Glare after capsulotomy

I have had continuing glare and starbursts after a second capsulotomy in my left eye on November 5, 2009.  (I had the second capsulotomy in the hope of alleviating the glare problem that developed after the first capsulotomy.)

Has anyone else had this problem, and did it improve over time?  I understand that in some cases, the glare condition may gradually improve as the remaining rim of the capsule becomes more opaque and blocks the scattered "glare light" from reaching the retina.  

The pupil diameter in my left eye is 4.0 mm.  I had an AcrySof MA60 6.0 mm lens (monofocal) placed in my left eye.  

Any information or insights would be appreciated.  

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

I would suggest a  second opinion looking for: IOL decentration, capsular edge problems, uncorrected refractive error, irregular cornea astitmatism and vitreous/macular pathology.

JCH MD

[andercom]

I have learned since making the initial post that the papillary aperture in each eye is 4.5 mm (not 4.0 mm as I reported) and the size of the YAG capsulotomy opening in the left eye is 5 x 5 mm (after the second capsulotomy.

My impression is that having the pupil size smaller than the size of the capsulotomy, and having both of these smaller than the IOL size, would be factors that would reduce glare.

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

That is correct.

JCH MD

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

Additional comment: your capsulotomy size and IOL optic size remain the same but your pupil size changes constantly. In twilight or dark your pupil size is larger than 4.5 MM and IOL edge or capsulotomy edge abberations could still be a problem.  Also dysphotopsia is possible with any type of IOL

JCH MD

[andercom]

Do you know if this problem tends to diminish over time, or whether anything can be done about it?  Is 4.5 mm an unusually large pupil size?

Also, I had the refraction in the left eye checked, and there was a small error that I had corrected.  It did not help.  I also had my prescription done in Crizal (anti glare lenses), but that did not help either.

Thank you for your replies.