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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7814
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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Dear Dr. Tom,Hi. I dont know if you can see my prior

Customer Question

Dear Dr. Tom, Hi. I don't know if you can see my prior questions to you, so I will briefly summarize my situation. I am a 49 year old female and I had cataract surgery 12/4/12 on my left eye and got a monofocal technis IOL put it. Everything went well but after 2.5 weeks I developed a streak when looking at point light sources. I treated for dry eye and waited for the streak to resolve. It got better but was still there at night so I had the YAG procedure done on 5/3. The streak is definitely gone - now the problem: I have TERRIBLE star bursting especially at night. It is really bad and if I could go back to having just the streak I would. I noticed it wasn't nearly as bad in brighter lighting when my pupil was small and thought maybe the hole in my capsule just needed to be made a little larger. I tried Alphagan P eye drops last night and they eliminated the starbursts for a short period. This morning, I saw my ophthalmologist who did my surgery and he says the capsule hole is large enough. He seemed really dismayed as to what could be causing the starbursts. He said he could YAG the capsule a bit more to see if this helps but first is starting me on 1% pilocarpine eye drops tonight and says my brain hopefully will adapt. Of course I googled on "Starbursts after YAG" and have seen other people with this same problem after their YAGs and it doesn't sound like the brain adapts. It is VERY discouraging. I don't know what else to try from here.  Have you seen this at all before and can you think of ANYTHING that might be the cause?  It seems like it has to be from light scattering off the edges of the newly created capsular hole - do you think enlarging it would alleviate the problem?  I REALLY appreciate any help.

Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Rick replied 1 year ago.

Dr. Rick :

Hi. I'm online and happy to answer your question today.

Dr. Rick :

I see that you have been waiting patiently for Dr. Tom. Unfortunately, he is not online. I would be happy to assist you with your problem if you would like.

Dr. Rick :

Let me know if you would rather wait for Dr Tom or if I can be of some service.

Customer: This is a very tough situation so I guess I would like it answered by both of you. I will pay twice. So go ahead.
Dr. Rick :

Ok.

Dr. Rick :

I think that just doing a little bit more Yag -- I call this polishing the edges of the capsule -- is the way to go. I've actually had to do this in a number of cases over the last 20 years for patients who have had symptoms like yours.

Dr. Rick :

I'm not really sure why the alphagan P should help as it really has no effect on the pupil...so this fact is very interesting.

Dr. Rick :

In any event, other than the risk of a slight brow ache from the 1% pilocarpine use (it will also lower your eye pressure as a bonus) it doesn't hurt to give the pilo a try .

Dr. Rick :

But, in the end, it is my opinion that doing a little bit more YAG is the way to go.

Dr. Rick :

Does this make sense to you?

Dr. Rick :

Are you there?

Dr. Rick :

I guess you have stepped away from your computer.

Dr. Rick :

I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS

Expert:  Dr. Rick replied 1 year ago.

Dr. Rick : Hi. I'm online and happy to answer your question today.
Dr. Rick : I see that you have been waiting patiently for Dr. Tom. Unfortunately, he is not online. I would be happy to assist you with your problem if you would like.
Dr. Rick : Let me know if you would rather wait for Dr Tom or if I can be of some service. Customer: This is a very tough situation so I guess I would like it answered by both of you. I will pay twice. So go ahead.
Dr. Rick : Ok.
Dr. Rick : I think that just doing a little bit more Yag -- I call this polishing the edges of the capsule -- is the way to go. I've actually had to do this in a number of cases over the last 20 years for patients who have had symptoms like yours.
Dr. Rick : I'm not really sure why the alphagan P should help as it really has no effect on the pupil...so this fact is very interesting.
Dr. Rick : In any event, other than the risk of a slight brow ache from the 1% pilocarpine use (it will also lower your eye pressure as a bonus) it doesn't hurt to give the pilo a try .
Dr. Rick : But, in the end, it is my opinion that doing a little bit more YAG is the way to go.
Dr. Rick : Does this make sense to you?
Dr. Rick : Are you there?
Dr. Rick : I guess you have stepped away from your computer.
Dr. Rick : I hope this information was helpful for you. But I do work for tips so I want to make sure you are happy with me before rating me. If you have another question on this or a related issue feel free to fire away. You may also receive an email survey after our chat, if you don’t feel that I have earned a “10” rating in all areas, please let me know what I can do to meet your expectations.

Thanks in advance,

Dr. Rick MD FACS
Customer: replied 1 year ago.

Sorry - I got called away on the phone and didn't log out. Thanks for the response.


 


Hearing that you had patients with similar issue is a bit of a relief. After you "polished the edges" in about what percent of patients did it rectify the situation? How much more capsule do you usually have to remove?


 


I am a bit surprised to read your comment about the alphagan P having no effect on pupil size. I have seen much on the internet about how it doesn't constrict the pupil but does keep it from dilating in the dark. It eliminated the starbursting for me although I have to say that the effect did not last long - not even 1/2 hr so not really a viable solution. I hope the pilocarpine works better tonight.


 

Expert:  Dr. Rick replied 1 year ago.
Karen,

It solved the problem in each and every one :)

While the internet may talk about alphagan P's pupil effects, I have to say that is not what is seen clinically. Also, the way the drug works it would not be expected to keep the pupil from dilating in the dark....but this is really just a side discussion and not to be confused with the issue at hand :)

I hope things work out well. Have a good evening.

It's safe for you to press the positive feedback button now if you so desire. And, never fear, even after you press that button I don't go up in a puff of smoke -- I'll still be right here to continue helping you, but, as I do work for tips, I want to make sure you are happy before rating me.
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 7814
Experience: Ophthalmology since 1994 with Retina sub-specialty interest
Dr. Rick and 2 other Eye Specialists are ready to help you
Customer: replied 1 year ago.

Thank you so much. I will leave positive feedback. As I said earlier, I wouldn't mind hearing another doctor's take on the situation, so I will resubmit the same question for Dr. Tom. Thank you.

Expert:  Dr. Rick replied 1 year ago.
My pleasure. Have a good night.
Expert:  Dr. Rick replied 1 year ago.
Karen,

I was just thinking about you today, as I noticed a bottle of Pilocarpine sitting on my exam bench.

Did the pilocarpine help last night?

I hope you are doing well and this starburst problem is cleared up soon.

Take care and have a good day.

Dr Rick MD FACS

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