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Getting glare problems after YAG laser capsulotomy
This morning I had YAG laser capsulotomy done on my right eye because of posterior capsular opacification. Before the op, I used to see starbursts around street lights that looked a bit like dandelion clocks. I thought the op would cure this, but I'm alarmed to find the problem is now much worse. Now, I get radial streaks, one of which is MANY times worse than what I was seeing before. Frankly, I'm terrified.
I did some quick research and found a post from an eye surgeon that said this can be due to the hole in the capsule being too small, and that it may have to be enlarged. This worries me for two reasons: (1) I had to wait a long time to have the op done, and I'd hate to be waiting for another long period to have it put right and (2) you have to have a contact lens put in just before the op, and I found that to be one of the worst experiences I've ever had - incredibly uncomfortable - and I dread having to go through that again.
It's only been a few hours since I had the op done, so I'm wondering: is there any chance that these streaks will go away? Or will I just have to have further work done on this eye? I'm extremely worried by this, and any advice would be most welcome.
I did some quick research and found a post from an eye surgeon that said this can be due to the hole in the capsule being too small, and that it may have to be enlarged. This worries me for two reasons: (1) I had to wait a long time to have the op done, and I'd hate to be waiting for another long period to have it put right and (2) you have to have a contact lens put in just before the op, and I found that to be one of the worst experiences I've ever had - incredibly uncomfortable - and I dread having to go through that again.
It's only been a few hours since I had the op done, so I'm wondering: is there any chance that these streaks will go away? Or will I just have to have further work done on this eye? I'm extremely worried by this, and any advice would be most welcome.
Dr Hagan
I'm just writing to thank you for your very detailed reply, and to bring you up to date on my problem.
Yesterday I went back to the hospital where I had the capsulotomy done, to have that eye looked at. I'm in the UK (I should have mentioned that before - sorry) and had the op done by our National Health Service, so I wasn't examined by the surgeon who'd done to procedure. Unfortunately, it's as I'd feared: the laser has pitted the IOL. grasping for a bit of hope, I asked the doc if this glare problem could be caused by the capsulotomy hole being too small, but she said no, because it was definitely big enough. I'd been wondering if these pits could have been caused by the surgeon using a cruciate cut, as this takes the laser shots right across the optical axis, but she said that from the shape of the hole, she was sure he'd used a circular cut. I asked her how this could have caused its so near to my centre of vision, and she said that with a circular cut, you still have to make one or two shots in the centre in order to cause the cut tissue to detach completely.
As I expected, she was very unhappy when I raised the question of replacing the lens, then she said they could try a lot of things before resorting that this. However, the only thing she mentioned seemed so obviously wrong to me that I'm surprised she said it: she said I could try 'glare reducing glasses. I honestly can't see how they could help., because my problem is one or more pits in the IOL - all that occurs after the light has reached my eye. I looked on Amazon to find out just what glare reducing glasses did, and it seems they just cut out blue light. I can't see that helping.
I asked her if Pilocarpine or Brimonidine might help (my idea was that they might reduce the pupil size enough to cover the pits that were causing the trouble). She said they wouldn't help. I still might try them, though I thing she's probably right, as I still get the problem when I look at a bright light, which should constrict the pupil as much as eye drops would do.
So I'm pinning my hopes in lens exchange. I'm grateful for those names you gave me (I remember Dr Maskett's from years ago when I read an article of his on dysphotopsias) but I don't know if it would be a good idea for me to go all the way to the United States - it might if your country definitely had expertise you can't get in the UK, but I just don't know if that's the case.
I've made an appointment to see someone privately about the possibility of lens exchange (I honestly wish I'd gone private to get the capsulotomy done!) The info online says he specialises in complex cataract surgery and is also a vitreoretinal surgeon, so it seems he's a sensible choice.
Once again, thank you for doing so much to help me.
I'm just writing to thank you for your very detailed reply, and to bring you up to date on my problem.
