cataracts; rezoom lens; glare and starbursts

[radm]

I had cataract surgery and rezoom lenses implanted in January and February of 2007. My readability is 20/20 and my vision is great during the day, however, when night time comes I am unable to drive because of halos and starbursts. I have used philocarpine and other drops including all types of tear producing drops. I have prescription glasses in  all colors as well as in many strengths. WE even tried using colored contacts. IT IS 7 MONTHS AFTER THE SURGERY AND I STILL CAN NOT SEE. I went to another surgeon and he did a laser yag on my left eye. That made the situation worse. I would have wonderful vision if I did not have to drive at night. I also inquired about the ID card and was told they do not give their patients a card. They did give me diopler numbers of 21.0 and 20.5. I am depressed and desperate. Does anyone have any suggestions? Please?

[John C Hagan III, MD, FACS]

Hello Radm.  It is well known that multifocal implants give reduced night vision. It's on the manufacturer's website and many postings here attest to that fact.  Also the manufacturers do not say that multifocal implants will completely free a person from glasses wear; most multifocal patients wear glasses for about 20% of the time. Many to most wear them for night vision.

Removing these implants is difficult. You can probably get by with glasses at night.

Use the search feature on this page to search the previous postings on your type of implant.


JCH MD Eye Physician & Surgeon

[radm]

Thank you for your input, however let me be more speciic. I am unable,  to drive at night. I have read other comments concerning the issues of starbursts and halos and I am certain they are all signiicant. I am 66 year old widow and a professor at a state college which is 23 miles away from where I reside. I can not teach any evening classes becasuse I can not drive at night. My objective in posting on this site was to secure information to receive help in dealing with this problem, possibly a solution in the form of either glasses or eye drops. I would like to know what others are doing that enables them to driive at night.

Thank you

[John C Hagan]

Perhaps other patients with mutifocal implants would like to comment. If you have not tried it some patient have had success with a prescription lens and anti-reflection lens (AR) coatings and/or polarized coatings.

If you cannot address this with glasses, tinted lens, etc at some point you may be looking at an implant exchange.

Hope our 'posters' can help you.

JCH MD FACS

[JodieJ]

You have my sympathy.  I'm not an eye care professional and do not have multifocal implants myself, but I do have a few suggestions for you based mostly on previous posts on this forum. ( A careful reading of the archives in the area of cataract/IOL from about January of '06 would be well worth your time.)   (1) Some multifocal wearers (especially those with Rezoom) have been helped greatly by leaving their overhead light on while driving at night.  This would certainly be worth trying if you haven't already done so.  (2)  Reportedly even slight astigmatism can cause major problems with halos/starbursts/glare for some multifocal recipients.  If this condition applies to you, a laser vision enhancement might prove very helpful.  (3) Eye surgeons apparently vary greatly in terms of their expertise in diagnosing/treating multifocal problems.  It wouldn't hurt to get a second (third) opinion from another doctor(s) who does a lot of multifocal surgery.  I don't know where you live, but several people have posted here to praise the exceptional skills of Dr. Kevin Waltz of Indianapolis.  (Dr. Waltz has multifocal implants himself.)  (4) Recent reports in the professional literature state that it takes about 12 months to achieve  neuroadaptation to multifocals.  So your night driving problems may well diminish on their own during the coming months.  (5) When I developed a fairly rare eye condition (unrelated to cataract/IOL) which the local doctors couldn't treat, I began searching the professional literature for relevant research.  In my case, email correspondence with the authors of this research helped me immensely.  In your case, you might start your research at www.eyeworld.org.  Best of luck!          

[radm]

Thank you for your responses. Ater reading your comment I went ffor a ride to try driving with the overhead lights on. Sorry to say, it did not work. I have tinted glasses and I will be seeing my eye doctor again tomorrow. Through this site, I found a starburst simulator and I am hoping that by using this tomorrow I will be able to allow him to see "how I see at night". I live in North New Jersey. Thank you so uch for your comments. Just knowing I am not alone in this battle has made me even more determined to do whatever is necessary to correct this condition. I also read that I should have an ID card with pertinent info.  The surgeon who implanted these ReZoom lens claimed the ID card was not necessary, ( response to my call today). I called Advanced Medical Optics in California and they confirmed that the ID card is extremely necessary to determine if the lens was the correct one for my vision. I followed that lead and sent a written request. I am open and willing to try any suggestion.

To everyone who has responded, thank you.

[radm]

Thank you for your response.  Could you please explain why an explant is so difficult? My eye doctor does not recommend it either.

