what is dysphotopsia after cataract surgerywhat is dysphotopsia after cataract surgery

Figure1 represents the image of the patients symptoms experienced in a shopping center, showing ceiling lights as multiple lights. ; supervision, X.L. New preventative approach for negative dysphotopsia. If dysphotopsia continues to be a problem after 3 to 4 months, your ophthalmologist will suggest treatment options. The number of cases progressively decreased in both groups throughout the clinical follow-up, and the difference was no longer statistically significant at months 3 and 12. Entoptic phenomena. However, the mechanism of dysphotopsia may not be simple, as there are report of dysphotopsia being induced by the tear meniscus even when the LI hole is hidden by the eyelid [7]. the contents by NLM or the National Institutes of Health. PD also needs to be distinguished from entoptic phenomena and photopsias, which are not caused by external light sources such as vitreomacular traction [3,8,9,14]. Bhalla J.S., Gupta S. DysphotopsiaUnraveling the Enigma. Welch N.R., Gregori N., Zabriskie N., Olson R.J. First author:Liliana Werner, MD, PhDDepartment of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah. suggested using square-edge IOL with a textured edge to prevent unwanted glare symptoms [22]. 11 Min Read After your new lens is inserted into your eye during cataract surgery, it may jiggle a bit. Please whitelist to support our site. This dissatisfaction can be due to a number of factors that go beyond visual outcome. 2022 Jan 1;48(1):1-2. doi: 10.1097/j.jcrs.0000000000000864. Figure 1. A study comparing three different types of MFIOL found that six months after MFIOL implantation, 65% to 79% of patients reported haloes and 43% to 64% reported glare symptoms [58]. Positive and negative dysphotopsia in patients with acrylic intraocular lenses. 2c-d). Treating, eliminating negative dysphotopsia - EyeWorld Large angle kappathe angle between the visual axis (an imaginary line connecting the point of gaze fixation and the fovea) and the pupil axis (an imaginary line running through the pupil center perpendicular to the cornea)might also contribute to ND development [34,41]. [35]. Most patients (75.3%) were not familiar with premIOLs, with 58.9% not willing to consider them in the context of a 2% risk of debilitating dysphotopsia and 54.2% rejecting a 5% risk of second surgery. Received 2022 Dec 7; Revised 2022 Dec 17; Accepted 2022 Dec 20. Fram NR. I almost never intervene in the first month, he said, adding that 3 months is about the time he thinks the patient needs in order to adapt or at least give it a true attempt. For those with problems that still persist, Dr. Basti again stressed that there is the possibility of surgically exchanging the lens. Since kinetic perimetry measures the extension of the visual field up to 90 degrees and the visual field of a normal individual can extend up to 110 degrees temporally, it is possible that scotomas reaching to the extreme periphery of the temporal visual field are being underestimated [26]. A corneal incision of approximately 1.5mm wide was created directly above the PI hole (c). Influence of the intraocular lens optic-haptic junction on illumination of the peripheral retina and negative dysphotopsia. 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. The same study also suggested that a higher number of diffractive rings may cause more intense symptoms and MFIOLs with a lower number of diffractive rings may provide patients with better quality of vision [58]. The second category of unhappy patients Dr. Basti sees are those with quality of vision issues. 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]. ESCRS' mission is to educate and help our peers excel in our field. Wolters Kluwer Health A study by Osher RH found that permanent ND symptoms could be a result of interaction between the IOL edge and anatomical predisposition of patients [31]. Hofmann T., Zuberbuhler B., Cervino A., Monts-Mic R., Haefliger E. Retinal straylight and complaint scores 18 months after implantation of the AcrySof monofocal and ReSTOR diffractive intraocular lenses. Profile of nasal retina using 6.0 and 7.0 mm optics Enlarge image. (763) 421-7420, Facebook In a ray-tracing analysis, Holladay et al. Bath P.E., Dang Y., Martin W.H. After cataract surgery, some patients experience an irregular crescent-shaped shadow in their visual field known as negative dysphotopsia - this usually resolves within a few months on its own; if this symptom arises it's