![]() ![]() Additionally, a silicone intraocular lens, typically the Bausch + Lomb LI61, will improve 80 to 90 percent of patients,” Dr. In our practice, we find that the STAAR Surgical three-piece copolymer lens (Collamer) offers us the best opportunity. “If that fails, the best thing to do is offer the patient a lens exchange and choose a lens that has a lower index of refraction, or one that has less surface reflectivity. However, making the pupil smaller pharmacologically, either with dilute pilocarpine or brimonidine, can often reduce symptoms. Positive dysphotopsia typically doesn’t resolve with time. Fixation holes facilitate capture of the IOL within the anterior capsulotomy. Note the peripheral groove and excellent centration. So, it still exists, and my sense is that the manufacturing sector has paid closer attention to multifocality, asphericity and toricity of IOLs than to patient-generated complaints,” he says.įigure 2. “For example, silicone and copolymer lenses tend to have a much lower incidence of positive dysphotopsia than acrylic lenses, but any truncated-edge IOL, including oval lenses, 2 will be associated with positive dysphotopsia. He notes that because the index of refraction and the surface reflectivity of lenses can be associated with positive dysphotopsia, certain IOLs will show less of a tendency. However, because positive dysphotopsia is due to internal reflection, altering the external edge of the lens seems unlikely to help,” Dr. Additionally, manufacturers altered the square edge of the IOL by making the front edge round or frosting the square edge. “The manufacturing sector eventually changed IOL design, putting more of the power on the front of the lens, which helped reduce internal reflection. This observation 1 is typically associated with high-index-of-refraction, low-radius-of-curvature IOLs. He notes that another, less widely known cause of positive dysphotopsia is reflections from the internal back surface of the front of the IOL. We really didn’t notice positive dysphotopsia until the advent of square-edge IOLs,” says Samuel Masket, MD, who is in practice in Los Angeles. “The literature is clear that the chief cause of positive dysphotopsia is square-edge IOLs, which became popular in the mid-90s because of their ability to reduce the incidence or retard the development of posterior capsule opacification. Positive dysphotopsia is characterized by undesired light streaks, arcs, and flashes that emanate from obliquely incident sources of light. ![]() Positive dysphotopsia is unwanted light, such as a streak, starburst, flicker, fog or haze, and negative dysphotopsia is a black line or crescent in the far periphery of patients’ vision,” explains Jack Holladay, MD, MSEE, FACS, who lives in Bellaire, Texas. “Dysphotopsia just means an unwanted image that patients see after cataract surgery. Note the excellent centration.ĭysphotopsia-positive and negative-that can occur after cataract surgery. The anterior capsulotomy fits into a peripheral groove in the IOL. First version of the Morcher 90S anti-dysphotopic IOL. Here’s what we know about dysphotopsia and the steps you can take to help minimize or prevent it.įigure 1. Recently, however, studies have emerged that have pinned down some of the chief causes of this frustrating effect of IOL implantation, and surgeons and industry are taking notice. Sometimes the squeaky wheel doesn’t get the grease: Despite dysphotopsia being the leading cause of patient dissatisfaction after uncomplicated cataract surgery, surgeons say precious little has been done to address it. ![]()
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