Positive Dysphotopsia after Cataract Surgery

Posted by bobbyo @bobbyo, Oct 30, 2021

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!

Interested in more discussions like this? Go to the Eye Conditions group.

Hello @bobbyo, Welcome to Connect. I had cataract surgery done to both of my eyes last year and was really happy with the results because I no longer had to wear glasses for driving. I had the standard IOLs used and I did notice some glare on bright days and sometimes at night. Regular sunglasses help me during the day. I was bugged because I always had to have 1.25 reading glasses with me to read labels at the store. The surgeon did give me an RX for glasses to fix the reading and suggested I could have them as bifocals or progressive lenses so I recently had a pair made and wear them most of the time and they seem to make a difference with the night time glare that I still noticed a little, although not as bad as prior to my cataract surgery.

Here are a couple of articles you may find helpful on the topic.
— Dealing with positive and negative dysphotopsias: https://www.ophthalmologytimes.com/view/dealing-positive-and-negative-dysphotopsias
— BLOG: Educate patients on transient nature of dysphotopsias: https://www.healio.com/news/optometry/20180424/educate-patients-on-transient-nature-of-dysphotopsias

Have you looked into getting photochromic contacts or glasses?

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@johnbishop

Hello @bobbyo, Welcome to Connect. I had cataract surgery done to both of my eyes last year and was really happy with the results because I no longer had to wear glasses for driving. I had the standard IOLs used and I did notice some glare on bright days and sometimes at night. Regular sunglasses help me during the day. I was bugged because I always had to have 1.25 reading glasses with me to read labels at the store. The surgeon did give me an RX for glasses to fix the reading and suggested I could have them as bifocals or progressive lenses so I recently had a pair made and wear them most of the time and they seem to make a difference with the night time glare that I still noticed a little, although not as bad as prior to my cataract surgery.

Here are a couple of articles you may find helpful on the topic.
— Dealing with positive and negative dysphotopsias: https://www.ophthalmologytimes.com/view/dealing-positive-and-negative-dysphotopsias
— BLOG: Educate patients on transient nature of dysphotopsias: https://www.healio.com/news/optometry/20180424/educate-patients-on-transient-nature-of-dysphotopsias

Have you looked into getting photochromic contacts or glasses?

Jump to this post

Thanks John! Yes, mine is positive dysphotopsia and I read that Healio article you referenced. My symptoms are severe temporal light streaks, bright splayed lights, starbursts and halos that are really tough at night and night-driving. It being my left eye, I have to eliminate use of the side-view and rear-view mirrors by turning them completely out of sight range when driving at night. The photochromic contacts or glasses I mentioned are like the “photo gray” lenses that were popular in eyeglasses of late 1970s-80s. They can, possibly, diffuse stray light that is reflecting off the sides of my IOLs and help my problem. That’s what I’m trying next. Thanks for your suggestions.

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I was told I had cataracts although I could read the phone book. I was diagnosed with astigmatism. Had the surgery and now I have double vision. Another Dr told me I have Irregular Astigmatism. Get a second opinion is my suggestion.

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I whole heartedly agree. Get a second opinion. A year after cataract surgery I have to wear glasses to see tv print (about 15 feet away) which we’re not necessary prior to surgery. And Although my close vision is slightly better, I also need prescription glasses for reading.
Very disappointed.

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Thank you. I can really empathize with you. You hear some people say after cataract surgery, “I see better than when I was 20!” or “I see perfectly.” You want it to be you (I want that to be me!). I have seen other doctors in my Pittsburgh, PA area for these problems, but they have no easy answers. I try to research online groups/forums. I, also, research cataract surgeons in other parts of the country (or, even outside the US) that have more experience with post cataract surgery problems and positive dysphotopsia, in particular. I don’t feel like I’m ready to travel in search of the “holy grail”, at least, yet.

My optometrist gave me miotic drops to shrink the left pupil a few months ago, but that was of no help. He is not really a proponent of their long term use because of side effects. So, I am going to try the photochromic lens (Acuvue Transitions) when my optometrist gets them to see if it calms these dysphotopsias at all.