important to contact an ophthalmologist immediately for assessment and possible treatment options. showed that glare occurs in 38% of eyes after MFIOL implantation [56]. ESCRS, C/O MCI, Suite 7 - 9 Article Light . ; validation, A.P., X.L., and G.P. Patients notice a curved reflection or shaddow on the edge of the vision. Woodward M.A., Randleman J.B., Stulting R.D. Negative dysphotopsia: Long-term study and possible explanation for transient symptoms. The anterior and posterior IOL surface curvature also seems to be an important factor for PD development [17,18]. Department of Ophthalmology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku-Gun, Ishikawa, 920 -0293, Kanzawa, Japan, Tsuyoshi Mito,Honoka Kawakami,Toru Ikoma,Yuki Ukai,Eri Kubo&Hiroshi Sasaki, You can also search for this author in Multifocal intraocular lenses in cataract surgery: Literature review of benefits and side effects. The same study showed reduced probability of PD by dispersing the reflected rays with rounded-edge IOL design (Figure 1B) [15]. Like. Positive dysphotopsia is a symptom caused by the reflection of incident light through the pupil at the inner surface of the intraocular lens (IOL) edge after cataract surgery and is perceived as an abnormal arcuate or radiating photopic image at night or indoors with a light source. Therefore, we monitor for issues that could become bothersome or limit patients after cataract surgery. 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). Dr. Basti generally groups unhappiness after otherwise perfect cataract surgery into three categories. Recent developments in pseudophakic dysphotopsia. Even though up to 67% of patients may experience positive dysphotopsia immediately after surgery, only 2.2% of the cases have persistent symptoms up to a year postoperatively. Holladay JT, Lang A, Portney V. Analysis of edge glare phenomena in intraocular lens edge designs. By using this website, you agree to our was a plate-haptic IOL with a larger optichaptic junction than the 6.0 mm IOL. This is seen after surgery due to reflections related to the new lens in the eye. However, the difficulty is that staining the cornea above the edge of the IOL requires staining the area near the center of the cornea. Depending on the form of the optical phenomenon and the effect it poses on vision, dysphotopsias are divided into positive and negative type. 1999;25(6):74852. At that time, therefore, approximately 20 million people were affected by cataract. This increase was greater in patients with complete resolution of ND symptoms after a supplementary sulcus-fixated IOL implantation was performed compared to those without complete symptom resolution [77]. Due to the frequent occurrence, it is very important that the surgeon informs the patient about the possibility of these phenomena and their harmless nature. MFIOLs are associated with higher incidence of PD symptoms compared to monofocal IOLs [50,51,52]. His preferred approach is the use of EDOF or hybrid IOLs that give a fuller range of vision, so both eyes have distance, compared to monovision where there is a discrepancy, he said. The PI holes with approximately the same size and position in both eyes were observed. Furthermore, a pilot kinetic perimetry investigation on four ND patients found inferotemporal peripheral scotoma to be larger in extent with both eyes fully opened compared to a peripherally occluding contact lens being applied to the contralateral eye [36]. Positive and Negative Dysphotopsias: Causes, Prevention, and - Springer Masket S., Fram N.R. Vera V, Naqi A, Belovay GW, Varma DK, Ahmed II. Although positive dysphotopsia is one of the most important symptoms that affect patients after cataract surgery, it is still not well known even among ophthalmologists. This approach likely minimizes the risk of falls due to loss of contrast and depth perception, he added. Briefly, the center of the PI hole was pierced with a 100 polypropylene suture, and the needle was pulled out of the eye. When Can I Return To Normal Activities After LASIK? The etiology of ND is not clearly defined, and the cause seems to be multifactorial. Leadership and Business Innovation Masterclass aims to expand the skill sets of all ophthalmologists. Visual complaints, Dr. Chang said, include positive and negative dysphotopsias. By implanting a secondary IOL in the ciliary sulcus, a piggy-back IOL, a larger area of the peripheral retina gets illuminated [73], which improves ND in approximately 73% of the cases [73]. If the incidence angle of