Positive Dysphotopsia after Cataract Surgery

Mine continues as it has been. To explain my present symptoms, as best I can: I have light streaks that are prevalent whenever there is a light source to my left or above. Sunlight to my left when driving makes me raise my hand to protect it so I can concentrate. When night driving, the worst comes from headlights from cars behind me shining into my rearview mirror. I get the streaks from above from bright ceiling lights and the higher lights in stores, arenas etc.

On another note, I, finally, went ahead with my right eye cataract surgery 10 days ago. In appointments and 2nd opinions over the last year, surgeons had claimed that the SN60WF was the “best lens available”. Since I feared PD with surgery on this eye, I asked them if they could consider a silicone, round-edge IOL to lower my risk of long term PD. They went with a silicone, 3-piece from Bausch and Lomb. It is more rounded edge to avoid reflection. I don’t have full specs on it but will get them.

On January 26th, I had this cataract surgery, a FOV and a primary posterior capsulotomy of the right eye. They went with a B & L, round-edge, silicone IOL that I mentioned. Unfortunately, during surgery, I experienced a vitreous hemorrhage that (per the surgeon) needs a few weeks to clear. I don’t want to be too concerned till I give it some time to alleviate. Doctors seemed pleased and I have follow-up appointment this Thursday. Initially, this eye doesn’t seem to have “light artifacts” (PD) of any note. I’m hopeful and will update in a couple months.

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Not sure how old this thread is,...I'm hoping you have success. Please update us on your progress. I'm holding off on the surgery to my left eye because I don't want 2 eyes with streaks. In all my research it looks like it comes down to the kind of lens used. Good luck to you.

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OK, I had hoped I had done adequate research on ways to avoid dysphotopsia for my recent “eye surgery #2.” I had this surgery on January 26th and was, initially, hopeful that I HAD avoided dysphotopsia (I expressed this previously).

Unfortunately, I’m experiencing significant PD which includes light streaks and shapes emanating from external lights that are located above me (such as, ceiling lights in bars/restaurants or the ceiling light in our living room). Not great. Doctors hope some further healing and neuroadaptation will help. It being 7+ weeks post surgery, I’m not sure how much it can improve.

NOTE: At my request, the surgeon implanted a 3-piece, round-edge IOL in attempt to avoid PD, which made sense. My 1st eye (done Dec 2019) has an Alcon SN60WF IOL which has a SQUARE-Edge. With a square-edge IOL, there is higher possibility of PD because of reflections off that square edge that may cause unwanted PD.
HOWEVER, another complication of mine may be that this eye has pigment dispersion/transillumination that may have contributed to this PD result. Bottom line is that doctors DON’T KNOW the true cause of my PD. They did take the best precautions they could on this surgery by using the silicone, round-edge IOL.

Sum: Disappointing 2nd surgery result, especially because I did, what I thought was, considerable homework. The newly diagnosed pigment dispersion syndrome of this right eye iris is, likely, a contributor to this eye’s post-surgical PD. What I’ve gathered from doctors is that blue-eyed people (like me) are much more likely to have PD than those with dark eyes.

I’m still hoping for some improvement, but not sure how much is possible. I will update with any significant changes

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I'm sorry bobbyo. I know this must be very frustrating for you. In all my research I came up with the same thing -- it comes down to the type of lens used, square vs round and silicone vs acrylic. Interesting about the pigment dispersion, I have blue eyes too. Maybe in your case it will get better with time. My situation is exactly the same, canned lights in the ceiling, chandeliers, over head lights in stores, even the angle of when the sun comes through my dining window, the streak occurs. Praying for you that it will smooth out and/or reach a tolerable level. Thank you for sharing this information. It's helpful.

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Thanks for your kind thoughts poc1115. They HAVE NOT diagnosed the pigment dispersion syndrome in eye #1, so maybe the PD is caused by the reflections off the square edges of the SN60. So, even with them honoring my request to use the B & L round edge silicone on eye #2, I’m left with PD on it too…. Maybe it’s the pigment dispersion problem or the blue eyes. They shrug there shoulders.

I appreciate your specific description of your positive dysphotopsia and how those situations mirror mine. Yes, it was interesting how the optometrist mentioned how ONLY his blue-eyed patients seem to struggle with PD. Anyhow, no answers for my problems but, I too, hope the symptoms settle down (or, tolerance increases) over time. Sure hope you find improvement too. Thanks so much!

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I also cannot look directly into the sun, up lights, Down lights, i cover my eyes, make my surrounding dark and then I use a small flashlight to guide myself at night…empathetically, Marianne

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OK, I had hoped I had done adequate research on ways to avoid dysphotopsia for my recent “eye surgery #2.” I had this surgery on January 26th and was, initially, hopeful that I HAD avoided dysphotopsia (I expressed this previously).

Unfortunately, I’m experiencing significant PD which includes light streaks and shapes emanating from external lights that are located above me (such as, ceiling lights in bars/restaurants or the ceiling light in our living room). Not great. Doctors hope some further healing and neuroadaptation will help. It being 7+ weeks post surgery, I’m not sure how much it can improve.

NOTE: At my request, the surgeon implanted a 3-piece, round-edge IOL in attempt to avoid PD, which made sense. My 1st eye (done Dec 2019) has an Alcon SN60WF IOL which has a SQUARE-Edge. With a square-edge IOL, there is higher possibility of PD because of reflections off that square edge that may cause unwanted PD.
HOWEVER, another complication of mine may be that this eye has pigment dispersion/transillumination that may have contributed to this PD result. Bottom line is that doctors DON’T KNOW the true cause of my PD. They did take the best precautions they could on this surgery by using the silicone, round-edge IOL.

Sum: Disappointing 2nd surgery result, especially because I did, what I thought was, considerable homework. The newly diagnosed pigment dispersion syndrome of this right eye iris is, likely, a contributor to this eye’s post-surgical PD. What I’ve gathered from doctors is that blue-eyed people (like me) are much more likely to have PD than those with dark eyes.

I’m still hoping for some improvement, but not sure how much is possible. I will update with any significant changes

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Thank you, Marianne. I, certainly, empathize with your situation and wish you well.

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I’m 69 and I had both eyes done with Alcon lens, am post surgery 7 months left eye snd 11 months right eye. My positive dysphotopsia causes the same light streaks with any lighting. ( even the moon at night has light streaks ) Thank you for bringing pigment disbursement to my attention,
I have green eyes and wasn’t aware of this.
I would never attempt a lens replacement- too risky on many levels. I’ve resigned myself to living with this but it’s very frustrating.

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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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