YAG laser capsulotomy - starbursts!!
Posted , 8 users are following.
Hi All,
I've not posted here in a while but suffice to say I'm returning now with an update on both the cataract surgery I had last summer and the unsatisfactory results of YAG laser in my LE last week.
To recap, cataract surgery left me with very good distance vision but didn't come hassle free. Both eyes almost immediately went through an aggressive PVD which left me with the most annoying smudgy floaters, plus still, to this day, I experience peripheral flashes of light at night. I've been given the all clear in terms of any damage to my retina in this regard, but I admit the floaters especially I find quite debilitating as they are in my central line of vision.
About a month after my surgery I also developed inflammation in my RE which needed drops - I believe a side effect from this was a shower of tiny cell-like floaters in my RE. Thankfully these have dissipated over time.
On top of all this, not long after the surgery I was informed I had developed PCO in my LE IOL and needed a YAG. This was scheduled last week on the NHS at a local eye clinic. I did mention to the optometrist providing the service that the only thing I was experiencing which I had put down to PCO was two extended spikes/rays of light from approaching car headlights, and that otherwise I wasn't sure if I needed the treatment.
Once she had examined my LE she confirmed the PCO was relatively mild and just off my central vision; i.e., deposited in the outer section of my IOL. She considered it best to tackle the issue now and so went ahead with the procedure with about 6 short laser zaps. It was over with very quickly and absolutely painless.
Anyway, I now no longer have two spikes extending from all light sources but literally a blast of long rays coming from all directions in my LE (my RE is fine). I looked at the moon earlier and it has rays extending from it. Likewise sunlight, and of course car headlights are now even worse than they were pre-YAG. So much so I'm unsure if I can drive at night in this state. The rays seems to rotate with eye movements which makes me wonder if there is a fragment of debris from the YAG creating this effect?
For those of you who've experienced this side effect....did it pass or was it remedied in some way at a later date?
0 likes, 17 replies
karin08666 elizabeth03298
Edited
Do you know what type of YAG "pattern" they used? I had the cruciate (cross) pattern. I noticed after my YAG (done in both eyes), I had more starbursts around all light sources, even the moon. I no longer see these starbursts, so maybe the same will happen to you (my YAG was done 7 months ago). However, one of the flaps from my cruciate YAG is slightly in my upper right hand vision and it floats around. When light hits it the light rays do rotate with the flap as it moves. I don't notice that all the time, just when light hits it from a certain angle. Not sure if this is what you are seeing with yours, but those are the things that happened with me.
Your story is so similar to mine. I had PCO 2 weeks after cataract surgery and now I am going through PVD. PVD is complete in my left eye, but not my right. I have cloud like floaters in my left eye the majority of my day. It feels like I am looking through a cloud or a milky film and I have a Weiss ring that zips around.
RonAKA karin08666
Posted
PCO and YAG is a subject of current interest to me as my optometrist recommended YAG in one of my eyes, saying PCO was developing. The laser specialist (an ophthalmologist that does cataract surgery as well as Lasik, PRK) recommended not going ahead with it and to just wait and watch until it becomes a vision issue.
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.In any case one of the things I have found is that risk of damage from YAG (like retinal tear, detachment, and floaters) is proportional to the energy used by the YAG laser. If one looks at it simply and compares two slices the diameter of the desired hole in a cross shape, the length of capsule cut is 2 times the diameter. With the other can opener circular method the length of the cut is Pi x D, or 3.14 D, so 50% more length of cut, and I would expect 50% more energy used by the YAG. And of course the bigger the diameter the more energy used, so they minimize it. But, the risk of damage to the critical vision area of the IOL is higher with the cross shape, so there is no perfect way of doing it. I suspect the can opener method may be limited to lens materials like silicone that are very susceptible to YAG damage. And, if they have to enlarge the diameter to deal with flap issues, it would seem that the cross shape would only take minimal energy to extend, while the can opener shape may take more.