the light rays onto the IOL exceeds a critical angle of about 35 off the visual axis, it can create an internal reflection in the IOL which projects onto the temporal retina [15,17]. Henderson B.A., Yi D.H., Constantine J.B., Geneva I.I. Some surgeons recommend replacement of the new lens, however that is not guaranteed to remove the recently occuring reflections. Specifically, 5.5 mm diameter IOLs were linked to an increased risk for dysphotopsia compared to 6 mm diameter IOLs [13]. EK and HS contributed to study design and manuscript revision. The reason for this, especially with diffractive technology, is how the depth of the field and dysphotopsias are related to each other. As PD is still not well known among ophthalmologists, it may be overlooked; thus, it is necessary to accumulate cases to determine if any pseudophakic LI or trabeculectomy cases develop PD. Hang in there and good luck! Excellent NHS cataract surgery is available within months in Essex after a consultation at our practice. Dr. Basti said its not uncommon for patients to be unhappy after what is otherwise a successful cataract surgery. Resolution of negative dysphotopsia after laser anterior capsulotomy. Therefore, surgical closure of the PI hole, as in this case, may be the most effective treatment. The ligature was returned into the eye (f), Postoperative slit-lamp photomicrographs. Cornea. Positive dysphotopsiathe unwanted images including rings, arcs, and central flashes that become bothersome after IOL implantationhave been associated with everything from the patient's ability to recognize the edge of the implanted IOL to corneal disease to multifocal IOLs to an oversized peripheral iridotomy (PI) that allows too much light sc. Dysphotopsia - EyeWiki Similar findings were observed by Masket et al. High RI of the optic material, in particular, acrylic IOLs, moves forward the anterior and the posterior border of the shadow reducing its width compared to silicone IOLs. noted PD symptoms in 80% of patients after MFIOL implantation, although only 5% of the patients found the symptoms as bothersome [57]. [Causes, Diagnosis and Therapy of Negative Dysphotopsia] Telling if its entopic is simple the patient sees the flash with his eyes closed, Dr Holladay said. Attentive eye care practitioners know these symptoms are generally temporary or can be managed through surgery, according to Dr. Papps. Pieh et al. Patients need to be given some time, and sometimes they just need to have a better understanding of the situation and explore it before making a big decision to exchange a lens. It may be possible that transient and persistent ND have different causes [31,33]. Symptoms can also be alleviated by pharmacologic mydriasis which increases the illumination of the peripheral retina [27,73]. Effect of a sulcus-fixated piggyback intraocular lens on negative dysphotopsia: Ray-tracing analysis. official website and that any information you provide is encrypted McCannel MA. 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. Negative dysphotopsia is the leading cause of dissatisfaction following uneventful cataract surgery. Schwiegerling J. On the other hand, Davison JA states that the use of miotic therapy does not improve PD symptoms [6]. And so, the first step is to establish the history.. J Cataract Refract Surg 1999;25:748752, 6. Henderson B.A., Geneva I.I. Cooke, D.L., Davison, J.A., Folden, D.V., Holladay, J.T., Masket, S. (2014) Treating, eliminating negative dysphotopsia. ND could, thus, be alleviated if IOL optic covered the anterior capsulotomy edge [27]. A good description of dysphotopsia can be found at Living Healthy 360. A review article from 2021 recommends pharmacological miosis as a conservative management method in highly symptomatic patients [3]. Distinct differences in anterior chamber configuration and peripheral aberrations in negative dysphotopsia. Negative dysphotopsias are relative and . In what I've read, positive dysphotopsia dissipates or goes away for many/most in the weeks and months following surgery. According to Holladay et al., the silicone IOLs reduce the width of the illumination gap and moves it more anteriorly [7]. Pseudophakic Dysphotopsia: Review of Incidence, Cause, and Treatment of Positive and Negative Dysphotopsia. Tsuyoshi Mito. The symptoms could be induced by out-of-focus images produced by the MFIOLs [55]. The same research mentioned a number of IOL properties that could affect ND incidence, including high RI, higher dioptric power, equi-biconvex or plano-convex