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Diagonal light streaks at night (dysphotopsia or wrinkle in capsule or ?)
On Nov 12 I had cataract surgery in my left (non-dominant) eye. Surgeon placed: AcrysofIQ Toric IOL SN6AT4. At one week+ following surgery I have NO astigmatism remaining, vision is 20/25. No problems with surgery. Opthamologist very happy with his work & my fast, problem free recovery. Apparently there is no swelling remaining. All good & problem free.
Well, it was problem free, until I got in my car in the dusk to drive away from his office following my one week post-op exam. Diagonal streaks of vivid glare at 45 deg stretched from tops of tall trees & rooftops to many yards in front of every oncoming car. In rush hour traffic with these streaks are everywhere form every tail light, headlight, street light, shop window. This is dangerous. Kind of pretty on a dark, rainy November night, but not conducive to safety. If I shut my left eye, they all disappear. But my vision with right eye is only 20/70 without glasses, so we have problem, Houston!
According to opthamologist this is caused by a wrinkle in the IOL capsule. Opthamologist mentioned the day after my surgery in an off-hand way there was a wrinkle, but I had not driven at night, so it had not bothered me. He now says that must be causing my "discomfort." Sorry, this is not discomfort, it is makes driving at night highly distracting, on the order of texting while driving (which I would never do). I had the cataract surgery because road glare was increasing, and color contest was decreasing, but these streaks of glare make my previous issues feel like nothing.
I have searched this site & read about dysphotopsia and about the problems that others are experiencing with diagonal streaks of glare caused either by dysphotopsia or other reasons. Some people have had their diagonal glare go away within a couple of weeks (oh, I am hoping for that outcome!). Others have had it last for months, even many months or years. Some needed YAG to make it go away.
I mentioned to my surgeon that I knew that YAG makes it difficult if not impossible to explant IOL if explanting is needed. He said he gives this issue 3 months to clear up. If problem doesn't go away, we would make decision to explant or do YAG before 3 months is up. However, he wanted me to go ahead with surgery on right eye, planned for 3 weeks from now. I said I would not be doing anything to my right eye until my left eye is functioning properly. I cannot imagine coping with both eyes doing this at the same time.
QUESTION: I am wondering how does he know whether this is dysphotopsia (he did not mention this term) or just a wrinkle in the capsule as he said?
To be clear: These diagonal lines are ALL precisely at the same angle, like a diagonal rain of bright light. Creates an abstract painting effect. When I **** my head over to the right so that my eyes are nearly perpendicular to the ground, the diagonal lines are horizontal. If I **** my head the other direction, the diagonal lines are nearly vertical. Shut my left eye, no diagonal lines at all in any direction. So right eye not involved. These streaks are visible in the daytime, but obviously not as distracting because of the lack of bright lights on the road, and the reduced contrast of light against dark in daytime.
I am going to be seeing my optometrist next week (not a related issue). He referred me to my opthamologist (both highly repeated in our community). Would an experienced optometrist be able to give a second opinion about this issue? I am not eager to get another doctor involved (hoping this will all go away soon), but should I be seeking second opinion if this does not go away in couple of weeks?
Thanks, HapK
Well, it was problem free, until I got in my car in the dusk to drive away from his office following my one week post-op exam. Diagonal streaks of vivid glare at 45 deg stretched from tops of tall trees & rooftops to many yards in front of every oncoming car. In rush hour traffic with these streaks are everywhere form every tail light, headlight, street light, shop window. This is dangerous. Kind of pretty on a dark, rainy November night, but not conducive to safety. If I shut my left eye, they all disappear. But my vision with right eye is only 20/70 without glasses, so we have problem, Houston!
According to opthamologist this is caused by a wrinkle in the IOL capsule. Opthamologist mentioned the day after my surgery in an off-hand way there was a wrinkle, but I had not driven at night, so it had not bothered me. He now says that must be causing my "discomfort." Sorry, this is not discomfort, it is makes driving at night highly distracting, on the order of texting while driving (which I would never do). I had the cataract surgery because road glare was increasing, and color contest was decreasing, but these streaks of glare make my previous issues feel like nothing.
