a bit, the other eye compensates somewhat, if I only look through Lara eye, starburst are stronger.
Starburst are still getting weaker, off course I don´t know where it ends, but actually I expect them to go away, or almost go away, it seems like it is heading in that direction.
For me the big change with starburst came, when I had the second eye fixed, this is when I really started to notice the starburst were fainting.
But that said, I am not bothered by the starburst, my nightvision is quite good, the starburst are just something that is around the lights, it is not blinding.
As you can tell, I had quite a lot astigmatism before surgery like you, but I have never seen starburst before.
I am not sure it helps you, but this is my experience with starbust.
I hope you find some way to improve your result.
ann39244 Guest
Posted
I found out I had cataracts in 10/2018.At that time, the only symptom I was having was seeing rainbow colored halos around lights. In March 2019, the first cataract surgery was done on my right eye. I had the Symfony EDOF implanted.I believed what I had heard and read; i.e., that the side effects after the first surgery were going to go fade after I was healed.So two weeks later in April, 2019, I had my left eye implanted with a Toric Symfony EDOF. I was seeing a starbursts, really huge starbursts, that also had multiple rings of light in them. The lights of cars turned into starbursts that extended onto the road in front of the car in front of me making it impossible to see what could be on the road in front of the car coming toward me.I could see the starbursts on a cloudy day and from dusk into the night. During the day, the glare from light was so overwhelming I was wearing sunglasses most of the time. I don't believe the starbursts ever faded and I would not drive at night.In July, 2019 I had the right Symfony lens replaced with a monofocal lens set for distance.A couple of days later, my distance vision was poor, not bright like my left eye and I was seeing multiple light streaks that are longer than the starbursts, also preventing good night time driving vision. The doc wants to do that YAG surgery and told me he can't say the light streaks will go away. I'm going to get a second opinion. I wish I knew more about other individuals experience with starbursts and light streaks and whether they eventually went away.
Guest ann39244
Posted
Sorry to hear that, it must be very bothersome.
From what I have heard and read, it can take up to one year before you know what you got. Some people have had severe visual side effects for maybe 6 month, and then between 6-12 month the side effects faints or disappear, but not in all cases.
If you have pco I believe it can cause these symptoms you have on the monofocal eye, I believe your eye doctor could be right.
I have read, that in some cases when doing iol exchange, the surgeon does not clean the capsular 100%, because in some cases it can cause the capsular to rupture. In these cases, the surgeon leaves it like it is, and then when the new iol settles, he will do the yag to finish the job.
In any case I think you are right to get a second opinion, when you no longer feel safe about your eye doctor.
ann39244 Guest
Posted
Thank you for your reply.
Most of what I read about the time period to wait for exchanging a lens was 4 to 6 months.
Since I had the visions problems immediately after surgery and saw no improvement over the course of the 4 months, I decided not wait to find out if the vision problems would go away or lessen. I will never know if this was the right decision or not.
coppp Guest
Posted
Thank you for your reply Danish, and sharing your experience. Hopefully it's a neuro thing? My right unoperated eye has a little bigger diameter of starburst effect but minus the longer streaks. I'm officially 8 weeks today, ill be patient.
So your Trifocal has less night issues than the Lara? Wow
coppp ann39244
Posted
Sounds like you went through a lot. Hope your starbursts subsides whether through time or from the YAG if you decide to do so. Keep us updated about your second opinion.
tamarinda coppp
Posted
So I just found this thread, although I've been on the forum for a few months, and I'm so grateful I did! I have the same conundrum as @michael85451, @rpk0925 and @mady301
@coppp, here's my answer to your question. I had bilateral oildrop (central) cataracts (now just in one eye since one has been "fixed"). In the worse eye, my right, which is my non-dominant eye, it started as rainbow halos around lights and grew over a few years to where any light looked like a Mercedes Benz logo: three radiating beams that met a halo circle. Other objects were blurry, somewhat correctable with a contact lens. In my left eye which has a less severe cataract, lights look triplicated in a triangle. So I see three instead of one, like a Venn diagram of lights. (For those of you who remember grade school math, haha!). Everything else also blurry, somewhat correctable.
