Positive Dysphotopsia after Cataract Surgery

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.

For starters, are your eyes of a light color? The square edge of IOL may be a factor, but this “light eye thing” may be something too. I don’t know; ophthalmologists are too inclined to educate patients.

For starters, are your eyes of a light color? The square edge of IOL may be a factor, but this “light eye thing” may be something too. I don’t know; ophthalmologists are too inclined to educate patients.

Excuse me, ophthalmologists are NOT to inclined to educate patients.

bobbyo - Thank you! your posts have done a lot to educate me about PD than most ophthalmologist would ever care to. Really appreciate your efforts.

Am 70 years old and had my Right Eye cataract surgery done about 12 years ago (Alcon SN60WF, monofocal). Took care of the cataract, but I still needed refractive correction with glasses. I see minor double image in RE when looking directly at bright lights with dark background. The ophthalmologist convinced me that it was because my RE was already compromised because of a prior Iris problem.

Recently, LE showed cataract, not too bad, and I had LE cataract surgery at the beginning of March 2023. (I do not know if it was unwise to use a different surgeon, but a very experienced one, who put in a HOYA acrylic IOL using laser surgery - this is in India). Almost from day 1 after this surgery, and it's 4 weeks now, I'm noticing starbursts while looking at car headlights; and the home / street lights appear in multiple layers blurring the overall appearance of those lights. Otherwise, optometrist measured the distance vision in this eye at almost 20/20. I'd end up using glasses with progressive lenses because of the RE issue. When questioned about starbursts and multiple light images, the ophthalmologist feels all this should settle down with time. I really hope so.

In the interim, I am really afraid that, with my RE already compromised, this could affect my night time driving and I do enjoy driving. Very worried and keeping my fingers crossed for now.

I do thank you, bobbyo and others, once again for so much useful information and links on this forum - I wish I had seen it before and reconsidered my cataract surgery decision at this stage.

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.

After having cataract surgery in both eyes over 6 months ago, and going from 20/20 vision to the present 20/70 I highly recommend getting a second opinion when an eye doctor recommends cataract surgery. I truly believe that my surgery was unnecessary and was only performed because I am on Medicare. My Opthamologist double and triple billed my Medicare insurance company for items he had made me pay out of pocket for. Even after having laser surgery done to clear up the post surgery massive scarring, I still have days where I feel like I’m looking through a foggy window. What I would give to go back in time and refuse the surgery. As patients we tend to trust our medical professionals more than they deserve to be trusted. From now on I will go for second opinions, even third ones before I let another unscrupulous and greedy physician mislead me into surgery. My eyesight that had allowed me to enjoy my drawing, crafting and reading passions in life has been stolen from me due to my botched and most likely unnecessary cataract surgery. I welcome any recommendations on how I can regain my wonderful sight back!

I decided not to go back to my original surgeon and went to another opthamologist for my (other)right eye. I described to him and the staff my problem. He looked and said it was a wrinkle not positive dysphotopsia. Come into this other room and I'll laser it for 15 seconds.
I did and my ray is gone. All that anguish gone in 15 seconds.
I was lucky I did not have my eyes done 2 weeks apart from the same surgeon.
My second opinion solved the problem. It gave me great satisfaction to cancel the checkup appointment with the first guy.
I scheduled my next surgery for the beginning of August with Dr. Kenneth Miller in Whippany, New Jersey.