what is dysphotopsia after cataract surgery

Positive pseudophakic dysphotopsia is characterized by the presence of halos, starbursts, flashes, streaks, and/or glare after uncomplicated cataract surgery with intraocular lens placement. Osher R.H. 4a-f), thereby closing the PI hole (Fig. was a plate-haptic IOL with a larger optichaptic junction than the 6.0 mm IOL. After cataract surgery, almost all patients experience some level of dryness in the eye. 1. 2023 EyeWorld News Service. Therefore, its important to counsel patients preoperatively and set expectations. The most commonly mentioned factors for occurrence of PD are IOL shape [12], sharp-edged design [11], RI [8], pupil size [2], and IOL size [10,13]. Such phenomena are common after cataract surgery because the intraocular lens (IOL) takes up only about 6% of the crystalline lens volume, leaving plenty of room for the vitreous to move after surgery. Nasal location of the pupil relative to the eyes optical axis (>2.6 or 0.3 mm on the cornea) can be the cause of exposure of the nasal retina to light rays [7,24]. The effect of the material of IOL and RI on the occurrence of PD symptoms is not unequivocally explained. However, one month after surgery, the difference in ND incidence was no longer statistically significant [43]. Stromal lenticule extraction, implantation expand refractive options. Positive and negative dysphotopsia in patients with acrylic intraocular lenses. Negative dysphotopsia is often described as a dark crescent-shaped blinder or shadow at the edge of a patients temporal field of vision. Figure 3. However, a 2021 meta-analysis study comparing EDOF and MFIOL implantation outcomes could not find significant advantages of EDOFs compared to MFIOLs [63]. Kinetic perimetry may reveal peripheral visual field defects [26,31]. In most cases, symptoms spontaneously resolve; however, in up to 2.2% of patients, symptoms persist up to one year after surgery [11]. Auffarth G.U., Brezin A., Caporossi A., Lafuma A., Mendicute J., Berdeaux G., Smith A. Erie J.C., Simpson M.J., Bandhauer M.H. One of the fundamental predispositions for an illumination gap to be perceived as a temporal arching shadow is the presence of functional nasal retina, which extends more anteriorly compared to the temporal retina [7,31,38]. Your US state privacy rights, Similarly, a 5-year follow-up study on 320 patients showed hydration of the temporal corneal wound at the end of surgery to possibly increase the risk for transient ND [33]. ; writingoriginal draft preparation, A.P. This is the first report of PD following intrascleral IOL fixation, possibly caused by the reflection of light at the edge of the IOL through the PI hole created during intrascleral IOL fixation. Dr. Chang finds that around 1 in 5 patients will mention these symptoms. ND is a diagnosis of exclusion where other possible ocular and neuro-ophthalmological pathologies should be excluded [29]. Any corneal abnormalities should be examined, including sequels of previous refractive surgery, presence of epithelial basement membrane disease, or microcystic oedema. and transmitted securely. Wei M., Brettell D., Bhardwaj G., Francis I.C. She said that she prefers cutting the lens in half rather than folding it because it gives her more control. ND is evoked by an external light source that is typically temporally oriented [8,27]. A 2020 study found that hydrophobic IOLs with a higher RI, especially acrylic IOLs, increase the incidence of PD [8]. Your privacy choices/Manage cookies we use in the preference centre. These visual symptoms typically resolve soon after surgery and rarely cause persistent problems for patients. J Cataract Refract Surg 2002;28:11121123, 5. However, the intervention can be linked to postoperative complications, such as earlier opacification of the posterior lens capsule, capsular block syndrome, iris chafe, and postoperative myopic refractive error (myopic shift) [27,29]. Cite this article. For those with dryness, routine postop drops have usually stopped around this time, he said, and many patients with dysphotopsia will see it resolve after several months as well. Provided by the Springer Nature SharedIt content-sharing initiative. One of the postoperative complications is iris capture of the IOL and IOP elevation associated with pupillary block [6]. Then, a main incision of approximately 1.5mm wide was created directly above the PI hole, the suture through the PI hole was pulled out of the eye from the anterior chamber, ligated, and trimmed to return the ligature to the eye (Fig. The third category of patients unhappy after cataract surgery are those with physical discomfort, like dry eye or a stinging sensation from eye drops, Dr. Basti said. A corneal incision of approximately 1.5mm wide was created directly above the PI hole (c). Therapeutic measures are needed in cases of long-term persisting problems [5]. Henderson B.A., Geneva I.I. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The PI hole did not overlap the edge of the IOL in the right eye, whereas the edge of the IOL was visible in the center of the PI hole in the left eye. 2001;27(7):10614. A concave region on the peripheral posterior surface of a biconvex IOL may prevent ND by increasing the area of illuminated peripheral retina and narrowing the illumination gap [45]. All Rights Reserved. Get the latest ophthalmology news delivered to your inbox every Friday. Sometimes the squeaky wheel doesnt get the grease: Despite dysphotopsia being the leading cause of patient dissatisfaction after uncomplicated cataract surgery, surgeons say precious little has been done to address it. He said that about a quarter of patients who experience this dissatisfaction will not actually spell it out for the surgeon, but if you probe, youll get to why they are unhappy. [(accessed on 24 November 2022)]; Chiam P.J.T., Chan J.H., Aggarwal R.K., Kasaby S. ReSTOR intraocular lens implantation in cataract surgery: Quality of vision. Note the peripheral groove and excellent centration. van Vught L., Dekker C.E., Stoel B.C., Luyten G.P.M., Beenakker J.W.M. Accordingly, we concluded that the abnormal photopic image in the left eye was caused by positive dysphotopsia, in which light passing through the PI hole was reflected by the edge of the IOL. Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology. Dysphotopsia, a lingering issue after cataract surgery: effect of IOL optic size J Cataract Refract Surg . Patients usually experience these phenomena near the visual axis, especially in low mesopic or scotopic conditions when the pupils dilate [2,6,9]. Hood C.T., Sugar A. Subjective complaints after cataract surgery: Common causes and management strategies. You should be able to go home on the same day as your cataract surgery. While it frequently resolves on its own, several physicians said it's important to discuss it with patients and explain what's going on. No ethical approval was obtained for this study. Karhanov M., Pluhek F., Mlk P., Vlil O., n M., Mareov K. The importance of angle kappa evaluation for implantation of diffractive multifocal intra-ocular lenses using pseudophakic eye model. However, if the problem continues a few months after surgery, ophthalmologists must step in to provide a treatment. Therefore, we monitor for issues that could become bothersome or limit patients after cataract surgery. Kora Y., Marumori M., Kizaki H., Yaguchi S., Kozawa T. Experimental study of small intraocular lenses using an eye model. Positive dysphotopsias, such as glare, halo, and starbursts, are generally noticed at night when driving and are especially associated with presbyopia-correcting IOLs. A PI hole that forms during intrascleral IOL fixation allows light into the lens surface and bounce off its edge, creating symptoms of dysphotopsia that gradually vanish when surgically closing off this opening providing further support for this theory. ; validation, A.P., X.L., and G.P. Patients may also be feeling the edge of the incision or even components of their eye drops, so its important to look for an abrasion, foreign body, or irregularity in the wound. Recent evidence suggests that dysphotopsia (PD) could be caused by square-edged IOLs used during cataract surgery to reduce posterior capsular opacification. Mendicute et al. A clinical study on 289 patients showed that ovoid IOL shape significantly contributes to the PD occurrence [12]. The first are patients whose refractive outcomes or the point where they expected vision to be is not exactly where it is. According to the manufacturer, both IOLs also have a 360-degree lens epithelial cell barrier on the posterior surface, which reduces the effective optic diameter to 6.5 mm for the Aspira-aXA IOL and to 5.5 mm for the Aspira-aA IOL. could not confirm these predictions [25]. Surgical intervention may be indicated in 0.07% of cases. Ophthalmology 2021;128:e195e205. Of course they will be thrilled with their results and not complain about dysphotopsias. The term dysphotopsia was propagated through the literature in the year 2000 to indicate any light-related visual phenomenon encountered by phakic and pseudophakic patients.13 The symptoms associated with pseudophakic dysphotopsia were further divided into positive and negative types.3,4 Dysphotopsia in association with monofocal intraocular lenses (IOLs) had already been described under other names, such as edge glare, photic phenomena, or undesired light images (terms used to describe the positive type), and has since been the object of numerous laboratory, clinical, and review articles.515, Patients generally describe positive dysphotopsia (PD) as unwanted bright images, such as light streaks, light arcs, central flashes, or starbursts within the visual field, which are usually induced by an oblique external light source. Some surgeons recommend replacement of the new lens, however that is not guaranteed to remove the recently occuring reflections. Capsular bag contraction can cause anterior axial movement of the IOL, reducing the axial space behind the iris, which could also be the reason for dysphotopsias [7]. "Dysphotopsia just means an unwanted image that patients see after cataract surgery. He estimated that around 30% of the unhappy patients he sees after cataract surgery fall into this category. One study suggests that a nasal anterior capsule overlying the anterior nasal part of the IOL optic could be a factor determining the presence of ND by reducing the intensity of rays transmitted to the retina due to ray reflections [34]. The critical angle of the acrylic IOL is smaller than that of silicon IOLs, which can cause an increased internal reflection with the former; the intensity of these reflections can be over 1000 times higher than those from an unaccommodated human lens [15]. Makhotkina N.Y., Nijkamp M.D., Berendschot T.T.J.M., van den Borne B., Nuijts R.M.M.A. Ultrasound biomicroscopy may be useful to determine IOL-to-iris distance [31]. Fifty-seven eyes received an IOL with an optic diameter of 7.0 mm and plate-haptics (Aspira-aXA, HumanOptics), and 63 eyes received an IOL with an optic diameter of 6.0 mm and C-loop haptics (Aspira-aA, HumanOptics). Like. A retrievable suture idea for anterior uveal problems. A combination of an unequal biconvex IOL design with a flatter anterior surface curvature and high IOL-refraction index increases the internal light reflections and causes more intensive and focused illumination of the retina which can result in unwanted glare images [17,18]. Fortunately, advances in lens edge design have minimized this problem. It is possible after surgery to be a little off from the target, Dr. Basti said, so its important to mention to patients that they may have to adjust the distance at which theyre reading. Consider that the vast majority of patients are 80+ and were essentially blind before surgery. What he will do is discuss with the patient the distances at which he or she likes to hold things. may email you for journal alerts and information, but is committed Negative dysphotopsia with spherical intraocular lenses. showed that glare occurs in 38% of eyes after MFIOL implantation [56]. However, positive dysphotopsias seldom result in lens replacement. There is also a possibility that central nervous system adaptation mechanisms could be involved in the ND development, although they are not yet clearly understood [35,36]. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Pseudophakic Dysphotopsia: Review of Incidence, Cause, and Treatment of Positive and Negative Dysphotopsia. In the last years, extended depth-of-focus IOLs (EDOF) have been introduced as presbyopia-correcting IOLs with the possibility of reducing PD occurrence [61,62].
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