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Bhogal-Bhamra GK, Aujla M, Kolli S, Sheppard AL, Wolffsohn JS. Glare prediction and mechanism of adaptation following implantation of hydrophilic and hydrophobic intraocular lenses. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1310468. [PMID: 38984113 PMCID: PMC11182291 DOI: 10.3389/fopht.2024.1310468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/01/2024] [Indexed: 07/11/2024]
Abstract
Purpose Glare is a known side effect of intraocular lens (IOL) implantation, affected principally by IOL material and optics, although it is reported subjectively to decrease in impact with time. However, little objective data have been published on changes over time, how these relate to subjective reports, and whether those who will report greater glare symptoms can be predicted prior to IOL implantation. Methods A total of 32 patients (aged 72.4 ± 8.0 years) with healthy eyes were implanted bilaterally with hydrophilic 600s (Rayner, Worthing, UK) or hydrophobic Acrysof (Alcon, Texas, USA) acrylic IOLs (n = 16 each, randomly assigned). Each patient reported their dysphotopsia symptoms subjectively using the validated forced choice photographic questionnaire for photic phenomena, and halo size resulting from a bright light in a dark environment was quantified objectively in eight orientations using the Aston Halometer. Assessment was performed binocularly pre-operatively and at 1, 2, 3, and 4 weeks after IOL implantation. Setting The study was carried out at the National Health Service Ophthalmology Department, Queen Elizabeth Hospital, Birmingham, UK. Results Visual acuity (average 0.37 ± 0.26 logMAR) did not correlate with subjective glare (r = 0.184, p = 0.494) or objective glare (r = 0.294, p = 0.270) pre-surgery. Objective halo size (F = 112.781, p < 0.001) decreased with cataract removal and IOL implantation and continued to decreased over the month after surgery. Subjective dysphotopsia complaints (p < 0.001) were also greater pre-surgery, but did not change thereafter (p = 0.228). In neither case was there a difference with IOL material (p > 0.05). It was not possible to predict post-surgery dysphotopsia from symptoms or a ratio of symptoms to halo size pre-surgery (p > 0.05). Conclusions Subjective dysphotopsia and objective halos caused by cataracts are greatly reduced by implantation of IOL after cataract removal causing few perceivable symptoms. However, objective measures are able to quantify a further reduction in light scatter over the first month post-IOL implantation, suggesting that any subjective effects over this period are due to the healing process and not due to neuroadaptation.
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Affiliation(s)
- Gurpreet K Bhogal-Bhamra
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
- University Hospitals Trust, Ophthalmology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Maana Aujla
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - Sai Kolli
- University Hospitals Trust, Ophthalmology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Amy L Sheppard
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
| | - James S Wolffsohn
- Ophthalmic Research Group, Aston University, Birmingham, United Kingdom
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Van Slycken M, Sallet G, Derveaux T. Supplementary Implantation of 1stQ AddOn ® Sulcus-Fixated Intraocular Lens to Treat Negative Dysphotopsia: A Retrospective Case Series. Case Rep Ophthalmol 2023; 14:540-545. [PMID: 37901624 PMCID: PMC10601885 DOI: 10.1159/000533686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/16/2023] [Indexed: 10/31/2023] Open
Abstract
Negative dysphotopsia (ND) refers to the subjective perception of an arc-shaped darkness or shadow in the temporal field of vision. This condition occurs after uneventful cataract surgery with an in-the-bag intraocular lens (IOL). To address this issue, supplementary implantation of conventional three-piece IOLs in the sulcus or dedicated supplementary Rayner Sulcoflex® IOL have been used successfully. The aim of this retrospective case series was to assess the effectiveness of resolving ND using a supplementary 1stQ AddOn® (Medicontur) IOL. The 1stQ AddOn® has a different design and optic size compared to the Rayner Sulcoflex®. Patients experiencing severe and persistent ND underwent supplementary implantation of the 1stQ AddOn® IOL. The primary outcome measure was the resolution of dysphotopsia. Nine eyes received the 1stQ AddOn® IOL, with complete symptom resolution observed in 6 eyes, partial improvement in 1 eye, and no change in 2 eyes. This indicates that supplementary implantation of the 1stQ AddOn® IOL can effectively and safely treat ND, performing equally well as the Rayner Sulcoflex®. The positive impact of sulcus-fixated supplementary IOLs seems to be related to the interaction between the central optic and the pupil margin.