In May 2019 I had a Tecnis ZKB00 multifocal +2.75 put in my right eye, and the incision fixed my minor astigmatism. Was going to do both within two weeks but I cancelled the second after what happened. Since this lens implant, I see lots of concentric halos and ghost images with the right eye. They are about as wide as the original Benz logo, so quite wide. A line of taillights at a stoplight was just a muddle of red circles: couldn't see the cars through the halos. A cyclist about 50-100 feet in front of me had red halos from the head of the rider to the axle of the wheel. I posted back then with drawings of what I was seeing. The diameter does decrease as I get closer to the object. I also have ghost images, which means any high-contrast letters have a shadow of the same color as the letter (white shadow if white, gray shadow if black). I see this on computer screens and big signs...actually, even just now if I close my left eye I can see it around the white ceramic dish on the table. I see a ghost image around the face of a person speaking at a conference with a projector screen behind them. I haven't been to any theater yet to see if it's present there. These things occur in the daytime but are much less and much less bothersome because everything else is so bright. The first few weeks were an emotional rollercoaster: almost ecstatic during the daytime with everything else being so sharp, then crushing defeat as twilight approached and halos and ghosts grew. One of my saddest moments was when I first saw the moon, and it has huge ghosting. Feels just so wrong.
It caused SUPER amounts of unease and stress, until @Deb03 on this forum suggested I use a contact lens to correct my left eye, which is my dominant eye. The dominant eye took over and very much decreased the positive dysphotopsias I had, although not to zero because that dominant eye can't be 100% corrected since it has a cataract still. But it eased my anxiety so I could start to see the light at the end of the tunnel. So for me, the sudden correction to 20/20 distance of my non-dominant eye caused a ton of stress. Which eye is dominant for you? Could this is at play here?
So now I have the same decision to make as others who answered here: what to do with the second eye, whether to exchange the first eye. Although I like the openness of my first surgeon and he did an excellent technical job, it's fair to get other opinions once something goes awry. I was just going to see two, but then one referred me to another who referred me to yet another.
These appear to be my options, not in any particular order:
(1) Put a second multifocal in the left eye, or a Symfony. That's like having a baby when you're considering getting divorced. I sort of WANT to think this could be possible and I could have all that multifocals promise, but I need good night vision for sailing and driving and so this is probably a dumb idea. "Once fooled, shame on you, twice fooled, shame on me."
(2) Put a monofocal for distance in my left eye now and be done with it. Would be nice to just move on in life, and hope that as Danish_Viking says, whatever residual effects I have fade over years. But is that accepting defeat? Or is that taking what life gives me and realizing it's the best? Of course, I could try a multifocal contact lens on top of that eye eventually, to see if I get some near vision with it.
(3) Put a monofocal for distance in my left eye now and pursue lens exchange in my right eye, with the idea of getting monovision. The best exchange specialist can't see me until December 31, 8 months after implant, and it takes a couple months to schedule the operation, so that would be February, 10 months post-op. According to my surgeon, "he'll take them out after they've been in there for years." According to his assistant, he's used to this because his schedule is always so booked far in advance.
Of note, I had "weak zonules" and so a retention ring was also placed in my capsule: four other ophthalmologists have now told me it's risky to do a lens exchange with weak zonules. Two wouldn't do the exchange because it's not their expertise. The other two said they wouldn't do it because of the zonules. If they rupture, I could end up with a lens in the anterior chamber, or sutured to the iris. So, even if the best specialist says he'll do it, is that maybe just too aggressive?
(4) Put an accommodating lens in the left eye (one ophtho says he highly recommends them and would get one himself (they all say that about their favorite!). He noted, in an aside, that they can require additional corneal tweaking...ugh. He also said if zonules were weak on the left eye, then he wouldn't be able to place the accommodating lens and would put in a monofocal.) This seems like opening a whole new can of worms.
(5) Get a capsulotomy on the right eye first because PCO could be causing the dysphotopsias, even though they've been there since day one. Then, if they clear, I would be free to get another multifocal. (One semi-retired ophtho said maybe the operating surgeon couldn't "polish the posterior capsule" intraoperatively.) The latest optho I saw is the best specialist for dysphotopsias and she said capsulotomy will definitely improve them although probably not take them away completely. She, however, would not do an exchange and recommends a monofocal in the left eye.