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Ok, I guess the lack of entries on post cataract dysphotopsias might show that they are, in fact, rare. That’s, certainly, good for the many people who have had cataract surgery, In reading online, seems that the data shows long term positive dysphotopsia occurs in about only 1.5% or so of patients. I’m thinking that this percentage is low as some post operative patients say, “well, my vision is fine except I can’t drive at night anymore because of the lights.” Also, when my surgeon tells me “dysphotopsias are very rare”, this gives me no solace since I am “1 for 1” (I had one eye done and got dysphotopsia 100 percent of the time).

With that, I’ll update what I’ve found out and done lately:
– I tried the photochromic contact lens in my eye in attempt to decrease the severe streaks and halos. The result was poor. I, actually, had worse halos/light glare and acuity was also worse
– Since, I have a very slight astigmatism, my optometrist gave me the very lowest power toric and it helps me a little to see street/highway signs. I’m, also, trying yellow glasses to try to calm the glare/halos/streaks at night driving with limited success.
– I explored the prospect of an lens exchange, but local doctors are strongly against it saying risks of a worse outcome are not worth it.

ALL of the above are related to my LEFT eye, the one on which I had cataract surgery in late 2019. As said previously, I put off surgery for RIGHT eye cataract this fall because of fear it will end up the same as my left. I continue to research surgeons in Pittsburgh area who know how to avoid the dysphotopsia problems of my first IOL implant. Thanks for any input.

REPLY
@bobbyo

Ok, I guess the lack of entries on post cataract dysphotopsias might show that they are, in fact, rare. That’s, certainly, good for the many people who have had cataract surgery, In reading online, seems that the data shows long term positive dysphotopsia occurs in about only 1.5% or so of patients. I’m thinking that this percentage is low as some post operative patients say, “well, my vision is fine except I can’t drive at night anymore because of the lights.” Also, when my surgeon tells me “dysphotopsias are very rare”, this gives me no solace since I am “1 for 1” (I had one eye done and got dysphotopsia 100 percent of the time).

With that, I’ll update what I’ve found out and done lately:
– I tried the photochromic contact lens in my eye in attempt to decrease the severe streaks and halos. The result was poor. I, actually, had worse halos/light glare and acuity was also worse
– Since, I have a very slight astigmatism, my optometrist gave me the very lowest power toric and it helps me a little to see street/highway signs. I’m, also, trying yellow glasses to try to calm the glare/halos/streaks at night driving with limited success.
– I explored the prospect of an lens exchange, but local doctors are strongly against it saying risks of a worse outcome are not worth it.

ALL of the above are related to my LEFT eye, the one on which I had cataract surgery in late 2019. As said previously, I put off surgery for RIGHT eye cataract this fall because of fear it will end up the same as my left. I continue to research surgeons in Pittsburgh area who know how to avoid the dysphotopsia problems of my first IOL implant. Thanks for any input.

Jump to this post

Bobby, I really appreciate that you posted what you’ve learned so far. Indeed dysphotopsias are rare. The information that you’ve posted will most definitely help the next rare person who searches for information like you’re doing today and they will feel less alone. Thank you.

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@bobbyo

Ok, I guess the lack of entries on post cataract dysphotopsias might show that they are, in fact, rare. That’s, certainly, good for the many people who have had cataract surgery, In reading online, seems that the data shows long term positive dysphotopsia occurs in about only 1.5% or so of patients. I’m thinking that this percentage is low as some post operative patients say, “well, my vision is fine except I can’t drive at night anymore because of the lights.” Also, when my surgeon tells me “dysphotopsias are very rare”, this gives me no solace since I am “1 for 1” (I had one eye done and got dysphotopsia 100 percent of the time).