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Affiliation(s)
- Maxim Van Slycken
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
| | - Guy Sallet
- Department of Ophthalmology, Ooginstituut, Aalst, Belgium
| | - Thierry Derveaux
- Department of Ophthalmology, Ghent University Hospital, Ghent, Belgium
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Adre E, Tonk R. Positive and Negative Dysphotopsias: Causes, Prevention, and Best Strategies for Treatment. CURRENT OPHTHALMOLOGY REPORTS 2021. [DOI: 10.1007/s40135-021-00278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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van Vught L, Dekker CE, Stoel BC, Luyten GPM, Beenakker JWM. Evaluation of intraocular lens position and retinal shape in negative dysphotopsia using high-resolution magnetic resonance imaging. J Cataract Refract Surg 2021; 47:1032-1038. [PMID: 33577270 DOI: 10.1097/j.jcrs.0000000000000576] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/26/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess potential relationships of intraocular lens (IOL) position and retinal shape in negative dysphotopsia (ND). SETTING Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. DESIGN Case-control study. METHODS High-resolution ocular magnetic resonance imaging (MRI) scans were performed in patients with ND and pseudophakic controls, and subsequently used to determine the displacement and tilt of the in-the-bag IOL about the pupil and iris. In addition, anterior segment tomography was used to assess the iris-IOL distance. Furthermore, the retinal shape was quantified from the MRI scans by fitting an ellipse to the segmented inner boundary of the retina. Both the IOL position and retinal shape were compared between groups to assess their potential role in the etiology of ND. RESULTS In total, 37 patients with ND and 26 pseudophakic controls were included in the study. The mean displacement and tilt of the IOL were less than 0.1 mm and 0.5 degrees, respectively, in both groups and all directions. The corresponding mean iris-IOL distance was 1.1 mm in both groups. Neither of these values differed statistically significantly between groups (all P values >.6). The retinal shape showed large variations but was not statistically significantly different between the groups in both the left-right (P = .10) and the anterior-posterior (P = .56) directions. CONCLUSIONS In this study, the in-the-bag IOL position and retinal shape did not statistically significantly differ between patients with ND and the general pseudophakic population. Given the large variation in retinal shape between subjects, however, it could still be an important factor in a multifactorial origin of ND.
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Affiliation(s)
- Luc van Vught
- From the Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands (van Vught, Luyten, Beenakker); Department of Radiology, C.J. Gorter Center for High Field MRI, Leiden University Medical Center, Leiden, the Netherlands (van Vught, Beenakker); Division of Image Processing (LKEB), Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (Dekker, Stoel)
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August consultation #8. J Cataract Refract Surg 2021; 47:1100-1101. [PMID: 34292901 DOI: 10.1097/01.j.jcrs.0000769516.88945.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dysphotopsiae and functional quality of vision after implantation of an intraocular lens with a 7.0 mm optic and plate haptic design. J Cataract Refract Surg 2021; 48:75-82. [PMID: 34224478 DOI: 10.1097/j.jcrs.0000000000000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the impact of IOL with 7.0 mm optic and plate haptic design on incidence of dysphotopsiae and visual functions after cataract surgery. SETTING Day-care clinic. DESIGN A prospective monocentric randomized patient-blinded comparative clinical study. METHODS Following preoperative measurements, patients underwent cataract surgery with implantation of two IOL designs - with 7.0 mm optic and plate haptics (group 1) or with 6.0 mm optic and C-loop haptics (group 2). In month 1, 3 and 12 follow-ups patients were examined, answered a questionnaire regarding satisfaction, spectacle dependence, frequency and extent of positive and negative dysphotopsiae, and underwent contrast sensitivity, mesopic vision and glare sensitivity testing. The data were analyzed as nominal, ordinal and metric with Chi-Square, Mann-Whitney-U, Wilcoxon and t-tests. RESULTS Group 1 comprised 57 eyes (43 patients) and group 2 comprised 63 eyes (43 patients). Corrected distance visual acuity was the same between groups throughout the study. Group 1 showed significantly lower incidence of positive and negative dysphotopsiae in month 1 follow-up (p=0.021 and 0.015, respectively) and a higher satisfaction rate in month 3 follow-up (p=0.006). Mean contrast sensitivity and mesopic vision with and without glare were the same in both groups. Positive dysphotopsiae cases in month 12 follow-up revealed lower photopic contrast sensitivity (p=0.005, 0.036 and 0.047, respectively), longer AL and greater preoperative pupil dynamics (p=0.04 and 0.06). CONCLUSIONS The IOL design with 7.0 mm optic diameter and plate haptics reduces dysphotopsiae, provides good visual acuity, contrast sensitivity, mesopic vision with and without glare and high patient satisfaction.
