Need help please done everything,, Dr.Hagan,,, Halos , Starburst, Glare

[pop888]

Hi , Male 43 years old myopic living in the UK,,I have really bad starburst,glare and ghosting especially night time even I notice those symptoms indoors daytime ,,these all started a few years back as slight ghosting specifically in 2017 and progressed to all kind of positive dysphotopsia...I have slight elevated eye pressure diagnosed back in 2017 and taking Monopost for it I was on latanaprost but the preservative BAK caused an eye reaction and inflammation this was January 2021 so straight away they put me on Monopost which is really good keeps my eye pressure around 16 , 17 all day ...

I have been also diagnosed with Pigment Dispersion syndrome,,,,Myopia caused me PDS and PDS caused the elevated pressure and I have also alot of floaters but doesn't bother me anymore ...and I remember one time at an eye test back in 2018 the Optometrist said there is a Corneal dystrophy evident under a slit lamp examination so I freaked out and went to an Opthalmologist whom confirmed that I don't have Corneal dystrophy...I think the Optometrist mistaken the PDS by Corneal dystrophy...this is my medical eye history..

Back to the starburst,, glare etc...those symptoms really bothering me in a matter of the last year I have seen about 5 Opthalmologists and numerous eye tests with Optometrists and they never gave me an answer what causes these symptoms ...I have had an advanced eye test in April this year involving OCT,,,,Corneal topography "Pentacam",,,,visual field ,,,even I had the IDesign wavefront abberometery all tests were in normal ranges and no Keratoconus and they never mentioned anything about irregular Astigmatism so I assume I don't have it ...one Optometrist mentioned I have large pupils measured in Scopotic condition,, measuring 7.4 mm both eyes but I don't think this is the case because on my old eye test report my Scopotic pupil measured 7.5 and didn't have all those symptoms...

I have seen a high volume Cornea specialist about a year ago whom confirmed PDS " Krukenberg Spindle ( Endothelial Pigment dusting) inferiorly in a linear pattern and no iris Transillumination defect...and confirmed Aberrometry within normal limit...he suggested to try Alphagan P which completely removed the issue of ghosting and glare this was a year ago but now when I try it ,, it removes the dysphotopsia by 85  percent so something is progressing here and I don't know what it is ... He also noted in the letter that there " is a subtle chance that if I have aberrations due to myopia with Astigmatism to try RGP contact lens but I haven't done that because I hate and don't tolerate contact lenses..

I really don't know what to do else the last Opthalmologists I have seen was in May this year he is Glaucoma and cataract specialist and couldn't find what causes my symptoms,,,even I had an eye test with an Optometrist like a week ago and she said everything looks fine ,,,Optic nerve macula retina from the OCT..

I have done the pinhole test and cleared all those symptoms but the hole I made has to be so tiny and centered to remove those symptoms,,,if the hole is a bit bigger I see the Starburst and ghosting ...I have a feeling that my symptoms are caused by some forms of irregular Astigmatism or a Cornea issue but I have seen the specialists and never mentioned anything about Cornea disease apart from the Pigment dispersion syndrome which I don't think can cause my severe symptoms...and they told me my lens is clear so no cataract but I feel my eyes or Pupil are not reacting properly to different lighting condition s and no RAPD as confirmed by doctors...Iam really looking for thoughts and opinions here especially from Dr.Hagan

My last RX is dated 02/09/2022
Right : Sph; -3.75 Cyl ; -2.00  Axis : 30
Left : Sph ; -2.75  Cyl ; -2.25  Axis : 150
Aided VA ,,Right : 6/4 Left : 6/4

Any thoughts or Opinions much appreciated

[alexA2233]

