Post-Cataract Surgery Glare: Causes and Solutions

Glare after cataract surgery?

Hello Doctor: I underwent cataract surgery on July 7, 2023, where the surgeon implanted a monofocal aspheric toric intraocular lens and informed me that I would retain 2.00 diopters of myopia (I was approximately -5.00 diopters preoperatively, with astigmatism of -1.75 diopters).
During follow-up visits, my corrected vision was measured at 1.0 to 1.2.
However, to this day, I experience glare when facing light sources or strong reflections, especially from LED bulbs, such as new streetlights and traffic signals.
There is a halo around the light source, particularly a long and pronounced horizontal glare on both sides of the light source.
Additionally, when viewing high-contrast images, such as black text on a white background, there is also a horizontal halo next to the text.
I consulted the surgeon, who stated that the surgery was very successful and recovery has been good (I have had two postoperative follow-ups).
However, I have been informed that I have 2.50 diopters of astigmatism (which I thought should not be present due to the toric lens).
The surgeon believes that 2.50 diopters should not cause such pronounced glare and suggested waiting for some time to see if lens correction could help.
I have also read that postoperative corneal edema could be a potential cause.
I would like to ask: 1.
Is this glare considered photophobia? Is it caused by astigmatism, or could there be other possibilities? 2.
Is the 2.50 diopters of astigmatism due to improper alignment? If it is misaligned, can it be corrected? 3.
The surgeon also mentioned that there could be other causes, such as issues with the macula.
If the macula is involved, is there a treatment available, or is it something I would just have to adapt to? I would appreciate your insights, as I am quite concerned.
Thank you for taking the time to assist me.

Brian Zhang, 50~59 year old female. Ask Date: 2023/07/13

Dr. Cai Wenyuan reply Ophthalmology

Observe the symptoms; if they persist, you may visit a medical center for evaluation.

Reply Date: 2023/07/13

More Info

Post-cataract surgery glare is a common issue that many patients experience, and it can be attributed to several factors. In your case, the symptoms you describe—such as halos around lights, particularly LED lights, and the presence of glare when viewing high-contrast images—are indeed indicative of glare and possibly other visual disturbances. Let’s break down your questions and concerns.

1. Is this glare caused by astigmatism or other factors?
Yes, the phenomenon you are experiencing can be classified as glare. Glare occurs when bright light sources cause discomfort or visual disturbances, such as halos or starbursts around lights. In your case, the halos around LED lights and the horizontal streaks you see could be related to several factors, including residual astigmatism, corneal edema, or even the optical properties of the intraocular lens (IOL) used during your surgery. While the 25 degrees of astigmatism you mentioned may contribute to the glare, it is not the sole cause. The lens design, the quality of the surgical procedure, and the healing process of the cornea also play significant roles.

2. Is the 25 degrees of astigmatism due to misalignment? Can it be corrected?
The 25 degrees of astigmatism you are experiencing could be due to a few reasons, including the natural curvature of your cornea, the positioning of the IOL, or even residual refractive error post-surgery. If the astigmatism is due to the IOL not being perfectly aligned, it may be possible to correct it with glasses or contact lenses. In some cases, if the astigmatism is significant and bothersome, further surgical options, such as laser vision correction, may be considered after your eyes have fully healed.

3. Could the glare be caused by issues with the macula?
Yes, it is possible that issues with the macula, such as macular edema or other retinal conditions, could contribute to visual disturbances. If your surgeon suspects that the macula may be involved, they may recommend further evaluation, such as optical coherence tomography (OCT), to assess the health of the macula and surrounding structures. If there are any underlying issues, treatment options may vary depending on the specific condition diagnosed.

In summary, the glare you are experiencing is likely multifactorial, involving residual astigmatism, potential corneal changes, and possibly other retinal factors. It is essential to maintain open communication with your ophthalmologist. If your symptoms persist or worsen, further evaluation may be warranted to rule out any complications or to explore corrective options.
In the meantime, you might find relief from glare by wearing anti-reflective glasses, especially at night or in bright light conditions. Additionally, giving your eyes time to adjust post-surgery is crucial, as many patients notice improvements in their symptoms over time. If you have ongoing concerns, don’t hesitate to seek a second opinion or further evaluation from a specialist. Your comfort and visual clarity are paramount, and there are often solutions available to enhance your quality of vision after cataract surgery.

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