Positive Dysphotopsia after Cataract Surgery

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.

Don’t let them do YAG yet! If for some reason you have do do a lens exchange YAG makes it more difficult.
In January I had Vivity multi focal put in. I have positive Dysphotopsia they said I’d nuero adapt but I didn’t.
Last Tuesday I started the process of a lens exchange. Left eye has a toric mono focal. On the 27th the right eye will get the same. I don’t care if I have to still wear glasses. Those lens will be out. I’ve already seen an improvement.

How many months was it before you did the lens exchange? Does the new lens have rounded edges? I have PD also and am really tired of the miserable effects . But I’m afraid it’s been too long and would cause the exchange to be difficult.

How many months was it before you did the lens exchange? Does the new lens have rounded edges? I have PD also and am really tired of the miserable effects . But I’m afraid it’s been too long and would cause the exchange to be difficult.

Hi, yes that fibrosis is the lens scarring into place in the capsular bag. The flickering that most experience in the few weeks post-op is normal and it is actual movement of the lens till it scars in place. But unfortunately my flickering is persistent 5 months later. In the videos I did it looks like my lens is moving but I think its catching light on the edge and rings of the square edge lens and makes it look like its moving. My surgeon has referred me to a specialist that I meet tomorrow to talk more about this. My surgeon says it could be loose zonules but it would not cause the pulsating vision so it is a separate issue from the PD.

I can't agree with you more about the industry shift to a material and design that was suppose to prevent PCO but created a worse problem. I to had PCO immediately. At least that can be addressed with a clinical YAG procedure vs possible surgery.

Will update if I learn more tomorrow.

Don’t let them do YAG yet! If for some reason you have do do a lens exchange YAG makes it more difficult.
In January I had Vivity multi focal put in. I have positive Dysphotopsia they said I’d nuero adapt but I didn’t.
Last Tuesday I started the process of a lens exchange. Left eye has a toric mono focal. On the 27th the right eye will get the same. I don’t care if I have to still wear glasses. Those lens will be out. I’ve already seen an improvement.

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.

My Positive Dysphotopsia
started right away. I would think if you are not experiencing problems with dysphotopsia now that it shouldn’t develop later. Living with this affects my everyday life.