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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!

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bobbyo | @bobbyo | Aug 8 6:17am
In reply to @tillymack "After having the Bausch & Lomb L161A0 in your second eye, were the symptoms in the..." + (show)
@tillymack

After having the Bausch & Lomb L161A0 in your second eye, were the symptoms in the first eye improved as well?

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No improvement in LE (left eye) dysphotopsia. BUT, the RE (right eye) with the B & L remains good. As said, I attribute that, rightly or wrongly, to my persistence in getting the round edged IOL.

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tillymack | @tillymack | Aug 8 8:44am

I wondered if having more visual support from your RE, you might notice a fading of the problem when both eyes are open? Would you say that overall, your vision in both eyes seems better in any way? On another note, is the B&L IOL you had implanted available in a toric do you know? Many thanks!

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1 reply
bobbyo | @bobbyo | Aug 9 8:20am
In reply to @tillymack "I wondered if having more visual support from your RE, you might notice a fading of..." + (show)
@tillymack

I wondered if having more visual support from your RE, you might notice a fading of the problem when both eyes are open? Would you say that overall, your vision in both eyes seems better in any way? On another note, is the B&L IOL you had implanted available in a toric do you know? Many thanks!

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Best thing I would say on LE is that there IS some amount of adaptation to the PD over (for me) 4 years time. BUT, temporal lights like driver-side, rear-view mirror and tunnel lights remain problematic. The “goodness” of the RE doesn’t win out, so to speak.

On B & L and torics, I don’t know. There are a number of round-edge IOLs and I’d ask your cataract surgeon to research with their vendors to find the best “fit” for you.
Best of Luck!

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rosebud4664 | @rosebud4664 | Aug 31 1:01pm

With cataracts I had no problem with night vision. After surgery on my left eye I had problems with light in that eye only. My surgeon say the capsule the IOL goes in can get, for want of a better word, saggy with age (I’m 78). Because the sac is larger than the lens that causes wrinkling of the sac which is what causes the light issue. With time the sac will probably tighten around the new lens, if not there is a simple laser treatment that will fix it.

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tillymack | @tillymack | Sep 21 2:37pm
In reply to @bobbyo "Thank you. I can really empathize with you. You hear some people say after cataract surgery,..." + (show)
@bobbyo

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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Hi Bobbyo, Were the photochromic lens (Acuvue Transitions) helpful in calming positive photopsias? I'm still looking for help with regard to my Maddox rod effect.

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tillymack | @tillymack | Sep 21 2:57pm
In reply to @bobbyo "Yes, I have the same PD symptoms (temporal lights streaks being the worst). Summary of ineffective..." + (show)
@bobbyo

Yes, I have the same PD symptoms (temporal lights streaks being the worst).

Summary of ineffective treatments I tried: photochromic contact lenses, miotic eyedrops, Vuity eyedrops. None were helpful.

Note: For my cataract surgery in 2019, I went with traditional/insurance-covered IOL and that provided correction for distance vision BUT NOT for astigmatism (mine is 50). Since I can’t see signs well enough when driving, optometrist gave me toric contact lens that allows me to read signs. My PD remains and I attribute to the shortfalls of the IOL they used, Alcon SN60WF. I will, definitely, have a different IOL (and, surgeon) when I have my right eye done.

Any insight you have on PD is much appreciated!

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Hi Bobbyo, Were you able to have your right eye cataract removed and replaced with an IOL? If so, I hope all went well.

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tillymack | @tillymack | Sep 21 3:01pm
In reply to @marshgirl "Hi John, Nighttime driving is still problematic with glare from headlights and streetlights. I've accepted the..." + (show)
@marshgirl

Hi John,
Nighttime driving is still problematic with glare from headlights and streetlights. I've accepted the fact that this is how my eyes reacted to the lens. Since it's been 15 months for my right eye and now going on 10 months for my left eye I don't think it will change.
Daytime outside I'm fine. Inside during the day in bright window lighting I sometimes get a glare.

I guess I've somewhat adapted (or accepted it I guess) and it doesn't seem to bother me as much.
My vision otherwise is fine so I try to focus on that.

Wishing you the best!

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Hi Marshgirl, Have you experienced any PCO which needed to be treated with the yag laser?

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tillymack | @tillymack | Sep 21 3:27pm
In reply to @bobbyo "What a great story! You informed yourself and found a “true” specialist so that you could..." + (show)
@bobbyo

What a great story! You informed yourself and found a “true” specialist so that you could have a better quality of vision and, thereby, a better quality of life.

I remain baffled that so many cataract surgeons pooh-pooh PD. But, being baffled did me no good, being persistent DID. I’m very glad I requested and received a better IOL for my right eye cataract surgery and because of that have no PD!

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Hi again Bobbyo, First I apologive for my comments asking questions I later find answered... I hope all continues to go well with your new lens!
I have experienced no improvement with my maddox rod effect and now face a yag laser procedure for growing PCO. I've been advised that the yag procedure may increase dysphotopsias and wonder if you have had the yag and if the treatment was a success in clearing PCO while at the same time not creating more starbursts or other artifacts.

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1 reply
tillymack | @tillymack | Sep 21 4:19pm

Hi adf13840,
Did you travel to see Dr. Safran and could he help you with the dysphotopsia?

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bobbyo | @bobbyo | Sep 22 7:26am
In reply to @tillymack "Hi again Bobbyo, First I apologive for my comments asking questions I later find answered... I..." + (show)
@tillymack

Hi again Bobbyo, First I apologive for my comments asking questions I later find answered... I hope all continues to go well with your new lens!
I have experienced no improvement with my maddox rod effect and now face a yag laser procedure for growing PCO. I've been advised that the yag procedure may increase dysphotopsias and wonder if you have had the yag and if the treatment was a success in clearing PCO while at the same time not creating more starbursts or other artifacts.

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Hi tillymack,

Yes, I had the yag done for the PCO on left eye. It helped relieve the blurriness that had developed. Unfortunately, it had no effect on the PD.

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