shape, negative aspheric surface, and IOL diameter [34]. Proposed etiologies have included design, smoothness, and thickness of the IOL edge, IOL material refractive index, IOL optic size, haptic configuration and orientation, pupil size, amount of functional nasal retina, edema from clear corneal incisions, distance between the iris and the IOL, and interaction between the anterior capsulorhexis and the IOL, among others.14,15 Laboratory analyses using ray-tracing optical modeling have greatly contributed to a better understanding of this phenomenon. Careers, Unable to load your collection due to an error. As a rule of thumb, the more range of vision you provide, the more dysphotopsia you may create, he said. For those who received presbyopia-correcting lenses, he will see them at week 1 as well. Monovision surgical techniques for correcting presbyopia may induce less PD compared to MFIOL implantation [64]. The ocular findings in eye position, ocular motility, intraocular pressure, and fundus were within normal limits. The disappearance of ND symptoms weeks after surgery could be associated with resolution of corneal edema [31]. Copyright 2023 Jobson Medical Information LLC unless otherwise noted. Another study on 600 patients that compared four different types of IOLs could not find a connection between IOL material and occurrence of PD either [13]. 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. Dysphotopsias are optical conditions characterized by abnormal visual phenomena, including light streaks, starbursts, rings, light arcs and flashes of light that occur without cause. found that translucent or opaque occlusion of the fellow eye resulted in subjective improvement of symptoms [35]. These findings were supported by laboratory scatterometry investigations [12]. At the time of his first visit, the corrected visual acuity in both eyes was good, and ocular findings in eye position, motility, intraocular pressure, and fundus were within normal limits. Dysphotopsias or Unwanted Visual Phenomena after Cataract Surgery A study of eleven patients with ND showed that symptoms may be objectively evaluated by kinetic perimetry testing as statistically significant constrictions of the peripheral temporal and inferior visual field [26]. Pieh S., Weghaupt H., Skorpik C. Contrast sensitivity and glare disability with diffractive and refractive multifocal intraocular lenses. Usually, you just have to reassure the patient. Nd:YAG laser capsulotomy of the posterior lens capsule in ND patients is not recommended as ND symptoms are not a result of the opacification of the posterior lens capsule and can make later surgical IOL exchange more difficult [9,31]. Illumination gap theorya gap between the different refraction of rays hitting the IOL optic periphery (yellow) and the rays that miss the IOL (red). In most cases of a new lens in the eye after cataract surgery the reflections dysphotopsia, reduces over time. This dissatisfaction can be due to a number of factors that go beyond visual outcome. A modified intraocular lens design to reduce negative dysphotopsia. CAS Dysphotopsias are of transient nature in most of the pseudophakic patients. Dysphotopsias are visual symptoms that some patients may notice in the first few weeks following cataract surgery. However, a study by Franchini et al. de Vries N.E., Webers C.A.B., Touwslager W.R.H., Bauer N.J.C., de Brabander J., Berendschot T.T., Nuijts R.M. Time course of dysphotopsia symptom persistence. J Cataract Refract Surg 2000;26:810816, 2. The right eye had good subjective visibility, but the patient noticed symptoms of light sources appearing divided into multiple lights indoors after surgery in the left eye. The effect of lens edge design versus anterior capsule overlap on posterior capsule opacification. Frequently, its the distance for working or using a computer that patients are not happy about, Dr. Basti said, estimating that half of unhappy patients after successful surgery would fall into this category. PD symptoms can resolve by correcting any postoperative refractive error, treating coexisting ocular surface diseases (e.g., dry eye syndrome), treating posterior capsular opacification, or by inducing pharmacological miosis [8,71,72]. Positive dysphotopsias are usually described by patients as glare, light streaks, starbursts, light arcs, rings, haloes, or flashes of light. "Dysphotopsia just means an unwanted image that patients see after cataract surgery. Diagnosing it may prove challenging as it could easily be mistaken for