(6) Just keep waiting for that super specialist on December 31 to see if he says something different. But if he says to do the left eye first and see how it goes, then that delays everything by two months.
A few side notes:
I'm am thinking that with one monofocal and one multifocal, when I need to obliterate the ghost images on near things (say, graphic designing), I'll have to wear glasses to make my dominant eye take over for near too. So, basically, the plan of having a monofocal in the dominant eye and a dysphotoptic multifocal in the nondominant eye, is asking one eye to pull most of the load and the second eye to be a mild assist. However, the dysphotopsia specialist surgeon I saw today said that as I start to use my right eye more, the dysphopsias may also improve. In other words, the brain won't adapt until forced to. She also said my case was straightforward, to just go ahead with the monofocal left eye, capsulotomy right eye and be done.
Reassuringly, she said that multifocal (bifocal) IOLs can still take a contact lens if vision changes over the decades. And that my case was straightforward: we know what's causing the problem.
I haven't discussed any of this with the original surgeon yet. Not sure if I should ask him to pull strings to get me in to the best specialist before the end of December, or if his intervention would sway the recommendations... I also have heard four different opinions about WHICH monofocal to get. And am not sure if I should go back to my original surgeon to do it. But that's for another thread.
So I'm very much interested in what you all decide to do or have done, @mady301, @rpk0925, and @michael85451 . And in hearing the outcomes of other folks on this thread. @mady301, I see on another thread that you went ahead with another Symfony. Glad you are happy with that! Would you be willing to share your decision process?
@ann39244 , I totally relate to what you said: "I'll never know if that was the right decision." The unknowing is so hard to cope with sometimes.
I apologize for the wall of text: it's late and I just can't edit it one more time. If folks feel I should just start a new thread about this, please do let me know.
With gratitude, tamarinda
W-H tamarinda
Posted
Great wall of China text there Tamarinda 😃 Do you have Cliff's Notes version of the options? 😃
Ok let me simplify...and what I would do for myself or my wife ( i am in a creative field btw and it seems you are too). You obviously are the best judge for your own eyes.
RE (Non Dominant Eye) already operated. IOL- Techni ZKB500 Bifocal (+2.75).
Capsule is weak so exchange is asking for trouble ( best surgeon or not). If it goes good then fine but are you willing to take that risk? A straight forward cataract OP is risky enough.
In your case higher chance of wrinkle being left in the capsule too or worse as you know. Wrinkles wil l effect your quality of vision.
YAG will hopefully make things better BUT you can still see that specialist before doing YAG if you want.
If you go with exchange then MONOFOCAL for near! I would not mess around with experimentation!
You could try Multifocal contact lenses and you could still implant add on Multifocal lenses on top in the future. They are easy/easier to install and exchange.
LE- (Dominant Eye) Not operated yet. What to do?
I would go with Monofocal for distance.
Cells can stick to it and the accommodation part goes out of the window. They can even end up in non ideal position as a result.
Question...
Q1- Your bifocal Technis IOL in the RE I don't understand well. What range is your sweet spot in cms? What was the thinking behind picking that lens and strength?
Q2- What is the current vision quality with your left eye?
Ok, Best regards
Dr. Professor W-H from University of life &
Eye surgery specialist (Google search based) lol 😃
Deb03 tamarinda
Posted
Preface - I have 2 monofocal IOLs. 😃
Recommendation - I don't know enough about how risky lens exchange would be so I really can't comment on that. I recommend a monofocal in your LE. However, if you plan to do that and a YAG in your right eye, then why not do the YAG first and see if it helps. If you go with a monofocal, I'd go with one that is known to cause less dysphotopsia. B&L Sofport AO is at the top of the list because of silicone material and low refractive index. If you go with acrylic, then go with a lower refractive index. I would wait until you see the exchange specialist before deciding though unless it is too stressful for you now. These surgeons who are pros at exchanges can do them years down the road. I personally don't recommend waiting that long but waiting a few months is probably okay.
