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Dr. Rick
Dr. Rick, Board Certified MD
Category: Eye
Satisfied Customers: 11417
Experience:  Ophthalmology since 1994 with Retina sub-specialty interest
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In the last 1 1/2 years, I had cataract surgery on my right

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In the last 1 1/2 years, I had cataract surgery on my right eye. At the time, the doctor told me I had very bad astigmatism and they put in a Toric Lens. I also had a scar on that eye. After the surgery, my vision improved, but it was still not clear. I was then sent to another doctor, who said my astigmatism was coming from the scar. He suggested removing the scar and replacing the Toric Lens with a normal lens. After replacing the lens, my eye has remained somewhat dilated, causing me to see halos around certain lights, especially at night. The doctor said I was seeing the edge of the lens he put in and has suggested replacing this lens with a more rounded lens. Please give me your opinion.
Dr. Rick :

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

Dr. Rick :

Are you available to chat?

Dr. Rick :

I guess you are no longer at your computer. We can use the Q&A system to answer your question.

Replacing the lens with a more rounded lens is the most aggressive treatment option. It will, however, address all causes of your symptoms. First, replacing the lens with another IOL which has more rounded edges and a larger optical zone will move the edge under your current pupil size. Also, at the time of the lens exchange, the pupil sized can be made smaller using proline sutures if indicated. This approach has the greatest chance of resolving your glare and halo concerns.... At the same time, this surgery has the greatest risk of possible complications: Infection, bleeding, poor lens centration, rupture of posterior capsule, etc. -- you know them well by now.

Another surgical option is to leave your present PCIOL in place and just do the pupilloplasty with the 10-0 proline suture. This is a fairly safe and easy surgery to perform. The surgical risks, while not zero, are less then the option above.

Another, intermediate risk, option is a cosmetic contact lens. This will solve your halo problem and has the added effect of making your pupil look more cosmetically normal from a distance. There are, however, still all the risks associated with contact lens wear.

Drops are the safest treatment choice. I would recommend Pilocarpine 1% 2-3x/day as needed to keep your pupil small enough to stop the glare and halo's. This is reversable, will make your pupil plenty small but might cause a brow ache at first. This ache tends to resolve with continued use.

Last but not least you could do nothing about your glare and just live with it....I don't think it would be fair to call this a "treatment" option :o)

From where I am sitting these are your possible choices. Which one should you choose? I can't tell you that. Myself? I'd probably give the contact lenses a try before doing surgery for the third time...but that is just me.

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Customer: replied 6 years ago.
Thank you for you answer. I have one question. In the fourth paragraph, what do you mean by - this is reversable ?
When you stop using drops the effect goes away.....this treatment, unlike surgery, is reversable. Does that make sense?

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