I have searched this site & read about dysphotopsia and about the problems that others are experiencing with diagonal streaks of glare caused either by dysphotopsia or other reasons. Some people have had their diagonal glare go away within a couple of weeks (oh, I am hoping for that outcome!). Others have had it last for months, even many months or years. Some needed YAG to make it go away.
I mentioned to my surgeon that I knew that YAG makes it difficult if not impossible to explant IOL if explanting is needed. He said he gives this issue 3 months to clear up. If problem doesn't go away, we would make decision to explant or do YAG before 3 months is up. However, he wanted me to go ahead with surgery on right eye, planned for 3 weeks from now. I said I would not be doing anything to my right eye until my left eye is functioning properly. I cannot imagine coping with both eyes doing this at the same time.
QUESTION: I am wondering how does he know whether this is dysphotopsia (he did not mention this term) or just a wrinkle in the capsule as he said?
To be clear: These diagonal lines are ALL precisely at the same angle, like a diagonal rain of bright light. Creates an abstract painting effect. When I **** my head over to the right so that my eyes are nearly perpendicular to the ground, the diagonal lines are horizontal. If I **** my head the other direction, the diagonal lines are nearly vertical. Shut my left eye, no diagonal lines at all in any direction. So right eye not involved. These streaks are visible in the daytime, but obviously not as distracting because of the lack of bright lights on the road, and the reduced contrast of light against dark in daytime.
I am going to be seeing my optometrist next week (not a related issue). He referred me to my opthamologist (both highly repeated in our community). Would an experienced optometrist be able to give a second opinion about this issue? I am not eager to get another doctor involved (hoping this will all go away soon), but should I be seeking second opinion if this does not go away in couple of weeks?
Thanks, HapK
Your best bet might be to go to that person's MedHelp.org home page and leave a message
JCH MD
JCH MD
I have the same problem and symptoms you described in your Nov 2013 discussion with one difference, namely, I have astigmatism in the affected eye. I would like to learn if your problem was resolved successfully, and if so, how it was resolved.
ChasJr
ChasJr
I have read them. Thank you.
The squeaking wheels, I am one, are searching the internet for answers to questions. I am always grateful to anyone who shares information in forums, especially busy professionals.
I now believe I am armed with enough information to get some resolution on my diagonal glare problem if it does not go away (and is not improved by glasses). I have someone I can see for a second opinion, an opthamologist at a teaching hospital that I have seen for an unrelated issue during chemo for breast cancer.
Since my cataract surgery, I have read dozens of journal articles about dysphotopsia & glare, as well as having this dialogue with you, so now I can at least understand the answers to questions better than I could have before I started asking questions. The essence of informed consent is asking questions and having enough information to understand the answers. So thank you for your patience. I won't be going into anything blindly ;)
HapKP
The squeaking wheels, I am one, are searching the internet for answers to questions. I am always grateful to anyone who shares information in forums, especially busy professionals.
I now believe I am armed with enough information to get some resolution on my diagonal glare problem if it does not go away (and is not improved by glasses). I have someone I can see for a second opinion, an opthamologist at a teaching hospital that I have seen for an unrelated issue during chemo for breast cancer.
Since my cataract surgery, I have read dozens of journal articles about dysphotopsia & glare, as well as having this dialogue with you, so now I can at least understand the answers to questions better than I could have before I started asking questions. The essence of informed consent is asking questions and having enough information to understand the answers. So thank you for your patience. I won't be going into anything blindly ;)
HapKP
8 Comments
I have this same problem and its getting crazy now. In addition to stretching beam of light rays with every blink. In the middle is now irregular lines that looks like circular cobwebs or stars. All this started after I had Vitrectomie for macular hole in 2013.
At first, it was just when I blink, but now, every light bulb, even in pictures and tvs. The worst is the Christmas deco lights, looks like little stars, and going out in the night is a nightmare, with all the light rays and star headlights and streetlights I have to scale though.