With that, I’ll update what I’ve found out and done lately:
– I tried the photochromic contact lens in my eye in attempt to decrease the severe streaks and halos. The result was poor. I, actually, had worse halos/light glare and acuity was also worse
– Since, I have a very slight astigmatism, my optometrist gave me the very lowest power toric and it helps me a little to see street/highway signs. I’m, also, trying yellow glasses to try to calm the glare/halos/streaks at night driving with limited success.
– I explored the prospect of an lens exchange, but local doctors are strongly against it saying risks of a worse outcome are not worth it.

ALL of the above are related to my LEFT eye, the one on which I had cataract surgery in late 2019. As said previously, I put off surgery for RIGHT eye cataract this fall because of fear it will end up the same as my left. I continue to research surgeons in Pittsburgh area who know how to avoid the dysphotopsia problems of my first IOL implant. Thanks for any input.

Jump to this post

Hello, I had cataract surgery done on both my eyes in June 3 weeks apart. I am severely myopic and have astigmatism. I upgraded to the premium Alcon Acrysof IQ toric lens. The left eye was done first and seemed great. However, I walked around without any correction on the right eye for 3 weeks, so didn't drive or do much at night. Immediately after surgery on the right eye, I noticed some glare/halos/streaks (starbursts), mostly in the left eye and most debilitating at night. The streaks are visible around every light source, both inside and outside. They told me that I had scarring and that a YAG would resolve my issues. Unfortunately, the YAG amplified the issues in both eyes, and both are equally affected. The "experts" now say they have no idea what the issue is. I've been going back and forth with the them, but am about to get a 2nd opinion. I believe it's the IOL. I will need to weigh the pros and cons of a lens exchange, if feasible, against the possibility of making a bad situation worse. I too have been prescribed drops that don't help. I've tried numerous sunglasses. The issues are amplified at night vs daytime due to amount of available light. My nighttime driving is totally compromised which is the worst part of this whole ordeal. I absolutely regret doing the surgery.

I appreciate your input and feedback on what you have tried. It's hard to resign myself to potentially having to deal with the side effects of the surgery for the rest of my life. Very depressing and difficult to come to terms with.

REPLY
@dsgreen5

Hello, I had cataract surgery done on both my eyes in June 3 weeks apart. I am severely myopic and have astigmatism. I upgraded to the premium Alcon Acrysof IQ toric lens. The left eye was done first and seemed great. However, I walked around without any correction on the right eye for 3 weeks, so didn't drive or do much at night. Immediately after surgery on the right eye, I noticed some glare/halos/streaks (starbursts), mostly in the left eye and most debilitating at night. The streaks are visible around every light source, both inside and outside. They told me that I had scarring and that a YAG would resolve my issues. Unfortunately, the YAG amplified the issues in both eyes, and both are equally affected. The "experts" now say they have no idea what the issue is. I've been going back and forth with the them, but am about to get a 2nd opinion. I believe it's the IOL. I will need to weigh the pros and cons of a lens exchange, if feasible, against the possibility of making a bad situation worse. I too have been prescribed drops that don't help. I've tried numerous sunglasses. The issues are amplified at night vs daytime due to amount of available light. My nighttime driving is totally compromised which is the worst part of this whole ordeal. I absolutely regret doing the surgery.

I appreciate your input and feedback on what you have tried. It's hard to resign myself to potentially having to deal with the side effects of the surgery for the rest of my life. Very depressing and difficult to come to terms with.

Jump to this post

First, I am sorry if I am redundant relative to my previous posts.

I am certainly sorry for your surgery result. Is it fair to say that the left had the light streaks immediately after your surgery, but it wasn’t yet as noticeable since you weren’t driving at night yet? How do you think your right eye surgery turned out?

As a parallel to your initial months post surgery, here were mine: I noticed better distance vision immediately, but I “babied it” in the initial days/weeks and was avoiding night driving entirely. In the first 2 weeks post surgery, I got very concerned about large influx of floaters and had to run back to doctor to a retinal tear repaired. Over the next few months, I struggled with the streaks AND the substantial floaters AND a gradual worsening of acuity/onset of starbursts around light sources (that deterioration caused by quick growth of PCO). In Dec 2020, doctors proposed remedying my PCO (in my case with vitrector) during a vitrectomy and this MAY also cure get rid of my temporal light streaks. Sooo, I had vitrectomy and surgery on PCO that yielded big help on floaters and acuity BUT the positive dysphotopsia/temporal lights streaks. In last year, this condition is worse, is anything.