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Intraocular lens far peripheral vision: image detail and negative dysphotopsia. J Cataract Refract Surg 2020; 46:451-458. [DOI: 10.1097/j.jcrs.0000000000000103] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Effect of a sulcus-fixated piggyback intraocular lens on negative dysphotopsia: Ray-tracing analysis. J Cataract Refract Surg 2019; 45:443-450. [DOI: 10.1016/j.jcrs.2018.10.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/21/2022]
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Simpson MJ. Simulated images of intraocular lens negative dysphotopsia and visual phenomena. JOURNAL OF THE OPTICAL SOCIETY OF AMERICA. A, OPTICS, IMAGE SCIENCE, AND VISION 2019; 36:B44-B51. [PMID: 31044954 DOI: 10.1364/josaa.36.000b44] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 01/20/2019] [Indexed: 06/09/2023]
Abstract
Simulated images were generated using an extended source to illustrate peripheral dark shadows in pseudophakic eye models. The shadows are a consequence of the intraocular lens being much smaller than the natural crystalline lens, which limits the extent of the focused image. Compensation is made for the cosine intensity falloff due to pupil obliquity, and the images are envisaged as being displayed on polar plots of visual angle corresponding to approximate retinal locations. Additional retinal illumination from light missing the lens reduces the shadow effect as the pupil diameter increases, in agreement with clinical observations. Lenses with two different cross-sectional profiles were evaluated, which both have shadows at about 85°, but with different characteristics. The iris thickness was found to affect the shadows by occluding peripheral rays. Images were also generated for a point source with a 5 mm pupil, where a double image is created for visual angles as low as 50°, which may contribute to visual phenomena at night. This type of modeling may help with patient evaluations and discussions.
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Alfonso JF, Lisa C, Alfonso-Bartolozzi B, Fernández-Vega-Cueto L, Montés-Micó R. Implantable Collamer Lens
®
for Management of Pseudophakic Ametropia in Eyes With a Spectrum of Previous Corneal Surgery. J Refract Surg 2018; 34:654-663. [DOI: 10.3928/1081597x-20180815-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/13/2018] [Indexed: 11/20/2022]
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Nuijts R. February consultation #5. J Cataract Refract Surg 2018; 44:249-250. [PMID: 29587984 DOI: 10.1016/j.jcrs.2018.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Management of positive dysphotopsia in a patient with prior refractive surgery. Can J Ophthalmol 2018; 53:e27-e29. [PMID: 29426456 DOI: 10.1016/j.jcjo.2017.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/02/2017] [Accepted: 06/13/2017] [Indexed: 11/24/2022]
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Makhotkina NY, Nijkamp MD, Berendschot TT, van den Borne B, Nuijts RM. Effect of active evaluation on the detection of negative dysphotopsia after sequential cataract surgery: discrepancy between incidences of unsolicited and solicited complaints. Acta Ophthalmol 2018; 96:81-87. [PMID: 28661569 DOI: 10.1111/aos.13508] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the incidence of negative dysphotopsia after sequential cataract surgery. METHODS Retrospective cohort study. The incidence of negative dysphotopsia was assessed by retrospective reviewing of medical records and interviews with patients between 2 and 4 months after sequential cataract surgery. Inclusion criteria were uncomplicated surgery, postoperative corrected distance visual acuity (CDVA) ≥20/25 Snellen and the absence of ocular comorbidity. The majority of intra-ocular lens (IOL) implants were one-piece AcrySof SN60WF (161 eyes). Other IOLs (29 eyes) were toric (SN6AT3-6), spherical (SN60AT), three-piece (MN60MA) and multifocal (ReSTOR SN6AD1, PanOptix TFNT00 and Finevision Micro F trifocal). RESULTS The study population was comprised of 95 patients with a mean age of 72 ± 10 years. Unsolicited complaints of negative dysphotopsia were reported by eight patients (8%), and two of them had a resolution of symptoms within 1 month of follow-up. Eighteen patients (19%) reported negative dysphotopsia at the time of the interview. Two patients reported bothersome negative dysphotopsia, and one of them was successfully treated with implantation of a supplementary IOL in the ciliary sulcus. Patients with negative dysphotopsia were younger than patients without dysphotopsia (p = 0.045) and had shorter axial eye length (p = 0.04), a tendency for higher IOL power (p = 0.09) and a higher CDVA (p = 0.001). CONCLUSION The incidence of unsolicited negative dysphotopsia after sequential cataract surgery appears to be a substantial underestimation of complaints identified in active interviewing. Although symptoms are not bothersome in the majority of cases, some patients with undiagnosed severe negative dysphotopsia may benefit from reassurance or secondary treatment.