My doctor says its a phamtom. Pls let me know if there is any solution
At first, it was just when I blink, but now, every light bulb, even in pictures and tvs. The worst is the Christmas deco lights, looks like little stars, and going out in the night is a nightmare, with all the light rays and star headlights and streetlights I have to scale though.
My doctor says its a phamtom. Pls let me know if there is any solution
These discussions relate to post operative cataract/IOL surgery with implants (IOLs) put in eye. Your problem is usually different and is due to distortion of the macula which is present almost always after macular hole surgery or epiretinal membrame (ERM) surgery. It is called metamorphopsia. Thanks also ofter look bigger or smaller or uneven than normal. On the other hand macular hole surgery which involves vitreous surgery almost always causes cataracts that grown reasonably fast so you may be developing post macula hole cataract. I doubt that it is 'phantom"
Thank you very much for your response. My main distortions comes from lights, anywhere light is, the glare from the light kind of white washes the images. In the absence of this glare from lights and looking into lights, images and letters all look alright without any distortions. Please is there any solution to this, how may my ophthalmologist help me?
I have been to the eye clinic this week and the chief consultant says everything looks fine from their perspective. I was given some Ciclosporine eye
drops. The diagonal beam of lights when I blink, the star looking streaks on all lights and the glare still persists.
I have been to the eye clinic this week and the chief consultant says everything looks fine from their perspective. I was given some Ciclosporine eye
drops. The diagonal beam of lights when I blink, the star looking streaks on all lights and the glare still persists.
Go to the restasis website and read about cyclosporine. It is used for severe dry eyes, taken twice/day for the rest of your life. NOTE: it takes 4-6 months to work and is for moderate or severe dry eyes not helped by artificial tears taken 4 or more times/day. Know what you are getting into and what the drug is for. If your problem is dry eyes then blinking and/or putting artificial tears in should help the beams you see. After macular hole surgery sometimes the pupil doesn't work well. Are your pupils the same size? is the operative pupil bigger?
Thank you Doctor for your prompt answer. I have never been told that my pupils have any problems. Though I have highly myopia and use glasses before the Vitrectomy in 2013. A few months after the surgery, I started seeing the diagonal streaks of light stretching from light source to me when I blink nothing more.
Fast forward to February 2015, I interned in a hospital as a nurse, barely a week into my internship, I noticed a milky/cloudy film covering my vision and light heads were stretching from the center and with every blink . I went to eye doctors and it was confirmed to be an infection. I was given Clindamycin antibiotics (3 parks of 60 capsules for 4x daily ) and a Prednisolon eye drop. The film cleared out and vision came back to usual at that point.
Exactly a year later Feb 2016, this milky film came back with a lot of floaters and severe pain that even moving the eyes was very painful, and all the bones surrounding my eyes ached. This time I was nursing my baby, and the chief (Prof) ophthalmologist decided to give me intravitreal Clindamycin, after which the floaters reduced but my vision continued to be cloudy and the pain persisted. They did further tests and the verdict was a combo infection of Toxoplasmosis and Zoster virus. I was placed on Cotrimoxazol and valtrex and Prednisolon eyes drops. this cleared the milkiness, however, It kept coming back whenever I stopped the cortisone drops or reduced it to 2-3 times a week. This has kept up for almost a year now and am still on the antiviral and Co-trim as well.
I believe they decided to change the drops, for fear of the side effects of its prolonged usage and because they still can't find any reason for my complains when they look into my eyes.
Now, I feel like there is still something that needs to be found out, which is causing this problems with the lights and the glaring. I hope this is not too much read here.
Do you think I should discontinue with the Ciclosporine? And from the above information, do you think there is another route to remedy? Many thanks again.
Fast forward to February 2015, I interned in a hospital as a nurse, barely a week into my internship, I noticed a milky/cloudy film covering my vision and light heads were stretching from the center and with every blink . I went to eye doctors and it was confirmed to be an infection. I was given Clindamycin antibiotics (3 parks of 60 capsules for 4x daily ) and a Prednisolon eye drop. The film cleared out and vision came back to usual at that point.
