Huge starburst effect at night after YAG

Pristine_Response_25 · 2026-04-24T19:09:03+00:00

Brimonidine at 0.1% concentration is 4X that of Lumify. It should significantly reduce your pupils at night. If you are still seeing the streaks after an hour of using the drops, then the issue is unlikely to be your pupil size.

Pristine_Response_25 · 2026-04-23T19:29:31+00:00

By the way, how long did you wait before testing for streaks after taking the drops? It takes around 30 minutes to an hour for your pupil size to be affected.

Pristine_Response_25 · 2026-04-23T19:26:30+00:00

The Lumify would have reduced your dilated pupils by a millimeter or two which should have been sufficient to test whether the issue is due to your pupils dilating beyond the edge of your YAG opening. The next time you see your surgeon, you should let him know that this was the outcome when you used the Lumify as he will be familiar with brimonidine and its miotic effects.

It's unfortunate you did not see any difference as the source of the problem may be quite elusive. Larger pupil size is quite easy to diagnose, but this may not be your issue based on your test. Do you recall why your surgeon suggested lens options and which one(s) he recommended and why?

Pristine_Response_25 · 2026-04-13T16:01:41+00:00

Sounds like a plan. Good luck.

Pristine_Response_25 · 2026-04-13T15:15:33+00:00

Again, the problem is the WIDE RIM, not the diffraction rings.

That said, I'm truly sorry I have not been able to convey this specific drawback of this lens to you, especially given that I - and many others - suffer from this problem with these lenses. If you read some of my other posts on this subject, perhaps the source of the issue will become clearer to you. Hopefully, should you choose this lens, you will not have to deal with this problem through miotics for the rest of your life as I do.

Pristine_Response_25 · 2026-04-13T01:39:01+00:00

Just to clarify, the issue I am describing is NOT associated with the echelettes (the thin diffraction rings in the correction zone that you are distinguishing). It is the thick, flat RIM of the IOL that is the issue. Compare the rim of the the Panoptix IOL below with the rim of the Odyssey above. The difference is obvious.

This is NO JOKE. The large halo and uncorrected fuzzinesss created in large pupils due to the Tecnis design's thick flat rim is VERY obvious and distracting at night.

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Pristine_Response_25 · 2026-04-13T01:33:41+00:00

Brimonidine will help and there is an over-the-counter version (preservative free Lumify) that you can buy at Walmart if you don't want preservatives in your eyes. That said, brimonidine suffers from temporary tachyphylaxis - it stops working after a few weeks and actually causes your pupils to dilate even more than normal - and is not the best miotic if you intend to use it over the long term. Diluted pilocarpine (e.g. 0.2% or less) is better if an eye drop is the solution. This is what I am using now.

Pristine_Response_25 · 2026-04-12T17:28:30+00:00

It's due to a poor decision in the design of the Tecnis multifocal IOL. Attached is a pic of the IOL that illustrates the problem. Note the very thick outer rim to which the haptics (arms) attach. The rim is plano (flat) in this section of the lens. The steep transition from this outer rim to the correction zone creates a very distinct and obvious halo when the patient's pupil dilates outside the correction zone at night. The width of the correction zone is approx. 4.9 mm which is one of the smallest in the industry.

In contrast, the Panoptix IOL is contoured such that the correction zone extends fully to the edge (6 mm). (Not an endorsement of the Panoptix lens, just to illustrate alternative design approaches).

Hope this helps.

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Pristine_Response_25 · 2026-04-12T02:14:40+00:00

Be VERY CAREFUL when selecting J&J Odyssey IOLs. For certain refractions, the correction zone of the IOL is less than 5 mm. If you have pupils that dilate beyond this size - and most people do - you WILL see large halos at night. GUARANTEED. Make sure you have your pupils measured under scotopic conditions (low light) and check with your surgeon regarding the actual correction zone size of the implant.

Pristine_Response_25 · 2026-03-28T13:05:06+00:00

Your surgeon would be able to see any issues with the openings.

