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Positive dysphotopsia
I’ve been coping with various light aberrations - streaks, starbursts, halos, glare and the Maddox rod effect - since monofocal IOLs were implanted in 2023-24. Apparently, these symptoms can be caused by PCO or positive dysphotopsia (or both). Positive dysphotopsia can be difficult to diagnose, at least in some cases. If these symptoms are caused by PCO, the treatment of choice would be the yag procedure. If caused by positive dysphotopsia, the best approach would be an IOL exchange, often with the LI61AO. I’d very much like to hear about the experience of others in this situation. For example, was either a yag or IOL exchange successful in improving such symptoms, and if an IOL exchange was performed, which IOL was chosen for this purpose? Many thanks for reading my post!
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YAG laser made my positive dysphotopsia worse. After having YAG it is very difficult to do a lens exchange. Most ophthalmologists won’t touch it.
I'm so sorry this happened to you. If you could do it over again, would you do the yag anyway to clear PCO, seek a lens exchange, or another alternative? Could you share what your PD symptoms were like and how they changed after the yag? Are you interested in pursuing a lens exchange if you could find the right surgeon? Sorry for all the questions! Many thanks for sharing your experience.
I also have PD, going on 4 months now. I just returned from a visit at the Cleveland Clinic to get a more expert opinion since my local doctor has not been helpful. The doctor in Cleveland has told me to give it 3 more months before I make any decisions. He said for most people it eventually goes away. His recommendation to me was a reverse optic capture, where they life the capsular bag up around the lens to try to block the light bouncing off the lens. He talked to me about a YAG also, but I told him I had read on this message board that almost no one gets better from that and he agreed. He also said that he tends to be conservative and typically avoids lens replacement as it can be risky. I found this doctor to be very trustworthy as he was very kind and really listened to me. He spent over an hour with me. If I ever get my other eye done, I plan to travel to Cleveland to have him do it.
Before the YAG I was seeing diagonal streaks of light. After the YAG I still saw it but additionally I see starbursts and halos. YAG also caused very annoying floaters which have not gone away.
Hi Carol, I neglected to mention the option of doing nothing which has also been recommended to me. Thank you for responding to my question as I'll certainly consider your experience. It seems that there is no solution without risks... Thank you again and best wishes moving forward.
Hi Mauigirl, I'm glad the doctor at the Cleveland Clinic was so helpful and reassuring. Could you confirm that he agreed that symptoms of PD almost never improve after yag?
Yes. He brought up reverse optic capture to me as the best option. He also mentioned YAG to me and I asked what that all entailed. I mentioned to him that I had done a lot of reading on this message board and have seen that almost everyone who has had a YAG has seen no improvement. He agreed with that. I'm guessing he only brought it up to give me all the options. He also said that he steers clear of lens replacement in most cases.
Most ophthamologists don't like to perform lens replacements of previous IOL. Quite a few do, though, so seems like a comfort level issue for them more than an absolute.
Yes, I had read in the attached article where two cataracts surgeons talked about issues post surgery that the yag laser may not improve PD but it can also make it worse.
https://www.eyeworld.org/2023/potential-issues-after-cataract-surgery/
I believe their audience for this article was other eye health professionals
Personally, I wouldn't do yag unless you need to the yag to improve your vision because of posterior capsular opacification (PCO) which is a very common complication that can occur typically years after cataract surgery. Unfortunately, I got PCO only 4 months after cataract surgery and had the Yag procedure one year ago. It was a very fast two minute procedure for both eyes.
The Yag laser eliminated the PCO I was experiencing, returning me to the 20/20 vision I had prior to PCO setting in. It also eliminated the relatively rare Maddox Rod issue I had in one eye (not a true PD issue).
However, the Yag did create very thin multiple light streaks at night on certain lights. While that did bother me, it was less bothersome than the Maddox Rod issue. It's been a year since my Yag and while the light streaks never really diminished, it's amazing how I really don't think about it much anymore and how I have adapted to it. It doesn't interfere with my driving or anything else and most of the time I'm not even conscious about it. I'm surprised. I remember reading something about 'neuro-adaptation' or something and just thought it was 'medicalese' of 'just learn to live with it'. Even if a cataract surgeon told me there was a very easy fix. I wouldn't bother - any procedure can have even a minor risk. Obviously if you do in time get the common PCO and your vision is affected, you'll have no choice but to get the Yag laser which my cataract surgeon said was about the safest thing they do. Best wishes
Hi Elliott,
I'm glad to hear you're doing well and symptoms of PD are fading and tolerable.