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Dr. Tom
Dr. Tom, Board Certified MD
Category: Eye
Satisfied Customers: 263
Experience:  30 years experience treating patients with eye problems
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This question is for Dr. Tom - Thanks!Dear Dr. Tom, Hi.

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This question is for Dr. Tom - Thanks!  Dear Dr. Tom, Hi. 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 and says my brain hopefully will adapt. I used the pilocarpine tonight and it completely eliminated the starburting. 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:  Camille-Mod replied 1 year ago.

Hi,

My name is XXXXX XXXXX I am the Moderator for this topic. Dr. Tom is not available right now, but I have sent him a message to follow up with you here, when he comes back online. If I can help further, please let me know. Thank you for your continued patience!

Camille

Expert:  Dr. Tom replied 1 year ago.

Hi.......I just got the message from the moderator saying you were still waiting for me......but yesterday I saw that Dr. Rick had gone ahead and answered your question, and I didn't want you to be charged twice. So to answer your question, yes I have observed symptoms like yours on numerous occasions. If the pupil dilates more at night to a size larger than the YAG opening star burst occur. So your ophthalmologist is giving you good advice. Please let me know if this answered your question.

Customer: replied 1 year ago.

Hi, thanks. XXXXX addressed my original question to you but Dr. Tom offered to answer. I told Dr. Tom that I would pay twice to get his opinion as well as yours.


 


What you have said makes sense except my ophthalmologist says my YAG opening IS large enough, so I am trying to get Dr. Tom and your best educated guess as to what else could be causing the large starbursts.


 


I have made an appointment with another cataract specialist outside my ophthalmologist's practice to have him double check the pupil / YAG opening sizes. I am hoping this is the cause as the YAG procedure was no big deal. I don't know what else it could be?


 


 

Expert:  Dr. Tom replied 1 year ago.

I'm just responding again to be sure you know that I replied to the moderator's notice that you were still trying to get a message to me.

 

Is there anything else I can answer beyond what I said above?

 

Dr. Tom

Customer: replied 1 year ago.

I replied to your first message but I guess you did not receive it so I have copied it below:


 


Hi, thanks. Yes, I addressed my original question to you but Dr. Tom offered to answer. I told Dr. Tom that I would pay twice to get his opinion as well as yours.


 


What you have said makes sense except my ophthalmologist says my YAG opening IS large enough, so I am trying to get Dr. Tom and your best educated guess as to what else could be causing the large starbursts.


 


I have made an appointment with another cataract specialist outside my ophthalmologist's practice to have him double check the pupil / YAG opening sizes. I am hoping this is the cause as the YAG procedure was no big deal. I don't know what else it could be?

Expert:  Dr. Tom replied 1 year ago.
Okay, it sounds like we are all squared away, except for your clicking on the positive button. Please do that so we don't keep sending emails back and forth to each other. By the way, it is good that you are going to seek a second opinion. You have not very best wishes Dr. Tom
Customer: replied 1 year ago.

But you haven't answered my question: since my ophthalmologist says my YAG opening IS large enough, what else could be causing the starbursting?

Expert:  Dr. Tom replied 1 year ago.

OK....let's go over this again....You posted to me and Dr. Rick answered first. Then I replied to your follow-up

 

You posted" 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?

 

Yes I have seen this. And the cause is likely what you already suspect.... reflections from the edge of the YAG opening when the pupil dialates. The pilocarpine test seems to have documented this. ....but again, you are doing the right thing to get another independent opinion as can only be done with the examination at the slit-lamp microscope. Please let me know how things turn out. And again, best wishes.

Dr. Tom, Board Certified MD
Category: Eye
Satisfied Customers: 263
Experience: 30 years experience treating patients with eye problems
Dr. Tom and other Eye Specialists are ready to help you
Customer: replied 1 year ago.

Thanks!

Expert:  Dr. Tom replied 1 year ago.
Thanks for the positive feedback. Please let me know how things work out.

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