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My YAG decision has now been postponed for at least a year, so I have that much time to think about it and worry! On the vitrectomy my surgeon and optometrist said that is only done as a very last resort and that I should put up with the PVD "zipping around", now in both of my eyes. The 3 year old one is now fading but still quite visible. The 18 month one is darker and more visible. I suspect I've got them to keep, and hopefully I can adapt to it.
karin08666 RonAKA
Edited
If the PCO is not affecting your vision, it is a good idea to wait. No sense getting a procedure done on your eye unnecessarily. My PCO was in both eyes and unfortunately quite bad. I couldn't drive at night and in both eyes it was like I was looking through a lens that was smeared with grease. It was hard for me to read street signs and it was getting hard for me to read.
I didn't even ask my surgeon what YAG pattern he would use. I figured it best he do what he was the most experienced doing.
My left eye finished PVD in mid August and my right eye I don't think is finished yet. I have a cloud floater in it too, but no Weiss ring yet.
ka76787 RonAKA
Posted
Have you read the article, "YAG-shots in IOLs: Safe or dangerous?"
I just read it, found it interesting.
RonAKA ka76787
Posted
Yes, I at least had it saved, so I presume I read it at some point. Looks interesting with a focus on the material of the IOL. For me that ship has sailed as I have acrylic hydrophobic material which is supposed to be most resistant to PCO, but according to the article more susceptible to be damaged with YAG.
ka76787 RonAKA
Posted
Yes, but I don't think the authors are suggesting avoiding the hydrophobic material, but rather to be mindful when administering the YAG, both in terms of correctly focusing the laser and perhaps choosing a pattern that avoids the center of the optic. The authors are concerned that if the YAG is being hurriedly and thoughtlessly administered the IOL can be damaged.
RonAKA ka76787
Posted
Yes, I would expect that experience is a prime requisite for doing a good job. I believe a couple of the tricks are to use a contact lens device to hold the eye still and open, plus provide better visualization of where the laser is focused. And, good practice is to focus the laser behind the capsule and bring it forward to start cutting without focusing the laser into the IOL itself. With a cruciate style method I presume you would start at the outside where damage to the IOL has less consequence and then work your way to the middle where focus is most critical and then over to the other side. I have read that risk of damage to the IOL is in the 1% range. Risk of a retinal detachment or tear is around 0.5%. That would be much more serious if it happened.
karin08666 RonAKA
Edited
I watched a Youtube video by Dr. Karl Brasse How to keep IOLs in premium shape if YAG laser treatment due to PCO is necessary. It showed how he uses the laser so the lens doesn't get damaged. It also shows some damaged IOLs, just to give you warning in case that is not something you want to see.
RonAKA karin08666
Posted
That is an interesting video. It makes one wonder how consistently these types of techniques are actually used. The YAG process is sold as being so simple to do that optometrists are allowed to do them in I believe 10 states in the US. There is a proposal to do the same in our province in Canada, but I don't believe it has been approved.
karin08666 RonAKA
Posted
When I was researching about YAG before I had mine done, I read articles about people who had their IOLs damaged by people who really had no proper training in how to do a YAG. A person has to make sure the doctor who is doing this procedure on them is very experienced. Hopefully that proposal you speak of does not happen anywhere in Canada. I have not heard about that in Manitoba yet.
RonAKA karin08666
Edited
I have mixed feeling about what it takes to do a YAG properly. I think we know that not all ophthalmologists take cataract surgery as seriously as others. Perhaps they consider YAG as a trivial procedure and not worthy of a lot of effort. On the other hand an optometrist may take it more seriously and do it right. Unless there are some red flags if I have to do it, I will go ahead with an ophthalmologist that does Lasik, PRK, as well as cataract surgery. In any case here is where Alberta is at.
