Positive Dysphotopsia after Cataract Surgery

Incidence of positive dysphotopsia is way higher than 1.5% of patients. Consider that the vast majority of patients are 80+ and were essentially blind before surgery. Of course they will be thrilled with their results and not complain about dysphotopsias. Others like you and I are less forgiving. I am looking at an hydrophilic iol in the sulcus (Raynor) to change the focal length and hopefully to minimize the dys. We'll see.

Thanks jsm. Your contention of “actual” long term dysphotopsias occurring in much more than 1.5% of cataract surgeries is mine too. I am finding various articles and forums online, but none has much data on age categories of those experiencing the long term dysphotopsia (like percentage of post IOL implant patients that experience long term dysphotopsias in their 50’s, 60’s, 70’s, 80’s etc.). If you can guide me to something, please do.

In the last few months, I’ve researched to find surgeons adept and experienced with treatment of dysphotopsias and IOL exchanges. Two doctors recommended a newer drug, Vivity, which is promoted as a presbyopia drug but has the effect of shrinking the pupil. They said this could, also, help my dysphotopsias. They gave me a sample bottle. I used it for a few days but my light streaks/halos were largely, unaffected. Also, since the drug shrinks the pupil so much, I had a lot of trouble seeing in lower light. I ceased using it.

The most accomplished IOL exchange surgeon I could find was Dr Stephen Safran, in Lawrenceville, NJ. You can see many of his surgeries on Youtube on his website. Since I, already, had a posterior capsultomy on this left eye, my local doctors and second opinion are NOT in favor of an IOL exchange.

jsm, just to make sure, is the sulcus IOL implant an IOL exchange (i.e. Explanting your present IOL and implanting new hydrophilic one). Can you tell me when you had your initial surgery and if you’ve had a subsequent posterior capsulotomy?

SO, I’m back to researching what to do on my RIGHT eye as the cataract is gradually worsening. I surely would like a better outcome on my right eye than I’ve had on my left.

I was encouraged that my local surgeon, at least, discussed employing a different approach on this right eye and IOL type. He conceded that the much-used SN60 has a higher incidence of dysphotopsias that the traditional, old-style PMMAs. Gives me hope that they with do all possible to avoid dysphotopic result when they implant an IOL in this right eye. I am trying to wait on surgery till late this year.

Thanks for your input and I’d love to hear anything else. Hope I’m understandable and not too long in my responses. I’ll keep updating.

Pleased to find this discussion. I, too, am searching for solutions after experiencing increased dry eye and halos at night (cataract surgery done four months ago). Halos presented immediately after surgery. They have not lessened. I notice if I stare right at a bright light, the halos briefly disappear. This leads me to believe my enlarged pupils are letting in light that hits the edge of the lens. Hope to try the eye drops someone mentioned to help reduce pupil size. Open to any other suggestions. I am in my 60s and I regret having the surgery. Will not be doing my other eye.

Hello, are you still having these same side effects? I had my cataract surgery at the end of 2021 and am having similar PD symptoms to what you describe. I have done a lot of research and have reached out to several specialists. If you are better that is great, please share what your current status is an how you resolved. If not and you would like to hear what I am trying let me know.

Yes, I have the same PD symptoms (temporal lights streaks being the worst).

Summary of ineffective treatments I tried: photochromic contact lenses, miotic eyedrops, Vuity eyedrops. None were helpful.

Note: For my cataract surgery in 2019, I went with traditional/insurance-covered IOL and that provided correction for distance vision BUT NOT for astigmatism (mine is 50). Since I can’t see signs well enough when driving, optometrist gave me toric contact lens that allows me to read signs. My PD remains and I attribute to the shortfalls of the IOL they used, Alcon SN60WF. I will, definitely, have a different IOL (and, surgeon) when I have my right eye done.

Any insight you have on PD is much appreciated!

Hello again, and first I want to say that I'm sorry your PD has not resolved. My main complaint is an annoying constant light show. I am going on almost 5 months post surgery from my second eye and the flickering, mostly when indoors around artificial light has not resolved. I did get a 2nd & 3rd opinion and they said it is Positive Disphotopsia and that if neuroadaption doesn't happen in 3 months then a ROC o IOL exchnage is the solution. My ophthamologist said yesterday that I could try ROC (reverse optic capture) and it that doesn't work do a lens exchange. Not thrilled with multiple surgeries, especially if no guarantee. I am fine outdoors. I need to figure out this flickering first because my doctor also wants to make sure the lens is not moving (Phacodonesis). His exam and 2 other DR. say it is not but the video I have looks like it is or is it just a refection of light bouncing off the square edge of the Panoptix lens? I can't post link but if you search lottemeiners1.wixsite with .com at end you can see it.
If It just takes time to resolve than I am willing to do that vs any interventions but also am sensitive to the optimal timing to do any surgery, especially an IOL exchange. My Dr. says that needs to happen sooner than later (2-6 months).
I think what is happening for many (3 %) who have the latest material for these lenses, acrylic, is that it is highly reflective and causing light splatter when it hits the lens. Especially if it is a square edge lens with rings like my AcrySof IQ Panoptix Lens. LE is a topic. I think there is a misalignment issue of the alpha angle of our eyes and optical angle of the IOL lens. I did not have a pre-op Corneal Topography w/ iTrace to evaluate so I would ask for this in the future. BTW 3 doctors assured me that I had the perfect surgery with a very centered lens and perfect refractive power. That is maybe the missing link because the lens may need to be aligned differently according to your Corneal Topography vs. centered. One size does not fit all.

