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Positive Dysphotopsia after Cataract Surgery

Posted by bobbyo @bobbyo, Oct 30, 2021

I’m 62 and had my left eye cataract done in December 2019 and still have significant peripheral light streaks and night glare and starbursts while driving (positive dysphotopsia). Makes me a little “white-knuckled” when night driving and is maddening overall. Local surgeons are not inclined to consider an IOL exchange and neither am I, at this point.
With that, has anyone:
- experienced dissipation of dysphotopsia symptoms as time passed?
- tried photochromic contacts or glasses and had success?
- other actions that helped you?

Thanks for any input!

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ag3 | @ag3 | Mar 31 7:18pm
In reply to @bobbyo "What a great story! You informed yourself and found a “true” specialist so that you could..." + (show)
@bobbyo

What a great story! You informed yourself and found a “true” specialist so that you could have a better quality of vision and, thereby, a better quality of life.

I remain baffled that so many cataract surgeons pooh-pooh PD. But, being baffled did me no good, being persistent DID. I’m very glad I requested and received a better IOL for my right eye cataract surgery and because of that have no PD!

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I'm so very, very glad you have no PD Bobbyo. Going into the lens exchange I'd remind myself of your initially having PD with the second lens, and then having it resolve in 3-4 months. It was a relief that I had none, but your information would have helped me weather a similar situation. So thank you for having continued to write!

I failed to mention some things of significance. On my querying Dr. Fish, he estimated that he did 10-15 lens exchanges a year. That's in comparison to 5 over the entire career of a middle-aged surgeon I consulted who advised against it. Further, Dr. Fish guessed that of all those, about 15 had been for those with PD, all of whom had either had dramatic reduction or disappearance of all PD, and all had been happy they'd had the exchange. He is a relatively quiet person in my experience and didn't offer any of this information without being asked. Virtually everyone I came in contact with at this well-run clinic had praise for him, saying he gets the lens exchanges from all around. He is also a cornea specialist.

REPLY
mayoconnectuser1 | @mayoconnectuser1 | Mar 31 9:15pm
In reply to @ag3 "I'd heard of it, but hadn't considered it. My original inclination to keep it simple has..." + (show)
@ag3

I'd heard of it, but hadn't considered it. My original inclination to keep it simple has been reinforced by my recent experience. It is Dr. Fish's opinion that it was the acrylic material and not the extended distance of the Vivity that was responsible for the positive dysphotopsias. Nevertheless, choosing a monofocal lens in the first place would have given me more options.

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Yes. LAL is also a monovision lens - of silicon, vs the far more common acrylic.

Don't LAL and Vivity cost about the same?

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jhs1950 | @jhs1950 | Apr 10 4:42pm
In reply to @adf13840 "HI @frankmiramonti. I recently had surgery in Kansas City with the Light Adjustable Lens and am..." + (show)
@adf13840

HI @frankmiramonti. I recently had surgery in Kansas City with the Light Adjustable Lens and am having the exact same negative dyspotpsia issues, as well as the lens jiggling, flickering, etc.

May I ask who did your lens exchange? I, too, am thinking of traveling to see Dr. Safran, as I do not want to do anything to this lens that will make things worse or make it harder to explant/exchange.

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Hi, I hope you have had improvement since June 2023. I did not realize that you could get dysphotopsias plus flickering with the LAL. I am scheduled to have LAL surgery in May in Kansas City. I am wondering if you would share who your ophthalmologist was that did your surgery. I have done so much research and I am not sure I am doing the right thing. Thank you for any help! There are so many questions about the LAL.

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elliott1953 | @elliott1953 | Apr 21 10:04am

I had laser cataract surgery on one eye four weeks ago and still see a stream of light at an approximately 45 degree angle through led and other bright lights. I was given the impression that this would dissipate in time and therefore proceeded with cataract surgery on the other eye last week. I now see, at times. a horizontal streak of light and some hazing around some lights in that eye, although it's less bothersome and may be fading and I am only out a week from that second surgery.

Another surgeon who examined me the day after my second surgery, informed me that the J & J Enhance lens used was smaller than my natural lens and that the capsule holding the lens would likely shrink over the next few months possibly correcting the issue. But he also noted that there was or could be (not sure exactly what he said) of a wrinkling in the capsule (or maybe the lens, not sure) that was causing the light streaking.

In any event, he told me that if the 'light issue' didn't resolve within 3 months, the issue could be addressed by the Yag laser.

