Bright light 4 point star after IOL

[EGW]

Both my eyes have monofocal Acrsof SN60WF implants. Vision is 20/40 without glasses. However, bright points of light (headlights, streelights, taillights, signallights) produce a 4 point star or "X". My right eye produces a line from lower left to upper right at about 45 degrees. My left eye produces a line from the upper left to the lower right at about 39 degrees. My two eyes, therefore, produce an "X" centered on the bright light.  Bright areas on a TV screen and bright large objects such as an advertising sign also produce the "X" pattern but with wider lines.  My optometrist can see the cause, perhaps the incomplete folding of the lens implant, with his microscope. Question: How long does it take for the lenses fold line to disappear?  How long does it take my brain to adjust to ignore it?  Is replacement of my implants the best solution?  I believe both lenses are installed within the lens capsule itself.

[John C Hagan III, MD, FACS, FAAO]

While most cases of dysphotopsia improve, many go away completely, some remain especially in a hyper-aware individual or someone that "goes looking" for it.

The edge is often the problem but it's the old rock and hard place. Square edges give more dysphotopsia but less posterior capsular opacification and fewer cases of Yag laser capsulotomy. Round edges give less light shows but have more PCO.

Bigger IOLs have less reflex problems but require large incisions but can create more surgery induced astigmatism.

Often a meticulous refractions and anti-reflective coating on aspheric glasses (something new) can minimize this problem.

JCH III MD

[EGW]

Thank you for your comments. I found "dysphotopia" info on the web and have a better understanding of what is happening. During my post operative visit my surgeon said the problem would go away, but that was back in March 07. I spoke to him again when my wife had her eye surgery - he said the condition might not go away. He seemed to be evading going into detail, that was in October. I recently sent a letter to my surgeon asking for a more detailed discussion and a floow up exam if needed. I expect an answer from him next week.  The web info says lens edge is the likely culprit. The graphic, however, appears to show an "arc" being produced. My problem are straight lines, similar to a defraction line caused by a very thin wire held in the path of a laser beam (although there are no interference nodes).  Unfortunately I tend to dwell on the problem, perhaps too much for my brain to learn to ignore it. However, the "shimmering" glare seen earlier in the presence of bright overhead flourescent lighting HAS subsided.

[John C Hagan III, MD, FACS, FAAO]

I think your optom is wrong as these IOL upon us (un-taco) virtually always. Plus its the last thing a surgeon checks before saying I'm done.  

See your surgeon for an evaluation to see the the capsule is turning cloudy, if you need glasses over the IOL.   Some glare, flare, arc, ghosting is normal especially without glasses and is called dysphotopsia and gets better with time.

JCH III MD

[EGW]

Saw my opthamoligst this morning. What my optom and I initially thought about lens not unfolding was incorrect, however, close to the problem. Both eyes have wrinkles in the posterior capsule. While not told why, I suspect the capsules did not shrink enough after surgery or perhaps the lens was slightly too small. Although my vision is excellent, except for the abberations, no opacificatiion, I am now scheduled for capsulotomy, both eyes, on  Feb 13th to remove the wrinkles. Wife also had catract surgery in October. One eye developed PCO. She's scheduled same day for yag capsulotomy.   The fun just keeps getting better. Thank you for your input. It is comforting to be able to get second opions.