Post-cataract surgery light streaks

Question

I am 5 months post-cataract surgery. Night time lights cause diagonal streaks in the operated on left eye. I have been treated in an eye center and have seen multiple doctors and each one has told me different things. One said
caused by the residual astigmatism from the surgery and that glasses should help,but they didn't. Another doctor said it is caused by the rim of the new IOL. One of them said that if and when a YAG is needed it can be corrected. I am trying to learn the root cause of these light streaks. Has any one had these streaks removed either through a subsequent procedure or simply disappear over time? I am really starting to give up on the latter as I become further and further removed from the initial post-surgery recovery time. If and when the second eye needs cataract surgery and this happens in the second eye as well I probably would lose the ability to drive at night. Thanks in advance to any one who provides feedback. It is greatly appreciated.

ozzlori · Answer

I have developed the same night vision problems in an unoperated eye after dilating drops were put in that eye and my night vision has been awful for 16 months (it was crystal clear before the dilating drops).  I wonder if dilating drops have caused this for anyone else.

Moira59 · Answer

I've had cataract surgery on both eyes and after each surgery I could see bright diagonal streaks when looking at bright objects or nighttime lights. My doctor said that they should clear up on their own, but if not, a treatment with a YAG laser would eliminate them. Fortunately both eyes resolved in time without any treatment. The left eye took only about 6 days, but the right eye streaks were with me for a while. I did notice, however, that these streaks were becoming shorter, and after a while I just stopped paying attention to them...they finally did leave, so give yourself a little more time.

JET314 · Answer

Your situation seems almost identical to mine. Cataract surgery in 2015 for both eyes, 30 days apart. Then the YAG about 3 months later. Then the starbursts, light swords. etc. but mostly in the left eye. It can happen in the right but seems to be less frequently. I hate this !! Can't read at night. I switch between 4-6 pairs of reading glasses for computer work and anything after dark you might as well forget.  Daytime is fine for distance and driving. I think there needs to be more info for people on what can happen with cataract surgeries. It's not all that great for everyone. I've had more than one doctor say "there's nothing wrong." Guess again !! And I'm not using the toric lens, just the IOL.

JohnHaganMD · Answer

I would strongly suggest you see one, ideally two, other different cataract/refractive surgery surgeons for 2nd and 3rd opinion about what best to do.  Folds in the posterior capsule usually do not cause problems (and are not the same as posterior capsular opacities)  Having a yag laser will make it much more difficult and less safe in case a IOL exchange is necessary.  Another thing that is very important is if your symptoms are "cured" by wearing glasses with your post op refraction. If yes then wearing glasses or having post op lasik might help if no then the problem may be the IOL itself. use the search feature and read about dysphotopsia (what you have) post operative with multifocal IOLS.

wimax · Answer

I had cataract surgery in my right eye in this past December, 2016. I had a multifocal lens replacement.   My vision is worse than before the surgery, especially my night vision.  When it is completely dark, I see multiple streaks across each headlight from ground to way up in the sky.  They are always at an angle from 2 to 8 on a clock.  I also have starburst and blurring on every street sign.  During the day, if I look at a light, there is a streak, fairly wide at the same angle.  I can live with the daytime streak, but can barely drive at night except with no oncoming traffic. Both my close and far off vision are worse.  I am told that they got my lens prescription incorrect and there is also a fold in my posterior capsule.  
    The doctor wants to do Yag surgery, but I am afraid that it will cause all the lights and glare to be worse than what is already is.  He also wants to do laser surgery to correct my vison.  Does this sound like the proper thing to do?  I would not think one could do laser surgery on an eye with lens replacement.  With two things wrong, I am having trouble trusting this surgeon.  Do these solutions sound correct?

JohnHaganMD · Answer

You need to start by getting a 2nd and 3rd opinion from an experienced cataract/refractive surgeon.

Your problem could be due to the toric IOL being "off axis", or cloudy posterior capsule being the two most common. Have you had glasses prescribed?