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https://collegeofoptometrists.ab.ca/wp-content/uploads/2021/03/Proposal-to-Expand-the-Optometry-Scope-of-Practice-Dec-2020.pdf
elizabeth03298
Posted
Hi Karin,
Thank you for your reply. I'm glad to hear the starbursts have subsided for you. This gives me hope.
Are you now able to drive at night, as in my condition currently, all approaching car headlights are surrounded by multiple thin rays which extend to my side of the road. It's not too debilitating whilst driving locally in my town, but as I am a photographer and tend to shoot in out of the way locations (and at night sometimes) I am going to be massively restricted as a driver. I can't see how I could drive with oncoming lights of that nature on a dark stretch of road.
I admit I have no idea what method this optometrist used. I was shocked to discover it wasn't an ophthalmologist carrying out the procedure and in the main found the whole thing very unprofessional and lacking in proper communication.
On the one hand the optometrist claimed the PCO wasn't that bad, as if determining out loud if I needed it at all, then she just went ahead with it anyway before I could rethink my decision over its necessity. It's always too rushed an affair - which was the same with the whole cataract process from start to finish.
I think my next port of call will be making an appointment with one of the best local ophthalmologists I can find. I was going to do this for the YAG but didn't want to pay the excess premium on my private healthcare as I just assumed all would go well (big mistake). I need to know if my IOL is pitted or if there is an edge to the pattern created which is creating the starburst effect.
In terms of you going through PVD, I hope it resolves itself quickly. I have had massive floaters in both eyes & peripheral flashes in dark surroundings for six months now. My only hope is when the PVD completes, as apparently it hasn't yet, the floaters will move out of my central vision.
karin08666 elizabeth03298
Posted
It is a good idea to see another highly qualified ophthalmologist. It could be the lens was pitted, but it could also be the capsulotomy just wasn't made big enough and as you say the edge is what is creating the starburst.
Before I had my YAG I couldn't drive at night because of the PCO. By the time I had my YAG it was spring/summer and it stayed light out long enough I never had the need to drive when it was dark. Then in August I had the PVD and all these big cloud like floaters obscuring my vision and I no longer feel comfortable driving at night. I'm therefore not sure what it was like to drive at night after my YAG.
I hope you get this all resolved. It is hard going through all these things after cataract surgery.
MargoB elizabeth03298
Edited
I’m so happy to find this as I had the YAG for PCO which happened fairly soon after my monofocal iol and combined victrectomy for floaters. I was the same originally with 2 streaks from light sources. Was still dialated last night and tonight went out and saw long rays in all directions from street and house lights and drove around the block and see them off headlights and street lights. I'll be calling the surgeon on Monday, but what I could tell from people online is that the pupil is dilating larger than the hole that was made in the bag from the laser which caused the starbursts from other people I saw online that had this done. no warning about this so it really freaked me out. I will update once I get more information but I’m keeping my fingers crossed if that’s what this is and that’s what the fix is. Also debris in there floating around is a mess.
karin08666 MargoB
Posted
MargoB could you please give me information about your vitrectomy for floaters. I am considering having one because my floaters are cloud like and I am looking through a milky film for the majority of my day with a Weiss ring zipping around. Did everything turn out ok or did you have any complications? Not something to be taken lightly, but not sure I can live with these floaters as they are affecting my life and the things I do.
mike38903 karin08666
Posted
karin08666, I understand that you had both PCO and cloud-like floaters, and now your PCO is gone after YAG treatment. I currently have both PCO and cloud floaters in both of my eyes. My question for you is, when you had both PCO and cloud floaters, were you able to distinguish between the two? I am not sure if the sensation of haze I am experiencing is actually caused by PCO or floaters. If it's due to floaters, I would consider waiting until PCO affects my vision and then opt for YAG, as you suggested.
karin08666 mike38903
Posted
I had cataract surgery in March last year. I got PCO 2 weeks later and waited a few months until it progressed to affecting my life to get YAG done. Three months after the YAG I got PVD which came with big cloud floaters. Your eye doctor should be able to tell you how bad the PCO is.