Exactly a year later Feb 2016, this milky film came back with a lot of floaters and severe pain that even moving the eyes was very painful, and all the bones surrounding my eyes ached. This time I was nursing my baby, and the chief (Prof) ophthalmologist decided to give me intravitreal Clindamycin, after which the floaters reduced but my vision continued to be cloudy and the pain persisted. They did further tests and the verdict was a combo infection of Toxoplasmosis and Zoster virus. I was placed on Cotrimoxazol and valtrex and Prednisolon eyes drops. this cleared the milkiness, however, It kept coming back whenever I stopped the cortisone drops or reduced it to 2-3 times a week. This has kept up for almost a year now and am still on the antiviral and Co-trim as well.
I believe they decided to change the drops, for fear of the side effects of its prolonged usage and because they still can't find any reason for my complains when they look into my eyes.
Now, I feel like there is still something that needs to be found out, which is causing this problems with the lights and the glaring. I hope this is not too much read here.
Do you think I should discontinue with the Ciclosporine? And from the above information, do you think there is another route to remedy? Many thanks again.
You have a ultra-serious problem. You have been treated for a ultra-serious internal eye infection (endophthalmitis). And toxoplasmosis and H Zoster can lead to complete loss of vision in the eye. You situation is precarious and you should not make any changes unless approved by the physicians treating you. If you have useful vision in that eye you are most fortunate and have received fine care.
Thank you very much. Yes indeed my doctors have been very kind and supportive. My right eye vision is as good as gone. The macular is affected and I only have some peripheral vision left (50%) and the left is scarred on most of the peripheral but 80% vision.
So I assume this problems with light is something I just have to live with?
So I assume this problems with light is something I just have to live with?
If it were easy to fix your team of Eye MDs would have done so by now. Do everything you can to take good care of your remaining eye. Guard against injury and disease.
MEDICAL PROFESSIONAL
These are all articles published in medical journals by Dr. Michael Kutryb and me on dysphotopsia. Some of data gleaned from these Eye Forums:
“Internet Forums Track Patients’ IOL Concerns: Premium intraocular lenses yield a disproportionately high number of patient complaints on these AAO-affiliated”, John C. Hagan III, MD, Michael Kutryb, MD, Review of Ophthalmology, April 2009 page 52-55
“Premium IOLs: Optimizing Outcomes Pre- and Postop Strategies. EyeNet magazine February 2009 Lori Baker Schena writer, John C. Hagan III MD Panel of Experts.
“Internet Advice: When Patients Go Online”, EyeNet magazine, May 2009 Mariam Karmel writer, quotes and feature research.
“Eye Care Patient Satisfaction is Weighed with Online Forums” Ophthalmology Times September 15, 2009 (with Michael Kutryb MD)
“Internet Forums Track Patients’ IOL Concerns: Premium intraocular lenses yield a disproportionately high number of patient complaints on these AAO-affiliated”, John C. Hagan III, MD, Michael Kutryb, MD, Review of Ophthalmology, April 2009 page 52-55
“Premium IOLs: Optimizing Outcomes Pre- and Postop Strategies. EyeNet magazine February 2009 Lori Baker Schena writer, John C. Hagan III MD Panel of Experts.
“Internet Advice: When Patients Go Online”, EyeNet magazine, May 2009 Mariam Karmel writer, quotes and feature research.
“Eye Care Patient Satisfaction is Weighed with Online Forums” Ophthalmology Times September 15, 2009 (with Michael Kutryb MD)
Somehow I missed this comment of yours when I was searching earlier. Wish I had seen this before my surgery, but then it never would have occurred to me that AcrysofIQ Toric lens might cause a problem. And your words would have meant nothing to me before my current crash course in the problems of glare (especially diagonal streaks) following cataract surgery. Now I personally have some context for your comment… unfortunately.
You wrote:
"Aspheric IOLs are less likely to cause glare than spheric. Square edges inhibit clouding of the posterior capsule and have lower yag rates but may have more glare/edge reflexes than round edges. The new aspheric Tecnis mono focal is, in my opinion, the best out there."