scotoma caused by retinal detachment; however, unlike retinal detachment it does not involve complete loss of vision and can therefore be diagnosed through slit lamp biomicroscopy or dilated pupillary examination. What Tests Are Done Before Cataract Surgery. Positive dysphotopsia as the cause of patient complaint following intraocular surgery other than cataract surgery has not been identified. The center of the PI hole was pierced with a 100 polypropylene suture (a). Part of The subjective symptoms of PD completely disappeared, the postoperative corrected VA was unchanged from the preoperative corrected VA, higher order aberrations measured with wavefront analyzer KR-1W (Topcon, Tokyo, Japan) showed no abnormalities before and after surgery, and no iris capture of IOL or intraocular pressure elevation has been observed to date. Osher RH observed a crescent-shaped shadow near the pupil when light was passing through the incision from a temporal angle [31]. A ray-tracing analysis suggested that 7.0 mm optic diameter IOLs enlarge and shift the illumination gap more peripherally compared to 6.0 mm diameter IOLs [46]. Contact Us Holladay J.T., Lang A., Portney V. Analysis of edge glare phenomena in intraocular lens edge designs. Holladay JT, Lang A, Portney V. Analysis of edge glare phenomena in intraocular lens edge designs. The https:// ensures that you are connecting to the Furthermore, high-angle input light was found to miss a 7.0 mm optic at a larger visual angle than a 6.0 mm optic, shifting illumination of the peripheral retina by this light anteriorly. Patient outcomes following implantation with a trifocal toric IOL: Twelve-month prospective multicentre study. your express consent. Negative dysphotopsia: Causes and rationale for prevention and treatment. The authors declare no conflict of interest. Therefore, its important to counsel patients preoperatively and set expectations. Dysphotopsia after cataract surgery or lens exchange is a relatively rare but annoying symptom after treatment for cataract. Get the latest ophthalmology news delivered to your inbox every Friday. Undesired light images associated with ovoid intraocular lenses. 1976;7(2):98103. Video images during surgery. Evaluation of intraocular lens position and retinal shape in negative dysphotopsia using high-resolution magnetic resonance imaging. Negative dysphotopsias are manifested as an arc-shaped shadow or line usually located in the temporal part of the visual field, similar to a temporal scotoma. Positive dysphotopsia after intrascleral intraocular lens fixation: a case report, https://doi.org/10.1186/s12886-022-02474-z, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Angle kappa is larger in hyperopic patients as significant correlation exists between angle kappa values and positive refractive errors [42]. ND seems to occur more commonly in left eyes or in women [29,31,33]. Incidence and causes of negative dysphotopsia after uncomplicated cataract surgeryA randomized clinical trial. volume22, Articlenumber:263 (2022) Henderson BA, Yi DH, Constantine JB, Geneva II. One of the most common causes of patient complaints is pseudophakic dysphotopsia, comprising diffractive, negative and positive dysphotopsias. PubMed Pseudophakic dysphotopsia: review of incidence, cause, and treatment of positive and negative dysphotopsia. This theoretical explanation is supported by patients complaining of glare symptoms occurring in low mesopic or scotopic light conditions such as reading at night with a light source on the side or driving at night (Figure 2A) [2]. We look at their personality type, we look at night driving checklists, we show simulations, but sometimes were just wrong. 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]. For the lower refractive index (1.46), the 6.0 mm IOL was modeled with a 5.5 mm optic surrounded by a 0.25 mm rim, and the 7.0 mm IOL was modeled with a 6.0 mm optic surrounded by a 0.5 mm rim. Erie J.C., Simpson M.J., Bandhauer M.H. Mendicute J., Kapp A., Lvy P., Krommes G., Arias-Puente A., Tomalla M., Barraquer E., Rozot P., Bouchut P. Evaluation of visual outcomes and patient satisfaction after implantation of a diffractive trifocal intraocular lens. A small number of nerves on the surface of your eye get cut when your surgeon makes the incisions necessary to reach your lens. government site. The incidence of negative dysphotopsias is up to 26% of all patients; however, by one year postoperatively, the symptoms usually persist in 0.13 to 3% of patients. In this 1-Minute