Guest tamarinda
Posted
Hi Tamarinda
Wow, yes, for a foreigner like me your post feels like an English exam 😃
Anyway, I don´t think I can add much really, but I will try to match your post anyway 😃
My own experience is off course only only one of many, maybe others have different outcomes, but regarding visual side effects I have found the edof to be at least twice as bad as the trifocal, opposite of what they are sold as. And combined with the fact that the edof gives less usable vision, I am not really a fan of edof any more.
My point is, for the left eye I would suggest monofocal or trifocal, with every other choice than that, you will loose something you could have had or add extra side effects for no reason.
If I should choose now, with the knowledge I have now, I would choose two trifocals, but I would not risk a lens exchange from edof to trifocal, even that it would give me more close up vision and less side effects. If something happens because of the surgery, I would kick myself for the rest of my life.
When i talked with my sister about it, she put it in words in a different way, she said, it is like getting plastic surgery, some can´t stop when they get started, because they never get really satisfied.
I think this is true, we have a risk of falling in the same mental trap with our eyes, so when I get these thoughts about what might could have been, I think of my sisters words 😃
That said I still get into situations, where I think "well, this I won´t be able to see, how do I get around it" but then I actually can see it without any problems, so I still have these types of positive surprises.
And I have actually started to forget all about my vision when I work and do other stuff, I believe not thinking about it after all must be one the best signs of a successful result 😃
I really hope you find your way, and at some point get to place, where you don´t think much about it either....
tamarinda Guest
Posted
Christian your English is amazing...I could certainly never do this in Danish! In this world wide web forum, we are all foreigners! Thank you for reading my looooong monologue! I haven't posted in a while because it's all been so uncertain, and last night it all came spilling out now that I saw the dysphotopsia specialist. She said sort of what your sister is saying, "You're making it complicated, and your case is straight-forward, which is good. Don't over complicate it."
Your comments are always so thoughtful and helpful. What your sister said is right on. What I admired about your attitude is how positive you have been this whole time. I bet what is happening is that you are forgetting how blind you were! And so many decades of cataracts and wow: just a few weeks for your brain to adapt and start, heh, wanting MORE.
I will repeat your own words: people have visual improvement even after years. You will too. I think I am starting to ignore the ghosting on my computer screens. So I may just accept it. Your point about kicking yourself for trying an exchange is totally right. I would do that too, and using that hypothetical hindsight perspective to make a choice is a good method.
Funny how each one of us has our bad thing and then says, "I'd never recommend that again." I never thought I would hear you say that about EDOFs.
Thank you for answering so quickly.
tamarinda Deb03
Posted
Thank you, Deb! I have been following your story too, and really appreciate your help.
I'm pretty sure that the capsulotomy makes future lens exchange impossible, so one has to be set with their IOLs before doing that. It's yet another decision to be made without being able to know the precise outcome, sigh.
Thanks for the info about monofocal dysphotopsias. My original surgeon recommends a B&L for "absolute best visual quality." The dysphotopsia expert recommended another acrylic to match the acrylic I already have, which I thought was odd, maybe interesting. Other ophthos have said it doesn't matter at all, as long as they are aspheric and the surgeon is comfortable with it.
None of them care about which ones have a higher incidence of PCO...I guess it's just a given that PCO happens to almost everyone.
Guest tamarinda
Posted
Yes, spot on, I really have a hard time remembering how bad my vision was, even it is not that long ago.
It is kind of like trying to remember pain, you remember it was unpleasant but it is impossible to replicate the pain in your mind, you can not replicate the actual feeling.
Off course I remember some things I did not see before, but now I almost don´t believe it 😃
That said I have a lot of these experiences, where I think of something I want to do, and I my head I am still restricted to the old way of doing things, so sometimes I still do things the hard way, and halfway through I realize I can see something, that just makes it so much easier.
Sometimes I still put my finger in the cup to feel when it is full, or sprinkle salt on my fingers to feel when it comes out of the container, and while I am doing it I realize that I can perfectly see what is happening, and then I ask myself what the h... am I doing 😃
About visual side effects, it is now about 3 month since i got the Lara, and side effects have become less rather suddenly the last week or two.
Starburst and concentric rings have the same size as before, but they are much harder to see, especially the starburst are almost invisible now.
I more or less expect most of it to be gone at some point, the prognoses feels very positive, but even it it does not change, I have really good night vision now compared to what I have had all my life, so nighttime driving is almost a pleasure now compared to before.