Treatment and exploration for treatment update:
– I have struggled to see road signs at night. Since I have very slight astigmatism (50), my optometrist gave me a toric contact lens that has helped me a little.
– My former company has a medical review/2nd opinion service that has begun compilation of my eye doctor/surgery records. It is They will develop a plan of best action and referral. Supposedly, they consult the “best of the best” in the country. I have found my search for specialists to be difficult, so I’m hopeful that they can guide me to someone who can help me 1.) with my left eye dysphotopsia and 2. with dysphotopsia avoidance of measures for my impending right cataract surgery. I will update!

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@dsgreen5

Hello, I had cataract surgery done on both my eyes in June 3 weeks apart. I am severely myopic and have astigmatism. I upgraded to the premium Alcon Acrysof IQ toric lens. The left eye was done first and seemed great. However, I walked around without any correction on the right eye for 3 weeks, so didn't drive or do much at night. Immediately after surgery on the right eye, I noticed some glare/halos/streaks (starbursts), mostly in the left eye and most debilitating at night. The streaks are visible around every light source, both inside and outside. They told me that I had scarring and that a YAG would resolve my issues. Unfortunately, the YAG amplified the issues in both eyes, and both are equally affected. The "experts" now say they have no idea what the issue is. I've been going back and forth with the them, but am about to get a 2nd opinion. I believe it's the IOL. I will need to weigh the pros and cons of a lens exchange, if feasible, against the possibility of making a bad situation worse. I too have been prescribed drops that don't help. I've tried numerous sunglasses. The issues are amplified at night vs daytime due to amount of available light. My nighttime driving is totally compromised which is the worst part of this whole ordeal. I absolutely regret doing the surgery.

I appreciate your input and feedback on what you have tried. It's hard to resign myself to potentially having to deal with the side effects of the surgery for the rest of my life. Very depressing and difficult to come to terms with.

Jump to this post

@dsgreen5 I am sorry about your light sensitivite eye troubles since having YAG surgery. How is your actual vision since cataract surgery and YAG? Were you able to achieve 20/20? Do you se see colors more clear and vibrant?

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@bobbyo

Ok, I guess the lack of entries on post cataract dysphotopsias might show that they are, in fact, rare. That’s, certainly, good for the many people who have had cataract surgery, In reading online, seems that the data shows long term positive dysphotopsia occurs in about only 1.5% or so of patients. I’m thinking that this percentage is low as some post operative patients say, “well, my vision is fine except I can’t drive at night anymore because of the lights.” Also, when my surgeon tells me “dysphotopsias are very rare”, this gives me no solace since I am “1 for 1” (I had one eye done and got dysphotopsia 100 percent of the time).

With that, I’ll update what I’ve found out and done lately:
– I tried the photochromic contact lens in my eye in attempt to decrease the severe streaks and halos. The result was poor. I, actually, had worse halos/light glare and acuity was also worse
– Since, I have a very slight astigmatism, my optometrist gave me the very lowest power toric and it helps me a little to see street/highway signs. I’m, also, trying yellow glasses to try to calm the glare/halos/streaks at night driving with limited success.
– I explored the prospect of an lens exchange, but local doctors are strongly against it saying risks of a worse outcome are not worth it.

ALL of the above are related to my LEFT eye, the one on which I had cataract surgery in late 2019. As said previously, I put off surgery for RIGHT eye cataract this fall because of fear it will end up the same as my left. I continue to research surgeons in Pittsburgh area who know how to avoid the dysphotopsia problems of my first IOL implant. Thanks for any input.

Jump to this post

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.

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@jsm22553

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.

Jump to this post

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.

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