JCH MD

NanaGchrisgj · Answer

I had cataract surgery in both eyes this past July. The right eye was done first. My doctor put in a toric lens which was for close vision. A week later he put a toric lens in my left eye which is for far vision. I started with fogginess in the right eye first. In September he performed YAG on the right eye. Since then I have been experiencing sharp streaks of light when seeing headlights or street lights. Just this past week he performed YAG on my left eye. The starburst effect is far worse than my right eye. There is also fogginess and my vision is worse. Driving at night is a horror for me. I am blinded by headlights, streetlights, etc. I can't use my high beams because the reflection of streets signs blinds me. I can't watch TV because it is too bright. I get pain in the left eye. My Dr. assures me there is nothing wrong. He says of the thousands of cases he has dealt with over the years, he has never heard of these symptoms post op. I can't help but feel that I am being conned. After reading the posts on here I know that this is not something that is only in mind. I know that others are experiencing the same serious problems that I am experiencing. I am so frustrated and don't know what to do next. I need to drive at night because I work rotating shifts. Please help!

JohnHaganMD · Answer

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Anomalychick · Answer

Ever since my YAG I live in what I can only describe as a post apocalyptic snow globe.
      I do not have a crystalens, I have the synchrony IOL which was never available in the US. Immediately after YAG I developed floor to ceiling starbursts. Mine also rotate. I can see a piece of the capsule moving through my vision that causes light beams to lengthen and rotate every time I move my eye. It also looks like fog or smoke, but can cause blurring or even temporary double vision as it passes through in certain situations. In my left eye its so thick it will actually reduce my vision below reading acuity as it passes through. In my right eye I can barely see it, but the rotation and star bursts are much worse in the right eye. They're like white windshield wipers that cross my field of vision whenever I move my eyes. (I can barely see the one in my right eye and if the one in my left wasnt so bad, I may never have realized thats what was causing it.)       
      3 cataract surgeons and a retinologist insist that I am perfectly fine and there is nothing that can be causing what I am describing. At the same time I have been completely and totally disabled by this. I can't read, I can't drive at night, and I am in a constant state of irritation about how ridiculously awful my vision is. Even walking the dog at night is a laser light show adventure that I can barely complete without worrying for my safety and becoming extremely depressed. At work I can watch rotating beams from every single light source sweep back and forth as I move my eyes.I am severely depressed and this has more or less derailed my entire life. (I am 31 years old and refuse to leave my house. The only reason I still have a job is because my cataracts were so bad my workplace thankfully still has me registered as visually impaired and gives me whatever I need including time off when I can't deal)  At the same time I can read the eye chart at 20/20 (For one second out of every 5) so the doctors say I must be fine. They are blaming dry eye, but I had severe dry eye before the YAG and did not have any of  these problems.  
          I cannot be sure about this, but I suspect that pieces of the back of the capsule are hanging out right behind the IOL. (Not by the retina) My retinologist told me three times I had no floaters that could be causing what I was describing and then all of a sudden he told me to hang on  because he got a glimpse of a tiny piece of debris IN FRONT of the vitreous that was not usually visible, but moved through my central vision when I move my eye. He swears its too small to be causing my problem. However, its location and movement perfectly matches my symptoms and I believe that it is somehow interacting with the specialized optics on my IOL to cause the starbursting. 
      The doctors keep insisting that YAG debris is reabsorbed over time, which is why I havent commited suicide yet. I believe a vitrectomy will solve the problem, but it seems like a pretty severe step for something that will supposedly go away on its own, that is not even in the vitreous. (And of course I doubt anyone would do one since I technically don't even have a visible floater) I wonder if explanting the IOL and going through the capsule to manually remove the piece lying behind it may be an option. I really have to wonder if I'd be better off with aphakic contact lenses or iris sutured IOLS and my vitreous intact than I am right now or I would be if I had a vitrectomy for this. I'm just taking it one day at a time hoping this gets better although I dont believe that it will anymore. (Its been 14 months since the YAG, and there has been no improvement. The piece in my left eye has lightened and become harder for me to see, and as it has done this the starbursting that eye has actually gotten more noticeable. My right eye has not changed, but the floater was nearly invisible to begin with)
 
       I have found around a dozen people complaining about these symptoms across the internet, and the only thing we have in common is that our doctors insist that there is nothing wrong with us, or admit that they don't know whats wrong with us. I am 99% sure it is unluckily located YAG debris (the tiny pieces of your capsule that the laser broke off) combined with the light bending properties of your IOL.
    Thats for the people who developed their problems after YAG. 
     I have also realized that the majority of people who had these problems before the YAG have Toric IOL's. There is too much that the doctors don't know.

markYO · Answer

I am going on 9 months with both eyes IOL. It's the standard lens, not toric. I have irregular astigmatism. Day vision is very good, not perfect and I drive and function well. I have glasses for night driving suffer those starbursts everyone talks about, but can still drive. Hoping it gets better over time.

fncpnts · Answer

I have the same problem you have.  Horrible at night trying to drive.  I won't let them perform a YAG because according to some people it might get worse.