QUESTION: One reason you praise the Tecnis is because of the frosted edge that's supposed to reduce glare? So it should reduce the chance of glare as well as reduce the chance of POC because of its square edge?
HapKP
You wrote:
"Aspheric IOLs are less likely to cause glare than spheric. Square edges inhibit clouding of the posterior capsule and have lower yag rates but may have more glare/edge reflexes than round edges. The new aspheric Tecnis mono focal is, in my opinion, the best out there."
QUESTION: One reason you praise the Tecnis is because of the frosted edge that's supposed to reduce glare? So it should reduce the chance of glare as well as reduce the chance of POC because of its square edge?
HapKP
For anyone who's interested:
There's research that shows that dysphotopsia is not just an annoyance or discomfort but a problem that affects patient function:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/modernmedicine/modern-medicine-feature-articles/road-optical-precision?id=&sk=&date=&pageID=3
http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B1a1ce70b-d78e-4121-b698-6efa2c8111a8%7D/study-pseudophakic-dysphotopsia-impedes-function
There's research that shows that dysphotopsia is not just an annoyance or discomfort but a problem that affects patient function:
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/modernmedicine/modern-medicine-feature-articles/road-optical-precision?id=&sk=&date=&pageID=3
http://www.healio.com/ophthalmology/cataract-surgery/news/online/%7B1a1ce70b-d78e-4121-b698-6efa2c8111a8%7D/study-pseudophakic-dysphotopsia-impedes-function
Interesting. I just found a report of "adverse event" filed with the FDA regarding the Alcon AcrySof IQ Toric lens. Its malposition at a slight tilt caused a patient to experience diagonal lines/glare. Posterior Capsule Opacification (POC) was observed.
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1813627
At least one person has been upset enough to file a complaint with the FDA. Doubt that helped much.
http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/detail.cfm?mdrfoi__id=1813627
At least one person has been upset enough to file a complaint with the FDA. Doubt that helped much.
You may be right, but I like to know as much as I can because when making medical choices, I have discovered the hard way that what you do not know may come back to bite you. (cancer survivor)
Have a good night, Hap
Have a good night, Hap
MEDICAL PROFESSIONAL
You are WAY too far along the decision tree. Come back to where you are now. Don't concern yourself with those thoughts at all. Just put your anxiety on hold till you see your optom, your surgeon and perhaps a second opinion.
JCH MD
JCH MD
Typo: "This is what I am have all my fingers crossed" should be "this is why I have all my fingers crossed….."
I understand, and I'm with you 100%…. up to the point of doing the YAG capsulotomy. However, I have read that many people have had their diagonal glare problem fixed by explanting the offending lens (once it is proven to be a lens problem). I am not eager to have an explant because any new surgery involves risk, but so does YAG. And YAG means that I am stuck with that lens. As I understand it from my surgeon he would rather explant than do YAG (if the lens is the problem), because YAG might not solve the problem and then it's more difficult if not impossible to explant the lens.
This is what I am have all my fingers crossed that this will all go away. I do not want to be in a d***ed if you do, d***ed if you don't situation.
LAST QUESTION: If after ascertaining that the lens is the cause of the problem and it is not astigmatism (old or new) and I do an explant, what would be the best lens to replace it with? Not interested in multifocal IOL lenses. I will probably use mono focal plain vanilla lens & go back to my lovely Varilux trifocals. So problem free!
If this does not go away and nothing we have discussed helps, then I will definitely get a second opinion.
Thank you again! This must be nearly a full-time job talking to people on this forum.
HapKP
This is what I am have all my fingers crossed that this will all go away. I do not want to be in a d***ed if you do, d***ed if you don't situation.
LAST QUESTION: If after ascertaining that the lens is the cause of the problem and it is not astigmatism (old or new) and I do an explant, what would be the best lens to replace it with? Not interested in multifocal IOL lenses. I will probably use mono focal plain vanilla lens & go back to my lovely Varilux trifocals. So problem free!
If this does not go away and nothing we have discussed helps, then I will definitely get a second opinion.
