Rings of light at night after IOL implantation

[pupillo]

Two weeks back I have been treated for cataract with IOL implantation (not multifocal) in my right eye. Now my day vision is ok, but the night vision is disturbed with rings of light of different diameter when looking at one or more spot of light (like car lights or just a lamp). Is this related to the type or size of lens used? Is it going to persist?
I would need to have also my left eye be operated, but I am worried that the same problem can arise. What should I do?

[mmrudy]

Halos or rings around lights at night are not an unusual phenomenon after cataract surgery. It can be surprising if no one warned you in advance, however.

I can not remember a time when I did not see halos. In my case, astigmatism in both eyes appears to be responsible. Recently, I had cataract surgery in the left eye. The surgeon replaced my lens with a toric IOL. This substantially reduced the halos to a very moderate level in the corrected eye.

Sometimes a spherical IOL will produce a halo effect. An aspheric IOL may be a better choice. You can search the list for info about aspheric IOL's.

Ask your opthamologist (or surgeon) what kind of IOL you received. Ask if you have  astigmatism. The astigmatism can be corrected with glasses, contact, surgery. If you don't have astigmatism, you may want to request an aspheric IOL for your left eye.

Will this phenomenon persist? I don't know. You are only two weeks post surgery and the eye is still healing. If they do persist, relax, give yourself a chance, you may be able to adapt and ignore the halos.

[Ray T Oyakawa, MD]

It should get better, especially when you get your glasses.

Dr. O.

[pupillo]

Thanks to both of you. You were both right in a way. Yes my right eye is somehow astigmatic. Since the day after the operation until yesterday I have been using temporary glasses without astigmatism correction. Yesterday I was given the prespcription for new glasses with astigmatism correction and it is already better, though not disappeared yet.
No, that effect wasn't reported in the long list of potential problems I was given and asked to undersign before the operation. Even in the simulations seen on this site I couldn't find it, as they are not exactly halos, but sharp, well defined concentric rings.
Thanks again for your comments.
Maurizio

[peakhope]

You might want to ask your doctor about LRI's to correct your astigmatism. They are an inexpensive, low-tech, surprisingly safe and effective procedure. I had LRI's done at the time my Crystalens HD's were implanted, and am very happy with the results.

I like that the blade stays away from your pupil area (so doesn't cause further glare) and that it is very forgiving, not requiring super-precise cuts. LRI recovery is much faster than PRK, and for me the idea of a Lasik flap is really icky.

Just make sure whoever does the LRI is an expert who has done a lot of them.

[pupillo]

It is now 6 months since the operation and the problem of rings of light at night is still there, though less frequent than early days. My doctor's opinion is that it can be related to the position of the IOL lens which may not be 100% correct. He himself warns about the risks of a new operation to reposition it. The lens used is RAYNER Model 620H, power +17.5D, length 12.5 mm.
Now the question is: what to do with the other eye also affected by cataract? Would you use a different lens or would you opt for a different surgeon?

[NeLso]

>... they are not exactly halos, but sharp, well defined concentric rings.

Please take what I say with a grain of salt because I am not a doctor.
(ie. I can steer you in a particular direction, but you need to do your own research)

From what you described, it looks like you have spherical aberation:
http://en.wikipedia.org/wiki/File:Spherical-aberration-disk.jpg

I forgot the name of the machine, but there is equipment out there that can measure the spherical aberration of your cornea.  Since your IOL is spherical, there is an additive effect.

From what I understand, a one-piece lens has a higher incidence of tilting.  Too much tilting is not good for negative-aspheric lenses.  Excessive tilting produces coma-aberration.  I don't think concentric circles comes from tilting, but your doctor knows best.  If tilting is the problem then an aberration-neutral lens will allow for tilting without causing aberration.  If tilting is not an issue, then go for a negative aspheric lens.  

[JodieJ]

The Raynor 620H IOL is not an aspheric IOL.  I don't think that the arguments in favor of a negative aspheric IOL would apply in pupillo's case.  (These arguments were used by Bausch & Lomb in an attempt to show that their IOLs were superior to those of their major competitors: the Tecnis and the AcrySof IQ.)

Pupillo, in your place I would definitely get a second (and perhaps a third) opinion about the bothersome rings of light.  I would certainly choose a different IOL for my second eye, and perhaps a different surgeon.

[NeLso]

Seaching through the reams of pdf's I saved in my harddrive, I found the topography machines.  The Carl Zeiss Meditec Hum­ph­rey Atlas, the Nidek-OPD scan and the Oculus Pentacam can do the cornea spherical aberration measurements.

“So, you can export your topography file to Dr. Sarver’s program and find out what the patient’s spherical aberration is,” says Dr. Holladay. “If it comes out to be +0.27 µm, then you know the Tecnis IOL with its -0.27 µm will be perfect. If it’s +0.15 µm, then the Alcon lens would be best. And, if it comes out to be zero, as might happen after a hyperopic LASIK, then the Bausch & Lomb lens would be the preferred option.”

This is the biggest issue I had in choosing a negative aberration lens.  I had no idea what the positive aberration from my cornea was!  

[JodieJ]

It is my understanding that cataract surgery itself can create an unknown amount of spherical aberration.  In this case, the type of pre-surgery measurement described above is total nonsense.

It wouldn't be difficult to design an experiment comparing the aspheric IOLs of different manufacturers.  If one of these brands is clearly superior, then why do no such studies exist?  (Hint:  No manufacturer will fund and carry out a study which is likely to show that the IOLs of their competitors are just as good as their own.)  

[pupillo]

Thanks to everybody for your comments.
In the last visit the doctor who operated put some drops in my right eye to dilate the pupil the most and he took a photograph of the eye. The lens margin can easily be seen in the bottom part which probably causes the problem at night, according to the doctor himself. In a way he admitted that the lens may not be perfectly positioned.
Can this be the only problem? In this case a different lens for the left eye is not required, but probably a different surgeon.