Positive Dysphotopsia after Cataract Surgery

I am embarrassed to say I don’t have the exact model and specs of this IOL, but it is made by Bausch and Lomb and a 3-piece silicone. I am 4.5 months past surgery and do have persisting PD, but I do think it’s a little better than a month ago. This right eye does have another condition called pigment dispersion that complicates things and made me more likely to have post operative PD. Note: I don’t have this condition in my left eye.

On your question of “coordinating” the 2 different IOL brands and specs of each eye, the surgeons did not tell me of anything to be concerned about.

As to consideration of IOL exchange on the left eye, I researched this and risks and out-of-pocket costs seemed to outweigh the potential reward. And, my Pittsburgh area second and third opinions were not in favor of a lens exchange.

Hope that’s of some help and good luck!

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This is, actually, meant as a reply to westchesterbaba

Forgive me if I didn’t make my explanation clear. With my left eye surgery in 2019, they implanted the typical Alcon SN60 that they use for, something like, 98% of their patients. Immediately after surgery, I had PD that is still significant to this day with temporal light streaks from external sources like sunlight, headlights and ceiling lights. From what I’ve read, the Alcon SN60 IOL that they implanted has a more squared edge that “could be” a source of light reflections off the of retina and be the cause the long term PD symptoms I’ve mentioned.

From what I read in the following 3 years since the left eye surgery, IOLs with more rounded edges can, possibly, help to avoid the light reflections and, thereby, avoid the PD. I used this info as my right eye cataract worsened and needed surgery which I had on 1/26/23. There were no guarantees that a round-edge IOL would be the answer, ESPECIALLY since I have pigment dispersion syndrome in this right eye. I asked for a rounded-edge IOL so that I would give myself the best chance of avoiding PD on this second eye. The surgeon made no promises, but I’m glad he gave me the best chance for success.

As said, post surgery 4.5 months, there IS Positive Dysphotopsia on this right eye. Still, I’m hopeful the PD will dissipate. It just makes sense to me that a lens with less surface edge for potential reflections (like a round-edge IOL) makes more sense than one with a square edge. Despite, the right eye PD, I think I pushed for the lens most likely to yield me the best vision.

This is so tricky for every person, but I hope I’ve adequately explained my rationale.

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Thank you so much for your explanation. I am in the same position with PD in left eye, surgery done 3/6/23, followed by a yag laser procedure on 5/25,23, with PD still persisting. I have a follow up this week with the surgeon who thought that the yag would have eliminated the PD.
I am holding on the right eye surgery, but I plan to require the surgeon to use a rounded edge lens. My left eye lens is a J&J DCBOO. This is the "standard" lens that is used by the surgeons in the uni medical practice I selected.
Unfortunately, you and I are in the small % of people who get PD, and, from what I've learned thru research, there's no predicting this outcome.

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Yes, it seems that a pretty small percentage get long term PD. Yours having only been done in March (2.5 months) and having had the YAG capsulotomy done only couple weeks ago, is there a chance the PD will settle down more?

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I have a very thick cataract on my right eye that developed after an infection when an Eylia shot for wet macular degeneration was done in early March. I had decent peripheral vision in that eye up until the infection and subsequent cataract which had helped with driving. The cataract is so dense that my retina specialist cannot do a scan to check the retina for changes and is urging me to get cataract surgery. The first cataract surgeon refused to do it. I see a second one later this month. This can’t be regarded as routine, so I’m worried that I may be at risk for even worse problems if I have cataract surgery done on my already damaged eye. Has anyone had cataract surgery done on a wet macular degeneration eye? On a cataract that developed because of an eyeball infection?

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I honestly don't know if the PD will "settle down" or I'll just learn to ignore it, which is what the literature suggests.
In any event, I do appreciate you taking the time to explain your situation and answer my questions.
I wish you the best going forward!

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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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