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Affiliation(s)
- Natalia Y. Makhotkina
- University Eye Clinic; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Marjan D. Nijkamp
- Faculty of Psychology and Educational sciences; Open University of the Netherlands; Heerlen The Netherlands
| | | | - Bart van den Borne
- Department of Health Promotion; University of Maastricht; Maastricht The Netherlands
| | - Rudy M.M.A. Nuijts
- University Eye Clinic; Maastricht University Medical Centre; Maastricht The Netherlands
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Effect of supplementary implantation of a sulcus-fixated intraocular lens in patients with negative dysphotopsia. J Cataract Refract Surg 2018; 44:209-218. [DOI: 10.1016/j.jcrs.2017.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/14/2017] [Accepted: 11/30/2017] [Indexed: 11/20/2022]
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Surgical management of negative dysphotopsia. J Cataract Refract Surg 2018; 44:6-16. [DOI: 10.1016/j.jcrs.2017.10.038] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 09/11/2017] [Accepted: 10/20/2017] [Indexed: 11/20/2022]
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Abstract
The appearance of a dark shadow in the temporal periphery, otherwise known as negative dysphotopsia, continues to be a problem for some patients after routine uncomplicated cataract surgery. Etiologies include type and design of intraocular lens (IOL), anatomical features and dimensions of the eye, pupil size, angle kappa, relationship of the optic to the anterior capsule, and the position of the optic/haptic junction of the IOL. Although the primary etiology remains controversial, it is clear that the cause is multifactorial. All of the factors should be considered when attempting to prevent or treat this phenomenon.
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Affiliation(s)
- Ivayla I Geneva
- Department of Internal Medicine, SUNY Upstate Medical University, Syracuse, NY
| | - Bonnie A Henderson
- Department of Ophthalmology, Tufts University School of Medicine, Boston, MA
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Fişuş AD, Madaras Z, Horváth KU. Research Article. The Prevalence of Dysphotopsia in Patients with Recent Cataract Surgery. ACTA MEDICA MARISIENSIS 2017. [DOI: 10.1515/amma-2017-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Pseudophakic dysphotopsia are becoming increasingly important as unwanted side effect after cataract surgery. Objective: The purpose of this study is to compare the photic symptoms experienced by patients after cataract surgery. Material and method: This is a prospective study that included 105 eyes from 99 patients, which underwent uncomplicated phacoemulsification and IOL implantation, between June 2015 and June 2016, performed at Ophthalmology Clinic Tg Mureș. Patients without visually consequential ocular co-morbidity completed a questionnaire, designed to assess subjectively perceived visual functioning and identify symptoms of dysphotopsia. Results: From the total number of patient, hydrophobic lenses were implanted in 95 patients and 10 patients received hydrophilic lenses. Photic effects were reported in 18% of treated eyes. Although the percentage of dysphotopsia is higher in the hydrophobic lenses category, there was no significant statistical difference between the two categories. Conclusion: The incidence and significance should not be overlooked, thus visual acuity is not enough for evaluating postoperative visual function.
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Affiliation(s)
| | - Zoltán Madaras
- Tîrgu Mureş County Hospital, Ophthalmology Clinic, Romania
| | - Karin Ursula Horváth
- Tîrgu Mureş County Hospital, Ophthalmology Clinic Romania
- University of Medicine and Pharmacy Tîrgu Mureş, Romania
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Rabie HM, Esfandiari H, Rikhtegar MH, Hekmat V. Management of sulcus-fixated single-piece intraocular lens-induced pigmentary glaucoma with 3-piece IOL exchange. Int Ophthalmol 2017; 38:145-150. [DOI: 10.1007/s10792-016-0435-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/27/2016] [Indexed: 11/25/2022]
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Palkovits S, Findl O. Pseudophake Dysphotopsien. SPEKTRUM DER AUGENHEILKUNDE 2016. [DOI: 10.1007/s00717-016-0313-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Current Theories and Methods for Managing Negative Dysphotopsia. Int Ophthalmol Clin 2016; 56:107-16. [PMID: 27257726 DOI: 10.1097/iio.0000000000000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taubenslag KJ, Groos EB, Parker MG, Ewald MD, Pilkinton DR. Successful treatment of negative dysphotopsia with in-the-bag intraocular lens exchange using a wide ovoid IOL. J Cataract Refract Surg 2016; 42:336-7. [DOI: 10.1016/j.jcrs.2016.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Indexed: 10/22/2022]
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Is the Memory Effect of the Blind Spot Involved in Negative Dysphotopsia after Cataract Surgery? J Ophthalmol 2015; 2015:786579. [PMID: 26425353 PMCID: PMC4575743 DOI: 10.1155/2015/786579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/24/2015] [Accepted: 08/05/2015] [Indexed: 11/18/2022] Open
Abstract
We present novel clinical observations on negative dysphotopsia (ND) in eyes that have undergone cataract surgery. In the past, shadow effects were alleged to be located in the far peripheral temporal visual field 50° to 100° away from the optical axis. In a small series of eight patients we found evidence of photic effects, described by the patients as shadows in the periphery that were objectively located much more centrally. In all cases, we could find an association of these phenomena with the blind spot. We hypothesize that the memory effect of the blind spot which is dislocated and changed in magnification due to replacement of the crystalline lens could be one determinant for pseudophakic ND. The scotoma of the optic nerve head and the main arteries and veins of the phakic eye are displaced in the pseudophakic eye depending on the specific characteristics and position of the intraocular lens within the eye.
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