Thank you again! This must be nearly a full-time job talking to people on this forum.
HapKP
MEDICAL PROFESSIONAL
There are several types of astigmatism: cornea due to regular or irregular astigmatism or lenticular/pseudophakic due to IOL torqueing or displacement.
See what the optoms says. If no solution and glasses do not eliminate the problem. Consider a second opinion with another surgeon. If he/she also feels due to posterior capsule opacity (a wrinkle is an opacity type) then most people would go ahead and do the yag capsulotomy at that time.
JCH MD
See what the optoms says. If no solution and glasses do not eliminate the problem. Consider a second opinion with another surgeon. If he/she also feels due to posterior capsule opacity (a wrinkle is an opacity type) then most people would go ahead and do the yag capsulotomy at that time.
JCH MD
Dear Dr. Hagan
I appreciate your prompt reply.
So you're saying that either it is caused by residual astigmatism which glasses can fix. Or it is caused by a fold/wrinkle in the capsule that glasses will not fix.
I asked my surgeon if I had ANY astigmatism remaining in my left eye. He checked and double checked and said that there is no astigmatism at all. I was at zero. During my one week post-op exam he said that everything was exactly where it should be & recited the numbers to his assistant for his notes. He had already told me about the wrinkle in the posterior capsule at the 24-hour post-op exam.
However, having my optom do the refraction to test whether the streak of glare goes away will in effect give me a second opinion on whether there is any astigmatism remaining. Can't hurt, although I am pretty certain my surgeon is right.
I suppose my old trifocals do not count as a test. I have been wearing them because they help with distance (e.g. small text on TV screen). They make no difference in respect of the diagonal glare/streaks/rays, neither better nor worse. I have tried my clip on sunglasses over these, they reduce the brightness of the diagonal glare but do not make it go away. I would be really happy if the streaks went away with glasses.
So if this a wrinkle or fold in the posterior capsule, what then? Wait & hope it goes away? How long would you wait if you could not drive at night because of the severity of the problem?
Thanks for your time, HapKP
I appreciate your prompt reply.
So you're saying that either it is caused by residual astigmatism which glasses can fix. Or it is caused by a fold/wrinkle in the capsule that glasses will not fix.
I asked my surgeon if I had ANY astigmatism remaining in my left eye. He checked and double checked and said that there is no astigmatism at all. I was at zero. During my one week post-op exam he said that everything was exactly where it should be & recited the numbers to his assistant for his notes. He had already told me about the wrinkle in the posterior capsule at the 24-hour post-op exam.
However, having my optom do the refraction to test whether the streak of glare goes away will in effect give me a second opinion on whether there is any astigmatism remaining. Can't hurt, although I am pretty certain my surgeon is right.
I suppose my old trifocals do not count as a test. I have been wearing them because they help with distance (e.g. small text on TV screen). They make no difference in respect of the diagonal glare/streaks/rays, neither better nor worse. I have tried my clip on sunglasses over these, they reduce the brightness of the diagonal glare but do not make it go away. I would be really happy if the streaks went away with glasses.
So if this a wrinkle or fold in the posterior capsule, what then? Wait & hope it goes away? How long would you wait if you could not drive at night because of the severity of the problem?
Thanks for your time, HapKP
MEDICAL PROFESSIONAL
The problem could be that you residual astigmatism, you may need glasses over the eye, the IOL could have rotated off axis. These types of problem will be corrected when glasses are worn.
If it is an opacity, fold or wrinkle in posterior capsule glasses will not make it go away.
You can have your optom do a meticulous refraction and put the prescription in trial frames and see if that makes the streak go away. If it does its not the posterior capsule and glasses will be needed.
If you are still not satisfied get another Eye MD surgeon second opinion
JC MD
If it is an opacity, fold or wrinkle in posterior capsule glasses will not make it go away.
You can have your optom do a meticulous refraction and put the prescription in trial frames and see if that makes the streak go away. If it does its not the posterior capsule and glasses will be needed.
If you are still not satisfied get another Eye MD surgeon second opinion
JC MD
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