Hello. I’m experiencing the similar symptoms. I’m 14 years old. First my vision got worse after quarantine in 2020. I didn’t go to an eye doctor until my vision got worse. I went to an ophthalmologist in September 2022. I got my glasses. But in april 2021 I started seeing like reflection of something where the light shines. I don’t know how to describe it. It is happening when I look at my phone for too long or when I’m tired, but sometimes it happens as soon as I wake up. It is happening in both of my eyes. My eye doctor said I have perfectly healthy eyes. Nothings wrong. Also the lights in the night appear to be like larger. I don’t know how to describe it not larger but like another layer. It’s not double vision. It also started happening when i look at my phone. Especially when there is black background and white letters. It is also worse when i look down. I think it’s called fluctating vision. I’m worried. Also starburst, glare and halos around really bright lights. I forgot to mention but it is happening more  in winter and on cloudy days. She said I don’t have dry eyes and everything is fine. But I’m still worried. Does anyone else knows what can cause this or is experiencing same symptoms? And could contact lenses help because she said maybe to try them? Thanks.

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

I'm sorry but your symptoms are too vague and ill defined to give you a specific cause or list of causes.

[alexA2233]

I’ll try to explain better.
As I said I have another layer of something. For example we have a table and I see a line above the table. Like a reflection, highlight. It was happening only when I look far but now it started happening when I watch my phone. Also my vision is blurry when i look near in one eye and a little bit more yellow.  Can you please tell what it could be and should I be worried? Thank you.

[alexA2233]

And I forgot to ask could this all be from anxiety because I have really bad anxiety.

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

anxiety makes everything worse, many of the posters here with unusual long standing problems with many normal eye exams have stated they are highly anxious

[alexA2233]

Thank you so much. I think i found what i have. Keratoconus. I see same as the people with that. Could this be missed on the eye exam

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

Yes it is possible. The test you would need to rule that out is a corea topography.   It is not part of a routine exam. If you have seen an ophthalmologist call and see if they will schedule. Do you have a copy of your glasses prescription? People with K-conus usually have a large amount of astigmatism. If you do post it

[alexA2233]

My ophthalmologist said I don’t have astigmatism. In one eye I have -1.75 and the other -1.5

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

You can go ahead and ask for the test but highly unlikely you have kerataconus

[alexA2233]

My ophthalmologist said I don’t have astigmatism. My glasses are in one eye -1.75 and in other -1.5. But I got my lenses and she increased by 1/4.

[alexA2233]

What else could I have and what do I do?

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

I have taken this discussion as far as I can go.  There are other posts you might find interesting, you can use the seach feature. Otherwise deal with your local ophthalmologist

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

After all those tests it is not at all likely that you have any serious problems.  Since your symptoms get worse with large pupil and better with small pupil my suggestion would be to speak with your glaucoma ophthalmologist and if you saw a retinal ophthalmologist and ask about a trial of dilute pilocarpine which makes the pupil small in light and dark and is now sold to help people in the early stages of middle age do without reading glasses. It is dilute pilocarpine and in the US sold under the brand name  VUITY

[pop888]

Thanks very much Doctor for your reply ,,The Glaucoma specialist doesn't know what is causing my dysphotospia and here in the UK they don't like and refuse to prescribe Pilocarpine because of the risk of retinal detachment especially with someone as me have floaters...the Glaucoma specialist said to carry on using the Monopost and to use Alphagan P as required but not so often ...And for me I really like The Monopost because no preservatives and very effective and also doesnt give me side effects apart from the occasional dry eyes....

But at one point I got suspicious about the Glaucoma drops that can cause me all those dysphotospia...I found a study somewhere on the internet saying that Glaucoma drops can cause some form of Iris muscle dysfunction that control the Pupil size in different lighting condition because I feel my pupil doesn't work properly or sluggish or over dilates in low lighting....what your thoughts about this explanation??

I was going to get the SLT done to come off the drops but my doctor is reluctant to do this because of my PDS could cause IOP spike but some doctors say it can be effective in my case if low laser power used ...I think I need second opinion....What do you think Doctor ??

Do you think I may have some sort of irregular Astigmatism that the corneal topography and wavefront abberometry wasn't able to pick up ?

Thanks very much for your effort

[pop888]

Sorry just to add to my last comment,,Any harm of using Alphagan P so often ? Any risk of retinal detachment or ocular surface disease with Alphagan ?