Video, Dr. Nicole Fram reviews a condition that can present after uncomplicated cataract surgery: negative dysphotopsia. Data is temporarily unavailable. April 2022 by Ellen Stodola Editorial Co-Director Even with a technically perfect outcome after cataract surgery, physicians may find that some patients are unhappy. Negative dysphotopsiasperceived dark areasare more difficult for patients to tolerate. However, sharp-edged IOLs are still commonly in use, as they slow down posterior capsule fibrosis [21]. Dysphotopsia after temporal versus superior laser peripheral iridotomy: a prospective randomized paired eye trial. PMMA IOLs with round-edge optics tend to result in less instances of positive dysphotopsia than older PMMA lenses with square edges, possibly because their round design disperses stray light more evenly across retina. All Rights Reserved. This scar tissue is not as reflective and decreases the brightness of the edge reflections. Here, we report a case of postoperative PD in a patient who underwent intrascleral IOL fixation for IOL subluxation. Neuroadaptive changes in negative dysphotopsia during contralateral eye occlusion. After cataract surgery, vision may not fully return for a few days. He recommended referring these cases to a retinal specialist for evaluation and treatment. showed that a sharp-edge IOL design increases the probability of a thin, ring-like image projecting onto the midperipheral retina [15]. In ND, an arc-shaped shadow or line is usually located in the temporal visual field similar to a temporal scotoma (Figure 2B) [3,6,13]. The same study also found an IOL exchange for a square-edged 3-piece silicone IOL to be the most successful in treating PD [8]. An irregular or abnormal pupil size could also play a key role in Parkinsons Disease (PD), with excess light reaching the retina through irregularly shaped or irregular-sized pupil openings and creating unwanted aberrations such as glare and halos that interfere with vision. According to Davison JA, in 0.07% of cases, an additional procedure is required to resolve PD [6]. The incidence of these adverse events has been increasing in recent years due to the increasing use of multifocal and toric IOLs in cataract surgery. The image depicted here is our own property. PD occurrence may also depend on the IOL diameter. In general, PD occurs in patients who have IOL inserted in cataract surgery and is caused by light rays from the outside passing through the pupil to the IOL, with some light reflecting off the inner surface of the IOL edge and forming an image on the retina [5], causing strong complaints in some cases. According to previous reports, most symptoms are related to the nature of the inserted intraocular lens (IOL) [2]. Generally, the better the early postoperative visual acuity, the more they complain. Square-edge IOL design appears to be the primary cause of reflected nighttime glare. For patients receiving monofocal lenses, Dr. Chang said he generally doesnt see them between eyes; if they do have a complaint, he makes sure the issue is addressed before operating on the second eye. This case report was conducted in accordance with the principles of the Declaration of Helsinki. Piovella M., Colonval S., Kapp A., Reiter J., Van Cauwenberge F., Alfonso J. Visual performance after bilateral implantation of 2 new presbyopia-correcting intraocular lenses: Trifocal versus extended range of vision. Secondary reverse optic capture is the best option for negative dysphotopsia, Fram said. De Vries et al. Incidence of positive dysphotopsia is way higher than 1.5% of patients. Computer modeling suggests that every pseudophakic eye has some arc of shadow on the retina, so its curious why some patients complain about it and others do not, he said. Satisfaction and dysphotopsia in the pseudophakic patient. J Cataract Refract Surg 2000;26:145147, 3. Reverse optic capture technique, sulcus placement of the IOL, and implantation of a secondary piggy-back IOL might improve ND symptoms [27]. All authors have read and approved the final manuscript. The authors declare that they have no competing interests. Since emotional responses may be difficult to differentiate from actual vision issues, its wise to see an eye doctor should you experience any persistent symptoms that you suspect could be visual in nature. PubMedGoogle Scholar. An IOL exchange for a sulcus-fixated round-edged silicon IOL may also be successful (Figure 5) [32,38,76]. Negative dysphotopsia: causes and rationale for prevention and treatment.