BlissPood · Answer

I had cataract surgery in 2011 with a regular lens to help with myopia. I was definitely not a candidate for the fancy lenses that do bi-focal, etc. My surgeon was from Boston and a leading man in this field. I have had zero problems with an Abbott IOL.  The local surgeon would not even think of doing the surgery since I had RK's and Lasik  previously and those MD's were no longer practicing so no idea at all about what Rx I needed as no idea of what my cornea was before all the surgeries. I can only say that when it comes to your vision, the best is really not good enough. My brother had success locally with one eye and the other is like you people are describing. No one can tell him what the problem is. It's was perfect but has developed a daytime glare even after YAG. I am now needing the other eye done so will have to go to Denver or Salt Lake City. I advised my cousin to get her cornea information pre-LASIK for the day when she needs cataract surgery. Yes, I have astigmatism from the RK cuts but my overall vision is close to 20/20. He did a magnificent job for having to guess at a size and correction. I drive at night and do as I please.  I hope this lens manufacturer helps some of you at least.

bookquilt · Answer

I have posted my cataract surgery experiences here, too, and I am still a work in progress. I had the option to spend thousands extra and do the high end bifocal lenses, but learned from a coworker how hard it is for her to drive after dark. Left eye received a regular distance lens after the right which needed the toric. Having read everyone's comments over a year, I am not sure whether it is the lens or the type of problems we bring to it, that is causing the halo/flare problems. I have dry eye but that has it's own set of shifts which change fairly rapidly by season, temperature, and whether the heat or AC is on in the car. I have had a change in astigamatism with the problem eye so am trying a new prescription. I do not ride the expressways at night, unless the oncoming traffic is low volume. I am fabulous on a dark country road in dry weather. Rain after dark is still a problem but I can manage lo speeds. The sodium lights on lit highways are not so kind. Biggest blessing: I can walk to my heart's content at night, seeing great even w/o myglasses, and taking public transit any time of day is a pleasure. I can match yarn and fabric for all my hobbies. Colors are great. I can see my neighbors and call them by name. 
The halo problems I had with my regular lens in the left eye have declined. I found that I was partially causing those myself getting tense and squinting. Right is out of my control. Have been curbing night driving when possible.
Wishing you the best and keep us posted on your path to success.

blueconoe · Answer

I had cataract surgery a month ago. even though I have astigmatism, my surgeon recommended simple monofocal lenses.  I had the post operative problem light streaks from headlights, etc. due to  fold in the capsular sac.

Today the surgeon perform YAG to correct the problem.  When she was done she said  “the wrinkle is gone, and I may need my prescription changed.”  Now my eye sight is generally worse as far as blurred vision.  And I now see starburst around lights instead of a streak.  nothing was mentioned about this possibility befor ether procedure.

In general I feel from a consumer point of view there is a lot lacking in the information provided about cataract surgery.  There seems to be an intentional cover-up of full and simple explanations of realities of the procedure.  The only information readily available is from the manufacturers of lenses, and it is misleading.  Now that the baby boomers will be lining up with cataracts, there needs to be a brighter light shown on the procedure and the information put out by the “industry.”

