Hello Tillymack

Further to your message, here’s my experience with capsular wrinkles, the maddox rod effect, and the Yag laser. (Much of the below I probably noted in past postings but there may be others that might find this posting useful).

To summarize, I had cataract surgery on both eyes, three weeks apart, in March/April this year. I was happy with the visual acuity. I learned after the second surgery that the light streak I was experiencing at a 45 degree angle was due to wrinkles in my right eye capsule. I also had wrinkles in the left eye.

From on-line research I learned that the light streak was ‘on all fours’ with the maddox rod effect (subsequently confirmed). I was told at that time that if the light streak issue did not self correct within 3 months that the Yag Laser could be used to remove the wrinkle and the maddox rod effect. Although considered a very safe procedure, I was aware of rare adverse effects from the yag so I decided to wait until my vision was affected by pco.

In early July, I noticed a significant decrease in the vision in my right eye. My surgeon confirmed pco and, unknown to me, I also had a similar level of opacification in the left eye (that eye not fully corrected to provide me with ‘mini-monovision). I therefore had the Yag laser procedure on both eyes.

Other than the dilation and freezing drops, nothing else was put into my eyes for the yag procedure - painless and quick, probably less than a minute per eye.

I was told that they’ve used the Yag as little as one-month post surgery if someone develops pco that quickly but generally the risks, while rare, are generally even less the greater the time lapse after surgery with 3-months being kind of a ‘safer’ time marker according to what I read on-line.

If one develops pco where the vision becomes compromised after cataract surgery, then one has little choice but to have the yag as the opacification does not self-correct and will only get worse in time.

The Yag immediately (or within a day or two, can’t recall) returned my vision to 20/20 in my right eye and it did remove that maddox rod 45 degree angle light streak. However, the laser caused a new glare disturbance in both eyes: multiple thin light-streaking rays in different directions.

I was aware of the far more serious potential complications that can occur after yag procedures; nevertheless, these rare and unexpected light streaks were disappointing, less annoying than the maddox rod streak though.

It’s been two months since the Yag procedure and, while I don’t think there has been an improvement in the streaks, I don’t think about it much anymore. It’s not affecting my night driving or my life. I haven’t found much information about this issue other than some speculation that it may be due to hole size, their location, or possibly lens damage.

However, I just had an appointment with my optometrist who said the lens is fine and so is everything else. She thinks that this glare issue could be related to the preventative iris iridotomy surgery I had years ago which makes hole(s) in the iris that she said are close to the implant. I don’t plan on doing anything about it. I may see my surgeon in a year’s time just to see if he might know or confirm the cause or my own knowledge. (My surgeon told me after my yag procedure when he had a tech to a scan of my retina that I had an epiretinal membrane in my left eye. I subsequently learned that it was there prior to my cataract surgery; that it’s very mild and has been stable and it’s not on the macula so that was a big relief).

So, if you are experiencing pco and it’s affecting your vision, I think you have to consider the yag. If it hasn’t been 3 months since your surgery and you can still function fine with the decline in vision, you may want to wait until the 3-month mark to even reduce the rare risks even further but best to speak to your surgeon or ophthalmologist about that. If you trust and are happy with him/her, who is someone that is highly qualified in cataract surgery, then you probably best to stick with the same individual.

If the opacification is in both eyes, you can always request that they do one eye at a time and the other a month later if you're concerned about the laser. The surgeon will probably tell you as mine did that the yag is about the safest procedure they do - still if you fall in that rare instance of a serious adverse affect, that’s little comfort.

Another thing I read about the yag is that some rare but post-yag adverse consequences may not occur for months later (e.g retinal detachment).

I also read that the Yag can be used effectively to eliminate wrinkles but if the issue is glare, the yag can make the glare worse. That’s what I read in this attached article (potential issues after cataract surgery) which I may have sent earlier.

Best wishes. Let me know how it goes

Mark (Elliott)