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Positive Dysphotopsia after Cataract Surgery
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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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.
I have very dark eyes.
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.
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1 ReactionDear aa2023,
Surely, hope you have improvement in the coming weeks and months. It is difficult decision on when to “pull the trigger” on an eye surgery, if at all.
I had thought that I was ready in October 2021 to get my RE done, but scared off because of the fear of getting PD like I had gotten with my LE. So, I did a lot of homework and got the surgeon to use the B & L silicone, round-edge for the RE this past January. However, No luck as this RE is, at least, as bad with PD symptoms as the LE as I near 9-weeks post surgery..
You do all you can to put yourself in the best position, but everyone's situation is different and results are rarely perfect.
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1 ReactionThis was written in May 2022. What has happened since?
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!
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1 ReactionFind a corneal surgeon and have a lens exchange. My doctor pushed multifocal lenses on me and I’ve had problems ever since. When he ignored my positive dystophotopsia and proceeded like nothing was wrong it crushed me. I couldn’t believe a doctor would let a patient live with all those visual disturbances.
Luckily I was able to find a surgeon to do a lens exchange. Going to mono focal. So I’ll have to wear glasses. It’s better than halos, starburst and haze.
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2 ReactionsWhere was the wrinkle?
Last year in March at the well established Pepose Vision Institute here in St. Louis. I had a $6,000.00 RX Sight LAL (Light Adjustable Lens) 20.0 D implanted be Dr. Pepose, in my left eye and immediately developed ND.
The following procedures have been done to my poor butchered left eye since then. : /
- a Reverse Optic Capture was performed at WashU. This diminished the shadow and transformed it to a blurry area of light non focused by the IOL. It’s like the frame on an eyeglass lens effect only it moves with the eye.
- Next a YAG capsulotomy (bad idea) that Dr. Pepose stopped mid procedure to reexamine the eye with slit lamp and then finished, subsequently the posterior capsule was not opened enough, confirmed by Dr. Gira at Ophthalmology consultants, inducing glaring light streaks.
- another YAG capsulotomy at Washington University in St. Louis to open up posterior capsule more and more evenly to correct the light streaks created by not making a good opening that was large enough - that had been done by the brilliant Dr. Jay Pepose who again, originally convinced me I needed cataract surgery in the first place, even though my real issue was vitreous opacities, aka floaters.
- Next Vitrectomy, to clear up the floaters and clouds in the eye - which it had to begin with, before cataract surgery with a crystalline natural lens that was not very clouded, in an eye with >= 20/20 acuity - but was told the vitreous opacity (floater cloud) was cataract. Post YAG’s I developed PVD (vitreous detachment) which increased the floaters. I also have right eye with cloud floaters. But the acuity is 20/15. Both eyes had LASIK 12 years ago.
- Next YAG pitting of the edge to ostensibly diffuse light from edge of the silicone RX Sight lens was tried twice with some minor improvement the first time and the second time made it worse than before producing arcs across from oblique light sources.
- Next and lastly on March 22 this year the RX Sight LAL was now explanted and a new Lucia 602 was implanted in the sulcus, behind the iris - as I was assured that would most likely be the final solution for the peripheral photopsia.
- Post last surgery developed corneal edema that went on for 3 weeks. That finally cleared up which brings the photopsia back into front stage.
The eye is now in worse shape than before surgery. The lens power was dropped from 20.0 Diopter to 19.0 because it was moved to sulcus. I have lost distance, and central acuity. Back to glasses for good distance vision and depth perception. I'm an avid tournament ballplayer that has now struggled mightily for the last two seasons to stay off the bench.
I now have floaters in the eye again, some pitch black ones that are most annoying. Worst of all I still have left peripheral blur/blob from left sourced peripheral light hitting my nasal retina.
All of the solutions they try seem to be hacks, yes hacks, that do not address the core issue, that of replacement lenses at 5-6.5 mm diameter that simply are not nearly the same diameter as the natural lens which is 9-9.5 mm. Current replacement lens optics in use are smaller in diameter than the natural lens. There are many light ray tracing studies that clearly model the issue of oblique peripheral light crossing the eye to the nasal retina, passing across the lens and emanating either from the edge of the lens light or bypassing the edge of the lens and hitting the nasal retina. The current state of FDA approved lense in the United States seem to be way behind. There are perhaps better lenses that perform better available outside the US. I'm going to see at least one or two more doctors, perhaps Dr. Safran in New Jersey, before I decide whether or not to go abroad for help. It's extremely disheartening to feel like I'm living in the third world of ophthalmology.
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