Glare after capsulotomy

[CC450]

I have significant glare in evening lighting conditions. This glare is apparent with all light except full sunlight or full direct overhead light. It is like someone is shining a light in my eyes and the light has streaks through it. I saw my eye surgeon one week after my YAG and he said my brain would eventually adjust to this. I am scheduled to see him again in 2 weeks, but it seems to be getting worse rather than better. I asked him about the opening at my 1 week appointment and he said everything looks perfect. I am 52 years old and unfortunately my daughter's house where I go to see my granddaughter has this lighting that causes glare and it is taking so much of the joy out of seeing her. I can't focus on anything but this glare. I thought the YAG was going to make it better and it is worse. I am so depressed about this and would be willing to try anything to make this better. Are there any treatments (at this point I don't care how risky) that anyone has to make this glare go away.

[Sandra M Brown, MD]

If you had a multifocal lens implant like a CrystalLens or Rezoom or Re-Stor, this type of glare is a common side effect that can be permanent because it is caused by the design of the implant.

If you had a monofocal implant (meaning no fancy up-close focus), you may still be getting glare from the edge of the lens capsule.  The fact that you don't have glare in bright light is due to your pupils shrinking to a small diameter, thereby cutting out light that is scattering as it passes through your lens implant.  If you have unusually large pupils, a YAG opening that is large enough for most patients may still be too small for you.

You didn't say how long ago you had your cataract surgery.  Some people do have to let the implant "settle in" for 6 months or more before the glare stops.

[CC450]

I had a monofocal lens implant and it was on April 15, 2009. I did not have any glare symptoms in the beginning--I only saw the edge of the lens for a short time. The glare started a couple months after my surgery and I thought it was because I needed the YAG treatment. The glare is actually worse now than it was--it is brighter (shinier) and it happens much more than it did before. Does that sound like something a larger opening might fix? Thank you for answering.

[Sandra M Brown, MD]

Based on your symptoms, it is possible that you need a larger YAG opening.  You are young and your pupil diameter in low light is definitely larger than that of patients in their 60s and above (pupil diameter in the dark is strongly correlated with age).  It is possible that you got the "standard diameter" YAG which simply isn't big enough.  Because we all shine lights into your eyes to examine you, of course your pupil shrinks down and hides the edge of the YAG so it looks "fine".

One simple experiment:  I would guess your glare is bad when looking at distant car headlights at night.  Using the tip of a pencil, punch a small hole about 2 mm in a 3 x 5 card.  You can even make 3, 4, and 5 mm holes.  Get yourself into a situation where you really have bad glare and then look through those holes.  Figure out the largest diameter hole that eliminates the glare.  Then have someone compare the diameter of the hole with the diameter of your pupil (you have to keep looking in the distance, under low light conditions) by holding the card up next to your eye.  If the hole is obviously smaller than your pupil, then the clear central zone of your lens implant is too small.  This is not the only explanation but it is the most likely.  If so, getting a larger YAG should reduce your symptoms.

[CC450]

Thank you so much! I will definitely do that experiment and I can't tell you happy I am that this might be resolved. I am hoping for the best. Thank you so much!!!!!!!!

[Cheryl327]

CC450, please post back your findings.  I have the same problem and would be interesting in hearing the results.

When I was 18 I had a detached retina and scleral buckle surgery.  As the years went by I developed cataracts in that eye.  Finally in May 2008 I had cataract surgery at age 37.  I had a lot of glare after the surgery and I then had YAG surgery Dec 2008.  My vision was beautiful for about 2 weeks and the glare came back.  The glare is terrible at night and my vision is not as clear as I was hoping - very frustrating.  I would love to hear how your story turns out.

[JodieJ]

Have you considered getting a second (or even third) opinion about your glare problem from an experienced cataract surgeon?

[CC450]

I will let you know. I have an appointmen on November 3 with my surgeon and I will see what he says. He told me last time my brain would eventually adjust to this, but it has been 6 months and it is not any better. I have had a second opinion and when I saw him last time he said the first step was the YAG and if that did not work there were a couple more things he could try (one being a piggyback lens to deflect some glare from the edges) and he thinks I need PRK to sharpen my vision (and I am not interested in that at this point). Neither one of them mentioned anything about the size of the opening. That would be a much better solution. I will post back and let you know.

[CC450]

Well, I went to see my surgeon today and he thinks the opening is large enough and he wants to give it 2-3 more months. I go back to see him at the end of January and if it is not better he said we could look into enlarging the opening. He is very consevative (which I like) so he said unless it is really bothering me it won't hurt anything to wait. It does bother me, but not to the point where I can't function. The majority of the time I don't have glare--it is just in certain lighting conditions. Please let me know how things turn out for you.

[Cheryl327]

Sorry you didn't get any answers from your latest appointment.  I plan on getting a second opinion but given all that my eye has already gone through, I'm a little leary.  My current opthamologist is highly rated and I've been going to him for 24 years.  What is the best way to find a top rated eye doctor that deals with these types of problems?