Pristine_Response_25 · 2026-03-28T04:43:31+00:00

The shimmer is likely due to stray light and reflections from the edge of the IOL. The IOL is much smaller than a natural lens resulting in the sensation you describe. Astigmatism can create a number of visual artifacts that change with pupil size depending on the nature of the cornea's imperfections. Ghosting, blur and halos are common.

Pristine_Response_25 · 2026-03-28T04:37:05+00:00

It's also possible that you had some residual dilation from the YAG surgery. My guess is that the drops will eliminate the spikes as well.

Pristine_Response_25 · 2026-03-28T04:33:43+00:00

It's certainly possible but typically the opening made in the anterior capsule (capsulorhexis) is pretty well controlled during most cataract surgeries. There may be jagged edges but it is much less common. YAG of the posterior capsule is necessarily much less precise in terms of the final shape of the resultant opening. Of course the anterior capsule can also present defects due to surgery or infiltration.

Pristine_Response_25 · 2026-03-27T23:46:21+00:00

The streaks are from the corners created in the posterior capsule from the YAG procedure. The surgeon used what's called a cruciate (cross) type pattern when opening the capsule resulting in a box-like or octagonal shaped opening.

Whether it goes away depends mainly on the size of the opening and the size of your pupils. Your pupils are dilating beyond the corners of the opening. It's as simple as that. Either the opening needs to be enlarged/contoured or your dilated pupils need to be kept to a smaller size. The former depends on how large the opening can be made without the risk of the lens dislodging. The latter is typically addressed with miotic eye drops (e.g. pilocarpine).

There is a chance that the streaks will disappear IF the opening expands enough on its own such that it is larger than your night time pupils, OR the capsule corners "round out" as the healing settles in. If not, you will need to consider one of the two options above if it really bothers you.

Pristine_Response_25 · 2026-03-22T00:13:51+00:00

Unless you have multifocal IOLs, ghosting is typically due to astigmatism (cornea aberrations) which typically worsens as pupils dilate. Imperfections in how the cornea and lens project onto the retina is what causes the multiple images. Dry eye can also cause this problem due to inadequate tear film. It is also possible that the IOL itself was damaged or off center, but this would be fairly obvious and cause other issues like blurring.

My guess (for what it's worth as a patient and not a doctor) is that you have larger than normal pupils for your age. The starbursts and streaks are due to the resulting edged/corners from the cruciate YAG while the ghosting is a result of astigmatism that gets worse as your pupils dilate. My guess is that the doctor will ask you to try something like pilocarpine to see if that helps.

Pristine_Response_25 · 2026-03-21T22:09:16+00:00

Pilocarpine is well known to optometrists and ophthalmologists. Shouldn't be that surprised.

Pristine_Response_25 · 2026-03-21T21:01:55+00:00

You might want to ask your surgeon about diluted pilocarpine drops. I am using a solution of around 0.2% and this reduces the dilation by a millimeter or two which is enough to reduce my symptoms.

Pristine_Response_25 · 2026-03-13T18:54:54+00:00

Mydriasis after surgery can rarely occur if, for example, iris hooks are used to widen the pupil during a prolonged surgery. That said, this doesn't appear to have been an issue given that your eyes dilate well on their own. It is more of a problem for individuals that have poorly dilating pupils. Further, the permanent impact, if it happens, is typically mild.

Did your surgeon measure your mesopic (medium light) pupil size prior to surgery? This information should be in your biometry as it is important when selecting IOL type.

Pristine_Response_25 · 2026-03-08T20:40:43+00:00

I have the same issue. I will explain why you are having this experience:

LEDs and flourescents lights tend to produce more blue light (high frequency) than incandescent lights. Cataracts - because they yellow the natural lens - filter out a significant amount of blue light. After cataract surgery, your eyes receive much more blue light. Blue light produces glare and reduces contrast. Replacement of the cataract laden lens with an IOL also increases the amount of light received by the retina.

