Progressive eyeglasses and starbursts

[Nancy_in_GA]

I'd like to know if anyone else ever experienced starbursts from bright lights at night wearing progressive lens (PAL) eyeglasses.  

Is this a type of distortion you might expect to get when the prescription/refraction is not quite right?

[Boogertown]

This is an old thread so I am answering in 2024. I also have become very unhappy driving at night because of gigantic star bursts with on coming traffic. Dangerous to the point I'm afraid I will not see a pedestrian on the sidewalk because the pedestrian might be hidden within the gigantic starbursts. It's both eyes and I wear progressive lenses which were supposedly very high quality. But they are about 3 years old now. I got tested for cataracts and they're not particularly bad.  My prescription has not changed so that was not the problem. A dread night driving now. But right before Christmas I got caught in a 2 hour traffic jam Write at sunset. At 1 point I took my glasses off to rub my eyes AZ and looked up and realized the starburst had reduced in size by 90%. It was my glasses!hat night online ordered some cheap bifocals with single vision on top and near vision on the bottom.  I still don't love driving at night but I would estimate it is 90% better with these single vision glasses versus my old progressives. It is possible if I get the lens replaced on the progressive That perhaps there are micro fractures I can't see. But for now I  Keep the single vision bifocals in my car and I put them on at night and everything is much safer.

[John C Hagan III, MD, FACS, FAAO]

If it has been 3 years since your last eye exam I would suggest you see an ophthalmologist for a full exam with dilated pupils A cataract can change quickly and a lot over 3 years. While there are a number of things that could cause those symptoms it is unlikely due to your glasses. This is the type of probably that necessatates an quaiity eye exam

[Boogertown]

Thank you so much for your concern. I just was examined by cataract specialist the same week before I accidentally discovered it was my glasses exaggerating the very sharp enormous halos. My doctor and i actually discussed in detail  That the only problem I was having was driving at night and oncoming traffic. It had recently gotten a whole lot worse. He rechecked my Rx too.   He said my cataracts were quite small and probably not worth the risk at this point. Cataract surgery is all this eye doctor does and he is very well respected. He also mentioned that cataract surgery does not always fix the Halo problem which gave me pause. All I know is that switching to single vision or regular bifocals diminishes the halos to a manageable degree ( ~90%) I am shocked and thrilled by this discovery.  I do need to get new lens too.But again thank you so much for your opinion.

[John C Hagan III, MD, FACS, FAAO]

If single vision redudes by 90% your symptoms that would make it far less likely that there is a disease like cataracts or cornea problem as the cause.  When you get new glasses be sure they are fitted exactly to your face and eyes. If the optical center of the lens is not over the center of your pupil it can induce symptoms like this. You might also discuss anti-glare coating. Good luck

[Boogertown]

Quick update. I replaced the progressive lenses last week with new progressive lenses, same rx and the starbursts are 90% gone! My optometrist was horrified by the microfractures in the old lenses. I always get the anti glare and crizal coatings but they only lasted 2 years. I will know next time. He said one thing I had never heard- that washing glasses by hand under hot water was very bad for the lens coatings. Is this common knowledge I had never heard of? Thanks

[mkh9]

Wow!

[John C Hagan III, MD, FACS, FAAO]

For anti-glare yes it is a killer. Should only use lens cleaning clothes approved for the type og glasses and if necessary professional lens wipes e.g. Zeiss  No matter what you do or where you buy your glasses and how careful you are after 2-3 years the coating will be crazed and look like gasoline on lens

[Boogertown]

Thank you. I did not know about the hot water nor actually how quickly lens wear out despite careful care. Super good to know. Thanks

[John C Hagan III, MD, FACS, FAAO]

You are welcome

[Nancy_in_GA]

Thank you.

[flossy93]

So glad to hear you got a better set of progressive lenses, even if you had to really work to achieve that.  You're right that Hoya lenses are typically of very high quality; it sounds like the issue with your glasses really was the prescription.  

FYI there's a lot of information out there about what 'visual inifinity' distance really is.  From what I've read it can be up to 30 feet, rather than the 20 you were quoted . You found out the hard way, but at least now you have a good pair of glasses that will work well.  

I've also found a few places that carry eyeglass frames which are 'taller' and that work well for people who need a functional near vision and distance vision segment both.  I found a few at Costco, although for the most part the 'short' vertical distance frame designs are what is common.

I'm glad you found glasses that work for you.  Hopefully the eyedrops will help with the starbursts.  Thank you again for sharing your feedback.  

[Nancy_in_GA]

This is a fairly unimportant topic in the grand scheme of things on this forum, but I will update because I hate it when folks don't follow up.

Reluctantly went back for a redo on the Hoya progressive lenses.  The worst problem was depth perception at my feet.  It made it dangerous to cross a street because you have to look both ways at a distance and then quickly focus down at the curbs.  After 2 weeks I still couldn't lose the sense of wanting to fall over forwards.

I think my optometrist is a bit annoyed with me because I went off reading about progressives and tried to figure out what was wrong before I went back.  Anyway I told him what I thought was wrong (drop the add back, move the segment height down by 2mm, and increase the minus in the distance correction).  He changed it all, and these new lenses are near perfect. No adaptation necessary.
  