Yesterday I went back to the hospital where I had the capsulotomy done, to have that eye looked at. I'm in the UK (I should have mentioned that before - sorry) and had the op done by our National Health Service, so I wasn't examined by the surgeon who'd done to procedure. Unfortunately, it's as I'd feared: the laser has pitted the IOL. grasping for a bit of hope, I asked the doc if this glare problem could be caused by the capsulotomy hole being too small, but she said no, because it was definitely big enough. I'd been wondering if these pits could have been caused by the surgeon using a cruciate cut, as this takes the laser shots right across the optical axis, but she said that from the shape of the hole, she was sure he'd used a circular cut. I asked her how this could have caused its so near to my centre of vision, and she said that with a circular cut, you still have to make one or two shots in the centre in order to cause the cut tissue to detach completely.
As I expected, she was very unhappy when I raised the question of replacing the lens, then she said they could try a lot of things before resorting that this. However, the only thing she mentioned seemed so obviously wrong to me that I'm surprised she said it: she said I could try 'glare reducing glasses. I honestly can't see how they could help., because my problem is one or more pits in the IOL - all that occurs after the light has reached my eye. I looked on Amazon to find out just what glare reducing glasses did, and it seems they just cut out blue light. I can't see that helping.
I asked her if Pilocarpine or Brimonidine might help (my idea was that they might reduce the pupil size enough to cover the pits that were causing the trouble). She said they wouldn't help. I still might try them, though I thing she's probably right, as I still get the problem when I look at a bright light, which should constrict the pupil as much as eye drops would do.
So I'm pinning my hopes in lens exchange. I'm grateful for those names you gave me (I remember Dr Maskett's from years ago when I read an article of his on dysphotopsias) but I don't know if it would be a good idea for me to go all the way to the United States - it might if your country definitely had expertise you can't get in the UK, but I just don't know if that's the case.
I've made an appointment to see someone privately about the possibility of lens exchange (I honestly wish I'd gone private to get the capsulotomy done!) The info online says he specialises in complex cataract surgery and is also a vitreoretinal surgeon, so it seems he's a sensible choice.
Once again, thank you for doing so much to help me.
1 Comments
I have said about all I'm going to say. Final comments. Very unlikely that IOL pitting is your problem. Marks on the IOL made during yag capsulotomy are not called IOL pitting, there is various terminology but laser marking or laser opacity is a much better term. Experienced surgeons do not laser through the optical center of the IOL. start peripharal and go around like a can opener. I would try all of those things on my list before you do IOL exchange which involves major risks. Your next choice, outside you health 'service' and with interest in complex IOL seems a good choice. Good luck
Dear Dr Hagan
I'm replying now rather than waking a couple of weeks because I think I've figured out the cause of my problem, but don't know if there's any solution, and I'm really depressed.
I noticed that I was getting this glare even while looking at a bright light indoors, where the light would constrict my pupils. This suggested to me that the size of the capsulotomy hole might not be the cause. Then I made a pinhole in a piece of card and looked through it at a bright light while moving it around in front of my eye. The streaking suddenly occurred when the pinhole was in two places, but disappeared when I moved the pinhole to a different part of the visual field.
I may be wrong, but this suggests pitting of the lens (something I'd not read about before getting the procedure done). From what I've read, pitting is quite common but only causes glare problems in very rare cases - I've a horrible feeling I'm one of those cases.
In a panic, I looked up solutions, but the only one seems to be IOL exchange, which apparently is difficult and risky after capsulotomy. The fact that I've had a pars plana vitrectomy in that eye might make lens exchange even more difficult.
Walking around at night has always been one of the greatest pleasures in my life, and I'm in shock to think that this will no longer hold any enjoyment for me, just because of a couple of tiny pits in my lens.
I'd thought of miotic eye drops as a solution - if my pupil closed down far enough to cover the pits, that might work. The problem here is, I developed an allergic reaction to Brimonidine, and the only time I tried Pilocarpine, I got a bad headache.
I don't know if you can suggest anything, Dr Hagan, but I'd be very grateful for your thoughts.
I'm replying now rather than waking a couple of weeks because I think I've figured out the cause of my problem, but don't know if there's any solution, and I'm really depressed.