[John C Hagan]

In an explant the 'arms' (called haptics) of the implant are usually firmly scarred in the capsular bag (the part of the human lens left in place to hold the implant).  Removing it can tear the membrane and cause the vitreous to come into the front of the eye where it can cause inflammation infection increased risk of retinal detachment.

If the implant comes out okay it's often hard to seat the new implant in the proper position again because the capsular bag is scarred shut. If the implant is not properly placed in the eye the implant can dislocate or move forward or backwards which changes the implant power.

Plus many explants are done because the implant has fallen out of place, is causing problems in the eye.

Each operation on the eye reduces the cell count of the back surface of the cornea. Each additional operation can damage these endothelial cells to the point that they can't do their job which is to keep the cornea dehydrated. If the cornea can't stay dehydrated the corneal compensates and turns cloudy. On the second operation the cell count is lower than on the first operation.

JCH MD Ophthalmologist

[radm]

Thank you for the explant information. I have been reading about, as well as trying,, all the suggestions presented on this forum. All I want to do is to be able to drive at night.

Thank you

[JakeMooreMD]

Hi,

Out of interest, would you be willing to describe in the most precise language possible the halo's you are experiencing.  

Thank you,

Jake Moore

[annp]

There is a program in Philadelphia called the "William Feinbloom Vision Rehabilitation Center". 215-276-6060.  They specialize in visual functioning assessments and interventions and may offer you some ideas.

Annp

[John C Hagan III, MD, FACS]

I would avoid signing up for expensive evaluations, expensive visual training and expensive corrective glasses.  That is part of the optometry school.  These interventions are for the most part not based on evidence based medicine.

JCH III MD FACS FAOO

[annp]

I mentioned this program because they address one's ability to use vision during functional tasks.  This is a low vision program and they serve a variety of eye conditions and concerns, ranging from legal blindness to peripheral vision loss from glaucoma, etc.  They are part of the optometry school and receive many referrals from opthalmologists who cannot offer any more medical interventions, or want to supplement their care.  

The presence of glare and light affects many tasks, including driving.   Managing this in order to drive may include an assessment by a professional who examines the functional aspect of vision, such as a low vision specialist.  The interventions vary and may not be expensive, such as wearing the correct filtered lens to block the annoying glare.  I also mentioned this program because I thought you were from south Jersey and now realize you are north Jersey.  If you are interested in a functional visual eval, the Lighthouse in NYC may offer you some ideas on glare and light management during night driving.  Good Luck!  Annp

[francieblaney50]

I had cataract surgeries Left eye (8-8-03) and right eye (1/21/05) last fall 2006 I started having starbursts in right eye and halo in left.  I get them inside from exposed bulbs and lights while driving. My eye surgeon used a laser on the right eye but it didn't help. I have seen a retna specialist, neurologist, and two specialists in chicago.  Finally, the surgeon at univ of chicago said I had SLK and very dry eye.  He put plugs in the tear ducts and that did help dryness; however, he says he doesn't know what the starbursts could be.  Is there some controversy here? I know that others have talked about rezoom lenses. My cards say SA60AT left is 20.0D and right is 20.0D Acrysof.  I have had every test and some more than once.  I'm 57 years old and I cannot drive at night.  I'm having trouble accepting that I will never be able to drive at night again but that  I don't have a major eye problem.  I know that the check on my pupils indicated that they are not large. The chicago surgeon said that I could have some excess conjunctiva surgically excised but this would be for SLK dry eye.  Could my problem be from my lens implants or are there other reasons for developing starbursts and halos? At this point I am rather frustrated.

[John C Hagan III, MD, FACS]

Hello, this is a very common problem and is discussed in many places in the two Eye Care Forum. You can use the search feature. Also look at this discussion thread (post in your internet browser)

http://www.medhelp.org/forums/EyeCare/messages/1595.html

It's quite likely that your problem is related to your IOL.  You might see an ophthalmologist that specializes in cataract surgery complications. In some instances the IOL is explanted and a type less prone to edge/glare problems put in (IOL exchange)

While there are several such groups in Chicago, one that I am familiar with is Manus Kraff MD and the Kraff Eye Institute. Dr. Manus Kraff MD is a previous president of the American Society of Catract and Refractive Surgery.

JCH III MD Eye Physician and Surgeon
Kansas City, MO, USA

[Occupant]

I have the same lens that you have except 11.5D and 9.5D. My astigmatism is not very severe (<0.75D) and I have had starbursts from day one, however they really only bother me at night while driving. They are not quite as bad as with the cataracts but close.

[gyuszi]

A related discussion, startburst effect after catract surgery was started.