We had a disagreement about the distance correction. He said 20' is "optical infinity," so I asked if having no accomodation whatsoever now could affect that.  He let me look out the window across the street and tried some minus lenses on top of my glasses that made distance vision crisp at that range, and came to an additional -0.75 distance correction (-3.50 instead of -2.75). Now I can read road signs clearly again at a hundred or so feet.  And I can lay on the couch and watch TV with these. :)

The only downside is computer distance, but I expected that.  I've never had a pair of progressives that worked well for that.  My old single visions set for 18" almost give me good vision everywhere indoors.  Go figure.  So single vision set at arms length may be good enough for all purpose indoor glasses.
  
Or I may try one of these new office lenses.  One thing I've learned, if you get your IOLs set for near vision there aren't as many options available for progressives.  They force you to have a wide near vision part, which is not important to me, and to get it clear glass or minus down there is difficult without messing up the rest of the lens.

Back to the starbursts.  They are still there at night, but smaller with these new lenses than the previous ones.  I think the anti-reflective coating helps.  I think Dr. Hagan was right on, about higher order aberration.  Seems like that can only be fixed with surgery, and only in a few cases.  Don't think it's necessary to even find out because I don't want any more cutting on my eyes and risk complications.  I can live with starbursts.   It's only serious on dark country roads at night.   I suppose there is a slim chance it is due to large pupils or dry eye.  But no one has ever said I have large pupils. I'll try the artifical tears with glycerin. Since dry eye increases with age it may be just another one of those things you have to cope with when you get old.  

Hope this information helps someone.

[Nancy_in_GA]

Update:  Well I believe I *over* thought this.  Just got new glasses yesterday and last night I went for a walk to test the night lights.  While the old progressives had short fat starbursts, these new ones have thin-rayed startbursts.  The rays go out to infinity.  When I'm passing a streetlight, just as it goes out of view, one ray (either 11/5 or 1/7 o'clock) passes down like it is going into my side pocket.  I actually tried to reach out and touch one.
  
One problem is I opted to bump up the add.  That is probably the cause of most of the other problems (swimming, distortion on the sides, narrow corridors).  But the far vision is only in about the top 1/4 inch of the lens.  Searched all over town and picked 40 mm high Rx sunglasses frames so that pupils were centered up and down.  So it's almost impossible to see your feet clearly now.

I suspect the optician just used the hard design lens without thinking, since you can only find short height regular frames now, and removed too much of the far vision area instead of keeping things centered vertically.  Maybe not.
  
These are Hoya lenses, and they are supposed to be good.
  
I may just chalk this one up to "tuition paid in the college of life," and go back to my old optician.  I always had good luck with progressives there and I always chose large lenses. And no bumping up the add again ever.

[John C Hagan III, MD, FACS, FAAO]

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[Nancy_in_GA]

Thanks flossy93.  You opened the door for a long post, I'm afraid.

Recap: Recent cataract surgery (3/6/14, 5/8/14) with near vision IOLs in both eyes. Still wearing old progressives right now waiting for things to settle down.  Clearer distance vision with them now than before surgery.

Before surgery I saw blurry starbursts (along with glare and haloes) at night.  

After one eye was done (~6 weeks out) the starbursts were still there in the IOL eye but very crisp needle-like rays (haloes and glare gone). Overall size of starbursts (ie, how far out rays extend) was same in both eyes.

One week out from surgery in both eyes---crisp starbursts in both eyes but no glare or haloes in either.

The results were the same for all the old progressive eyeglasses I could drag out of the closet, but the most recent pair is the worst. Optometrist says my current eyeglass Rx is just a little bit too strong for distance now.
  
I also found an old pair of single visions made for the computer---about 18" focus.  When I put these on the starbursts disappear completely, but of course things are blurry in general.
    
You only see my surgeon once at the next day follow-up, unless an emergency.  At the one week follow up yesterday the optometrist (I learned more from him than the surgeon), said eyes were excellent in terms of pressure, no swelling, edema.

We talked about night time single vision driving glasses and he said they would be perfectly legal.  I had decided that would be the back up plan if new progressive prescription didn't make the starbursts go away.  I can just keep them in the car as long as they are melt proof.

I'm still on anti-inflammatory and steroid drops in the newest eye.  Done with antibiotic drops.

Guess I'm just trying to anticipate what could happen ahead of time, and forewarn the optometrist.  Don't want to have to make a quick decision, or make him redo lenses unnecessarily.  And of course I always want to know *why* things are as they are.  It's a curse ;) .

[Nancy_in_GA]

Thank you Dr. Hagan!  Already had cataract surgery. It didn't occur to me it could be something related to the cornea. If things don't work out when I get new eyeglasses, I'll certainly try to see an ophthalmologist and get to the bottom of it.

[John C Hagan III, MD, FACS, FAAO]

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[flossy93]

Do you see the starbursts at night without the glasses?  Given your intentional nearsightedness after the surgery you may not be able to tell.

Also, you didn't mention but is the starburst issue in one eye or both?  I'm wondering if it's related to how much time has passed since the cataract surgery, or if it's independent.

I remember from a different thread that you recently had cataract surgery on both eyes, and you said you had a followup appt this week.

Did the surgeon note any swelling (edema) on your cornea or inside the eye?  Was there any other post-surgical issue noted during the exam?  Are you still using anti-inflammatory eyedrops or other post-surgery meds?

As Dr. Hagan says, starbursts in general are related to the eye itself rather than glasses, but can be caused by different things.  The first step would have been to discuss with your surgeon at this past week's appt what he sees if anything.  

If he detected nothing, you can see a retina specialist to make sure the back of your eye is fine (cataract surgery can cause macular swelling too).  

Next step after that might be to try different glasses (single vision distance glasses for driving, for example) to see if those reduce the problem compared to the progressives, if no cause within the eye itself can be identified for the starbursts.