Positive Dysphotopsia after Cataract Surgery

Thanks for responding bobbyo! I had the halos from the get-go. The doctor blows off the issue.

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Read back to sbvrd’s May 23rd entry and link reference. Many commonly used lenses are notorious for leaving the patient with some halos and not the “cleanest” night vision. Need to find experienced surgeons who are willing and able to optimize your vision result.

See sbvrd’s doctor references too. In hindsight, I should have read much more about the surgery pitfalls and found a more sympathetic and helpful surgery group.

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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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I decided not to go back to my original surgeon and went to another opthamologist for my (other)right eye. I described to him and the staff my problem. He looked and said it was a wrinkle not positive dysphotopsia. Come into this other room and I'll laser it for 15 seconds.
I did and my ray is gone. All that anguish gone in 15 seconds.
I was lucky I did not have my eyes done 2 weeks apart from the same surgeon.
My second opinion solved the problem. It gave me great satisfaction to cancel the checkup appointment with the first guy.
I scheduled my next surgery for the beginning of August with Dr. Kenneth Miller in Whippany, New Jersey.

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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.

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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.

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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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