Bill2634 · Answer

I had cataract surgery in both eyes in November 2010, 10 days apart.  In addition to the cataracts I had severe astigmatism plus binocular double vision and myopia.  I knew that I would continue to wear eyeglasses after surgery because of the binocular double vision, so I had no illusions that any implanted lenses would make me spectacle free. At the pre-op appointment I told the surgeon that I would only be interested in a lens other than the most basic implant if the lens would make it easier for my optometrist to fit me with glasses (the multiple eye issues required compromises in achieving the best vision results from glasses).  The surgeon said that the Toric lenses for astigmatism would eliminate or greatly reduce the prism in the glasses after surgery, allowing the optometrist to concentrate better on the binocular double vision and any other issues.  Often cataract patients after surgery on one eye just pop out the lens of their glasses for the operated eye and can then continue almost indefinitely until the second eye surgery.  I had the second surgery 10 days after the first because my vision was very distorted due to having removed the lens in the glasses for the operated eye and trying to see with the operated eye and the unoperated eye that was looking through a glass lens with significant prism for both double vision and astigmatism.  There was some ghosting in the first operated eye at night, but less of a problem than the problem of trying to see with one operated eye without glasses and one unoperated eye looking through glasses.  
After the second surgery I did not see any ghosting at night in that eye, and thought I was home free.  Within about a week, the night ghosting started in the second eye and the first eye developed halos at night.  Then a month later the second eye developed severe diagonal streaking when looking at headlights, taillights or any bright light at night, including candlelight at a night dinner, as well as sun reflections off metal etc. in the daytime.  I have read enough on-line to suspect that the Toric lenses are the problem.  My surgeon says that 1% - 3% of cataract patients develop these problems and I would have them even if just the regular lenses had been installed at the time of surgery.  The cataract surgeon, another eye surgeon and my optometrist have all told me that the lenses are properly placed.  I had not previously read about the fold in the capsular sac that John Libbel mentions, and do not know what a YAG procedure is.
I have been on a couple of different types of eyedrops for the past 3 months, and they have not helped.  I cannot drive at night because of the streaks.  yesterday my surgeon started me on 2 new types of drops.  He believes at this point that my problem is severe dry eye (he performed a green dye test on my eyes yesterday which led him to believe that this is a problem) and prescribed the drops for 8 weeks.
If I had it to do over again, I would reject Toric lenses, and that is my recommendation to anyone who knows that they will still need corrective lenses after cataract surgery to address other vision issues.  it's a lot easier to adjust prescription lenses than to deal with implanted lenses that may be causing a problem.   I have spoken to the surgeon about removing the Toric lenses and replacing them with the basic lens.  He says that it will not solve the problem.  I have also mentioned it to my optometrist.  The optometrist got back to me after discussing the situation with 3 or 4 other eye surgeons and the optometrist says that the other surgeons conclude that I should be patient and that there is a significant risk that my vision could end up worse if an attempt is made to replace the Toric lenses.  My optometrist says that some of these night vision issues after cataract surgery resolve themselves up to 12 months after cataract surgery.
At this point my daytime vision is better as a result of the cataract surgery, but my nightime vision is much worse than it was when I had cataracts.

AJ2011 · Answer

How long after your YAG surgery did the streak disappear ?  I had the surgery yestrerday to remove a wrinkle in my capsular sac, I am seeing some improvement but wondered how long it was before you did.

JodieJ · Answer

Above response was meant for yvonnez.

JodieJ · Answer

If your lens is defective, would it be possible to have it explanted and replaced?

yvonnez · Answer

I had an acrysof SN60WF lens implanted in my left eye in November 2009 and have had long diagonal streaks of light going through every car headlight and streetlight at night as well as off of every piece of metal in the daytime ever since. I have had many, many other problems with this lens and have gone through all kinds of tests. I have found out that there is a crease across the lens (probably from when it was folded before insertion) which is causing this horrible effect, so it will never go away. I hope for your sake this is not your problem.

AAO-MD-JH · Answer

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JohnLibbel · Answer

I, too, had a very pronounced streak after receiving a toric lens.  It would appear diagonally when looking at any bright light source, such as a headlight at night.

My surgeon believed it was caused by a minute fold in the capsular sac.  He proved to be correct.  It disappeared immediately after a YAG was performed.

Good luck.

jaycat · Answer

I had surgery on one eye 3 months ago, & have ghosting & starbursts from lights that make night driving impossible.  I've also been told it's due to a combination of residual & surgery induced astigmatism, but glasses don't fix it.
Last week a contact lens specialist at the hospital tried a rigid contact lens on my operated eye, & so far as I could tell, in the treatment room, that seemed to help a lot (with the ghosting anyway).  I'm waiting for a trial contact lens to be made up for me, & my next appointment isn't for another 3 weeks, but I'm hopeful that it might help sufficiently for me to manage night driving again.
I was also told by a nurse about a friend of hers who had both eyes done & couldn't night drive because of the light effects - it took about a year but she did eventually experience improvement & begin to be glad she's had the surgery done.

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