I noticed that I was getting this glare even while looking at a bright light indoors, where the light would constrict my pupils. This suggested to me that the size of the capsulotomy hole might not be the cause. Then I made a pinhole in a piece of card and looked through it at a bright light while moving it around in front of my eye. The streaking suddenly occurred when the pinhole was in two places, but disappeared when I moved the pinhole to a different part of the visual field.
I may be wrong, but this suggests pitting of the lens (something I'd not read about before getting the procedure done). From what I've read, pitting is quite common but only causes glare problems in very rare cases - I've a horrible feeling I'm one of those cases.
In a panic, I looked up solutions, but the only one seems to be IOL exchange, which apparently is difficult and risky after capsulotomy. The fact that I've had a pars plana vitrectomy in that eye might make lens exchange even more difficult.
Walking around at night has always been one of the greatest pleasures in my life, and I'm in shock to think that this will no longer hold any enjoyment for me, just because of a couple of tiny pits in my lens.
I'd thought of miotic eye drops as a solution - if my pupil closed down far enough to cover the pits, that might work. The problem here is, I developed an allergic reaction to Brimonidine, and the only time I tried Pilocarpine, I got a bad headache.
I don't know if you can suggest anything, Dr Hagan, but I'd be very grateful for your thoughts.
1 Comments
It is highly unlikely that IOL pitting is the cause of your problem. And as you have found out it is very unlikely that the size of the capsulotomy is the problems. These are some possible solutions based on the multiple causes of the problem:
1. UNCORRECTED REFRACTIVE ERROR: If a careful glasses test eliminates the streaking then you should wear glasses or contact lens
2. IRREGULAR CORNEAL ASTIGMATISM; this can usually be diagnosed with a corneal topography. Can often be treated by contact lens usually gas permealbe, or in stome cases surface LASIK (PRK)
3. IOL DYSPHOTOPSIA: Since pupil size is often the problem, worse when pupil is big, better when pupil is small. Several options. If you tried 1% pilo and had problems but the smaller pupil helped, you could have a pharmacist dilute the pilocarpine down to 0/5% or 0.75% OR since you had problem with bromonidine if it helped and you were on the generic you can try the Brand Name Alphagan-P which has a patented and gentler preservative than the BAK in the generic.
4. SOFT IRIS COLOR Contacts: Thses are soft contacts that have a iris on them and are usually used for cosmetic changing iris color. Helping problems like yours has been described.
All of the above and other things should be tried before you do any intraocular surgery which carries much higher risk. If you have the financial wherewithall to fly to national experts on this kind of problem e.g. Robert Oscher, MD Cincinnati or Sam Masket MD in California, or Doug Koch, MD in Texas or ask your local opthalmic surgeon to refer you that would also be an option.
1. UNCORRECTED REFRACTIVE ERROR: If a careful glasses test eliminates the streaking then you should wear glasses or contact lens
2. IRREGULAR CORNEAL ASTIGMATISM; this can usually be diagnosed with a corneal topography. Can often be treated by contact lens usually gas permealbe, or in stome cases surface LASIK (PRK)
3. IOL DYSPHOTOPSIA: Since pupil size is often the problem, worse when pupil is big, better when pupil is small. Several options. If you tried 1% pilo and had problems but the smaller pupil helped, you could have a pharmacist dilute the pilocarpine down to 0/5% or 0.75% OR since you had problem with bromonidine if it helped and you were on the generic you can try the Brand Name Alphagan-P which has a patented and gentler preservative than the BAK in the generic.
4. SOFT IRIS COLOR Contacts: Thses are soft contacts that have a iris on them and are usually used for cosmetic changing iris color. Helping problems like yours has been described.
All of the above and other things should be tried before you do any intraocular surgery which carries much higher risk. If you have the financial wherewithall to fly to national experts on this kind of problem e.g. Robert Oscher, MD Cincinnati or Sam Masket MD in California, or Doug Koch, MD in Texas or ask your local opthalmic surgeon to refer you that would also be an option.
Thank you for replying so promptly. I'll wait a couple of weeks as you suggest.
1 Comments
MEDICAL PROFESSIONAL
If you still have the problem in 2 weeks repost. It is way too early to tell now
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