YAG Laser Starbursts

[user4444]

I had ICLs (implantable contact lenses) in both eyes in 2016. Two years later Dr told me they caused cataracts in both eyes. Right eye progressively got worse. Had cataract surgery in right eye (RxLAL) in Aug. 2020. Month following, Dr informed me that I may need YAG in that eye eventually based on what he was seeing. First part of 2021 I noticed my vision declining. Dr recommended YAG laser in right eye. Had YAG procedure in May 2021. Immediately following surgery (as soon as dilation wore off) I noticed starbusts in right eye when looking at lights in dimly lit rooms during the day and consistently at night (traffic lights, street lamps, etc). Are starbursts normal after YAG and will they go away on their own? I plan to see my Dr, but would appreciate any input here if you've experienced this or seen it in your patients.

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

First I'm assuming that you have  the ICL removed.  And always wary of acronyms  by (RxLAL) do you mean light adjusted lens? If not what do you mean.    And do you have starbursts with wearing prescription glasses?  Or is this without glasses?  If you have residual myopia/hyperopia/astigmatism you may need glasses to eliminate the glare. If you do have glasses and this does not eliminate the problem I would get an independent 2nd opinion as your problem is NOT common after yag capsulotomy.  AND ANY ONE READING THIS CONSIDERING IMPLANTABLE CONTACT LENS TAKE THIS TO HEART. I DON'T RECOMMEND THEM TO MY PATIENTS FOR THESE REASONS; CATARACTS/GLAUCOMA/INFLAMMATION/ CORNEA DAMAGE.

[user4444]

Thank you Dr Hagen for the reply!
1) Yes, the ICL was removed.
2) Yes, RXLAL was the light adjusted lens that was used.

I do not currently wear glasses. The starbursts are without glasses.

I also appreciate your recommendation to NOT get ICLs. They ruined my eyes at a young age (mid-30s). Literally the worst decision of my life.

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

At your next visit I would suggest you ask for an end point final glasses refraction to determine if you have residual refractive error. If so and your problem persists you may need to consider prescription glasses if they help your starbursts.

[JPR333]

Dr. Hagan,

Thank you your posts. They are very helpful and very much appreciated.

It’s been about a month since I had the YAG procedure in my left eye. I did have a PCO and the doctor did the cruciate pattern.

Everything went fine except for the starbursts around bright lights at night - they weren’t there before I did the YAG, so just curious what could be causing them. I do have a slight ERM in that eye but was told by retinal specialist it looked fine.

They are very bothersome at night and not sure what to do. I’m trying to get used to them but wondering if this is temporary or something I’m going to have to live with. Would love to know what could cause this.

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

If nothing is working, you still have them then get a second independent opinion.  Some causes: uncorrected myopia/astigmatism/hyperopia (corrected with glasses,  irregular corneal astigmatism: corrected with contact lens.   IOL decentration,  residual PCO in visual axis, lens pitting from the Yag laser, and too small of a posterior capsule opening.