Here are articles that explain that more. Again can't post links but google:
How to Reduce Higher-Order Aberrations
Understanding spherical aberration
USING ANGLE ALPHA IN PREMIUM IOL SCREENING
Positive Dysphotopsia After Toric Trifocal IOL Implantation
Can't Get No Satisfaction: Post-cataract Surgery Dysphotopsias

I have tried the Vuity drops like you with same results. I was interested in the contact lenses you tried but sounds like that wasn't helpful. I am also trying drops that dilate my eyes because when I get dilated in the Doc office the pulsating vision goes away. I have tried with my Doc's advice OTC, Naphcon A which dilates your pupils slightly and it does offer some relief. Again, for me all is good outdoors on a bright sunny day when the light is not coming in at an angle but is overall and my eyes are dialated. Another thing that helps is to occlude (block) one eye, either eye, and the pulsating vision goes away. I have tried wearing a patch but then all gets blurred because I nee both eyes to focus.

I think Time healing option is a caveat, Optic capture a crap shoot and from most specialists I have talked to, IOL explant/exchange the consistent solution that would solve PD. All say they would also use a silicone lens, like Bausch + Lomb L161. It has rounded edges, less prone to developing PCO and is not reflective like acrylic. For me unfortunately it will be giving up the Multi-Focal I have for Mono - 1 distance. Not happy about that because I do see 20/30 in the doc office and outside. It becomes a quality of vision decision for indoors when it becomes vision that pulsates and is in soft focus. I cannot see peoples faces clearly, read street signs and text has a soft blur around it.

I have talked to many specialists and will list them here as well as informative forums I have visited;
Dr Fram, Advanced Vision Care
Dr. Robert Bailey, Wills Eye Center
Dr. Safran, NJ
Dr Foster, Eye Center No. Colorado
Dr. Olsen, Moran Eye Center

Forums to google:
Patient.Info - Panoptix Experience

Patient.Info - flickering-sensation-after-cataract-surgery

I hope this helps. I am happy to answer any more questions. It is hard to navigate this eye world as a novice but vision is so important, that I keep digging through the weeds. I wish I had done this much research before a procedure that I was told by so many, including my DR., would give me perfect vision.

Thank you for all of your valuable research and insight. You refer to yourself as a “novice”, but you seem more like an experienced cataract surgeon!

Background: I’m longtime myopic and I’d employed monovision for many years with contact lenses. Had retinal surgery in left eye in 2018 and it prompted quick development of the cataract. In 2019, they implanted the distance vision Alcon SN60 and I experienced, almost immediate PD AND clouding of the posterior capsule. I, also, had significant floaters in that eye. My Vitreo-retinal surgeon, in whom I have fairly high confidence, advised a concurrent FOV and PCO which I had done. He believed this procedure could also help the PD. However, that surgery took care of the floaters and cloudy capsule, but was no help to the PD. And, since posterior capsule is now gone, an attempt at IOL explant/implant is of prohibitive risk to many surgeons.

I appreciate all of your site and doctor references and will check them out. Doctors that I’ve seen in my Pittsburgh area are not in favor of IOL exchanges. I had good communication with Dr. Safran, and he seems to have considerable, positive IOL exchange experience.

At this point, it doesn’t seem there are any easy answers to improve my left eye PD. It’s been 2 and a half years now and I hope age-related pupiler reduction and neuradaptation will give me incremental help.

As this right eye cataract has advanced, I need to decide on the lens and power to select for best ongoing vision. With the shortfalls of my left surgery, it is not a simple decision! Again, thank you for your wonderful input and let me know anything else you find out!

You have had quite the journey with eye surgery, so sorry for all the problems with your left eye.

I hope to meet with a specialist in the next week to learn more. I will share anymore additional info I get that may help. I do feel like I have learned quite a bit and wish I had known some of this going into the initial surgery. I alsoo wore contacts for over 50 years and my cataracts were not to developed yet but I couldn't get Lasik due to the fact that the cataracts were beginning. In hindsight, I would have not done the surgery but I was told by many that they loved their new vision and even my own surgeon said I would have better vision than Lasik could provide. Unfortunately I fell into the 3% category with side effects that are quite annoying. For me they truly effect my quality of life since I am a designer and fine artist.

This whole journey for me really has me convinced that the ophthalmology industry really needs to invest more in pre-op diagnostics and be ready for more solutions post op if these situations occur. We may only be in the 3% but that is about 108,000 patients who are having visual disturbances and when its you that is 100% in my eyes. But I am determined to resolve this issue and will hopefully regain desirable vision. Thanks for sharing and listening. It does help to talk with those who know what you are experiencing and I want to help as many as I can to find answers to an unfortunate problem that I am afraid will become more prevalent with these newer lenses being brought to the market. Wonder how many in Alcon, J&J, B&L, etc. research & development departments for these IOL's have tried them in their own eyes?

Hi again, I ran across this article that may be helpful in selecting a lens for your right eye. On page 3 under results they list the lenses used to resolve PD side effects.

Best of luck to you!

Hi, Thanks for the good article. In reading it, I noticed they referenced the flickering light symptom as a non-PD that “can” persist through about 1 month post cataract surgery and then subsides after some fibrosis occurs. I suppose that your condition, having persisted for 5 months, could not be attributed to that? Just trying to help.

It amazes me that monovision IOLs like mine, the square-edged, acrylic Alcon SN60WF, are the go-to for most cataract surgeons because they inhibit PCO development. However, I developed PCO almost immediately after my surgery AND got this very bothersome PD to boot! Figured they knew what they were doing..

Again, thanks