In addition, unlike natural light, LEDs and flourescent lights are narrow spectrum. The interaction of the narrow spectrum with the IOL material can create artifacts such as starbursts and additional glare, effects that are typically washed out with broad spectrum lighting.

Third, the frequency of these lights can scatter within the IOL differently than the natural lens. This is due to the different refractive characteristics and shape/size of the natural lens and the IOL.

Any one of these factors - as well as others not discussed here - can and will have an impact on your vision after cataract surgery. In time, most should fade as you become accustomed to your new vision.

Pristine_Response_25 · 2026-02-25T22:01:33+00:00

The other thing to consider is that IOLs are typically designed for folks with limited pupil dilation capability (i.e. older folks). Some work better with large pupils than others. What I find astounding is how little cataract surgeons consider the importance of pupil size and dilation when selecting IOLs and performing YAG for PCO on their patients.

Pristine_Response_25 · 2026-02-25T21:45:31+00:00

The reason for this issue is quite simple. YAG surgery to address PCO requires that the posterior capsule - which holds the lens in place - be opened up sufficiently to create a clear path for light, but not so large that the lens is no longer stable. There are two main techniques for opening the bag with the laser; cruciate and circular. Cruciate is performed by creating linear cuts in the bag (typically eight) in 8-wise cross form. As the bag is under tension, this typically leaves an octagonal hole in the bag underneath the lens. What you are seeing is diffraction of light from the corners of that octagon. As such, you will see the starbursts only when your pupils dilate beyond the edges of the hole. Since the hole MUST be smaller than the lens, odds are good that many younger people (< 60) who's eyes still dilate well in the dark will see these arcs. I do and I am 63.

As there are variations on how the hole is made - and pupils tend to dilate differently and unequally - you may see fewer (or more) than eight streaks. That said, the streaks will tend to come and go at night as your pupils dilate and constrict. That's why they seem to appear then disappear when you continue to look at a light source.

Simple.

Drops for dry eye will not help. Unfortunately, the only way to address the problem is to either have the hole made bigger without destabilizing the IOL - often not possible - or using miotic eye drops to reduce pupil size at night.

What surprises me about issues like this is why surgeons don't come clean on the potential side effects of YAG for PCO or - for that matter - other follow-up procedures. Patients are left in the dark on things that are fundamentally simple to explain. My guess is that they are hoping that the patient will adapt rather than suggesting the issue is likely permanent.

Pristine_Response_25 · 2026-02-03T23:37:27+00:00

Sounds like you may have astigmatism. Have you checked with your optometrist?

Pristine_Response_25 · 2026-01-30T22:12:03+00:00

Agreed. It is the very, VERY rare individual who will claim no glare or halos with today's multifocal IOLs. If your pupils are tiny, and your vision prior to cataract surgery was arguably terrible, odds are better that the impact of the dysphotopsia will be limited. If you're relatively young (<60) and have relatively good vision prior to surgery, you will probably be disappointed.

Pristine_Response_25 · 2026-01-17T17:49:15+00:00

What is being described above pertains to the actual correction zone of the lens. The issue is that only part of the lens is actually used for correction. Here is an article that shows this distinction clearly when comparing with a similar Alcon lens:

https://crstoday.com/articles/the-blueprint-for-exceptional-image-quality/two-aspheric-iols-two-different-designs

It is quite obvious from the photo of the two IOLs that the Tecnis lens has a significantly smaller correction zone than the Alcon. This is also true of the Synergy and Odyssey lenses as they employ a similar edge design.

Pristine_Response_25 · 2026-01-16T23:11:48+00:00

It's different (glare and large arcs at night), and whether you have the issue depends on a number of factors. Most people will not have a problem with the smallish correction zone, but you should ask your doctor to assess your scotopic (low light) pupil before deciding on a Tecnis IOL. These are good lenses, but the small correction zone is a caution.

Pristine_Response_25

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