And yes, you are right, I was a big fan of edof before I got the trifocal.
I think if I had gotten two edof´s I would probably still promote them to anyone, because it does give me amazing vision compared to before, and it does add intermediate range on top of what I could have had with a monofocal, but when I got the trifocal I must admit that one is just that little bit better.
W-H Guest
Posted
That is funny 😃 Glad your vision is good.
Within 4 months my wife forgot that the bathroom sink usually has water droplets on the surface. So one week after the OP when she could see sharp it was an interesting moment.
Another funny thing is that I have 160% vision but Presbyopia is kicking in so near vision is getting slightly blurry. I have spent so much time on this cataract stuff that sometimes I wonder why is the IOL not focusing today! Then I realize that my wife got the near vision IOL and not me 😃
tamarinda Guest
Posted
Aw, it deleted my whole answer just before posting!
Just wanted to agree... last night I noticed I still lean IN to things when they get blurry, when I can just pull back an inch (hehe: 2.5cm) and it will be clear.
Your story of how you got buy using your fingers instead of your eyes reminds us all that any imperfection can be managed. 😃
Maybe these conniptions are the only way Life could give me what I want! I mean, I never would have selected one mono and one multi, right? But I could have lovely bilateral summation with depth perception for outdoor activities, clear night and day vision, and some good near too. I have a feeling a far monofocal for me would give me some intermediate vision....just a hunch, but we'll see.
Hahaha... that's my favorite phrase now: "Wait and SEE!"
Life works out.
😃
Deb03 tamarinda
Posted
Regarding monofocal IOL choices, I don't understand why you need to have the same material lens as the Tecnis. I'd pick the one least likely to cause dysphotopsia. I am halfway through my exchange and currently have one acrylic with yellow tint and one silicone with no tint. While I can tell a slight color difference when I close off one eye, it's not significant. If you end up slightly myopic you should get some intermediate vision.
ad12345 Deb03
Posted
@Deb03 Do you experience PD in both eyes?
Hudsongrl tamarinda
Posted
i would probably leave your left surgical eye alone, get a monofocal IOL in your right. let your eyes try to balance with each other which can take some time. then correct any issues you might still have with contact lenses. i had the ghosting at night after my cataract surgery on right eye only. i now wear a contact on top of that IOL in that eye and voila no ghosting. the eye was undercorrected by -.75 and is my dominant eye. i hope you can get this resolved because the ghosting on signs at night and on tv crawl was driving me crazy.
Hudsongrl
Posted
sorry i had your eyes reversed. leave your right alone for now, monofocal in left and see how you accomodate after fixing your left eye. tweak with contact lenses if need be before doing any further surgery on your right eye.
tamarinda Hudsongrl
Posted
Thanks! I got your following message where you get the sides right. 😃.
Did you have ghosting with a monofocal, multifocal or EDOF lens? It must have been so hard in your dominant eye. Mine is my non-dominant at least, which is why correcting my dominant eye for distance really helped.
My multifocal IOL seems to have settled a bit far-sighted. I think it's +0.25. I tried to mimic monovision with a contact lens that made my right eye more nearsighted, but it made the halos WAY worse.
I agree that the ghosting on those yellow highway signs is one of the more annoying instances of it. On one particularly dark night with freshly painted highway lines, I was seeing white vertical beams above every dashed line, like searchlights. It was almost psychedelic. (Heh, maybe taking that perspective...that this is all like tripping -- which I've never done -- would put a positive spin on it. Just enjoy the ride...)
The lastest ophtho I saw, the dysphotopsia expert, said, "You'll start using that right eye more and it will adjust." I think that our brains don't neuroadapt until forced to...until we rely on a given eye. It makes sense but also seems impossible...if there is a shadow around everything as it gets projected onto the retina, how can my brain know that that is NOT real? But somehow it does...
Hudsongrl tamarinda
Posted
yes the ghosting was in my right dominant eye with a monofocal lens. i now wear a -.50 contact lens over it and the gjosting is gone. While I had the bad ghosting we were in Las Vegas on vacation. Oh my all the lights at night... it WAS psychodelic. The brain is an amazing thing and your optho is right the neuroadaptation kicks in.