I wonder:
1. if others have had their 'light issues' whether due to wrinkling or otherwise self-corrected within months;
2. if not, whether they adjusted to it over time as opposed to taking a risk with the yag laser; and,
3. I wonder if this occurrence was due to having my cataract surgery done by laser as opposed to the more traditional manual method

REPLY
1 reply
tillymack | @tillymack | Jun 27 4:51am

Hello, I came across your post while searching for others who had developed a Maddox rod effect after cataract surgery 2 weeks ago. I noticed this on day 1 post surgery. Yag was suggested as treatment but I am currently in a wait and see pattern. Could you let me know if the silicon lens exchange was effective in alleviating your symptoms? Many thanks.

REPLY
mayoconnectuser1 | @mayoconnectuser1 | Jun 28 11:04am
In reply to @elliott1953 "I had laser cataract surgery on one eye four weeks ago and still see a stream..." + (show)
@elliott1953

I had laser cataract surgery on one eye four weeks ago and still see a stream of light at an approximately 45 degree angle through led and other bright lights. I was given the impression that this would dissipate in time and therefore proceeded with cataract surgery on the other eye last week. I now see, at times. a horizontal streak of light and some hazing around some lights in that eye, although it's less bothersome and may be fading and I am only out a week from that second surgery.

Another surgeon who examined me the day after my second surgery, informed me that the J & J Enhance lens used was smaller than my natural lens and that the capsule holding the lens would likely shrink over the next few months possibly correcting the issue. But he also noted that there was or could be (not sure exactly what he said) of a wrinkling in the capsule (or maybe the lens, not sure) that was causing the light streaking.

In any event, he told me that if the 'light issue' didn't resolve within 3 months, the issue could be addressed by the Yag laser.

I wonder:
1. if others have had their 'light issues' whether due to wrinkling or otherwise self-corrected within months;
2. if not, whether they adjusted to it over time as opposed to taking a risk with the yag laser; and,
3. I wonder if this occurrence was due to having my cataract surgery done by laser as opposed to the more traditional manual method

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Elliott,

Which IOL do you have?

I had light streaks with my LALs (this month) - different axis for each (one was 10 and 4, the other 2 and 8 on the clock). At day five both artifacts went away.

REPLY
elliott1953 | @elliott1953 | Jun 28 12:09pm

Mayoconnectuser1,

In reply to your question, I had the J&J Eyehance lenses but my light streak is due to a wrinkle in the capsule, not the IOL itself. Glad to hear yours went away quickly.

Elliott

REPLY
tillymack | @tillymack | Jul 14 9:15pm
In reply to @poc1115 "Rare? Really? I just had cataract surgery 4 days ago. I too have the streaks of..." + (show)
@poc1115

Rare? Really? I just had cataract surgery 4 days ago. I too have the streaks of light depending of the light source. After a lot of research it sounds fairly common and so far I have not come across any information that states this is temporary or that it goes away. I turned to Mayo because it is a trusted scholarly institution. This forum is interesting but it's like the blind leading the blind. Clinical professional input would be helpful

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You might try Reddit.com/r/CataractSurgery for occasional input from cataract surgeons.

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tillymack | @tillymack | Jul 14 9:36pm
In reply to @poc1115 "I'm also curious about the incidence of PD with the use of laser assist vs bladed..." + (show)
@poc1115

I'm also curious about the incidence of PD with the use of laser assist vs bladed surgery. I opted for laser, it probably has no bearing since it's thought to be the material and shape of the lens replacement, but I am curious. Saw my opthalmologist yesterday and he said no one knows why or how some people get PD, that they just do. At my one month post op visit we test for new eyeglass RX and he said that a new RX (if needed) may calm down the streaks. Needless to say I won't be doing my other eye any time soon.

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In answer to your question about laser assist vs blade, I have the maddox rod effect after bladed surgery. How are you doing now? I hope you have noticed some improvement with or without yag surgery. I was interested to read that your doctor suggested that glasses might calm down the streaks. Did you find that was correct?

REPLY
tillymack | @tillymack | Aug 7 10:29am
In reply to @bobbyo "What a great story! You informed yourself and found a “true” specialist so that you could..." + (show)
@bobbyo

What a great story! You informed yourself and found a “true” specialist so that you could have a better quality of vision and, thereby, a better quality of life.

I remain baffled that so many cataract surgeons pooh-pooh PD. But, being baffled did me no good, being persistent DID. I’m very glad I requested and received a better IOL for my right eye cataract surgery and because of that have no PD!

Jump to this post

After having the Bausch & Lomb L161A0 in your second eye, were the symptoms in the first eye improved as well?

REPLY
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