Acknowledgements Positive dysphotopsia The presenter does not - - PowerPoint PPT Presentation

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Pseudophakic Dysphotopsia: 5 Pearls

Stephen D. McLeod, MD

Theresa M. and Wayne M. Caygill, MD Distinguished Professor and Chair Department of Ophthalmology Francis I. Proctor Foundation University of California San Francisco

Acknowledgements

• The presenter does not have a financial

interest in the subject matter of this presentation

Pseudophakic Dysphotopsia

• Positive dysphotopsia

– Bright artifact (arc, streak, ring, halo) associated with glare source, often under certain light conditions or at a particular location in the field – 50% immediately postop, decreasing to 0.2% to 2% over 12 months

• Negative dysphotopsia

– Crescent or arc of dark – Up to 15% immediately postop, resolving in 80% of affected patients – Risk factors:

• Square edge
• High refractive index material (acrylic)
• Small optic

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Pseudophakic Dysphotopsia

Pearl 1

• Your surgery will most

likely be perfect— centered, on optic capsulorhexis

• The patient doesn’t want

to hear how perfect your surgery was…

• Acknowledge the

problem

Pseudophakic Dysphotopsia

Pearl 2

• Pilocarpine doesn’t

work

• (some reports actually

suggest improvement with dilation)

Pseudophakic Dysphotopsia

Pearl 3

• Be patient: Holladay argues that

spontaneous resolution of symptoms might be due to progressive opacification of the anterior capsule that diffuses incident light

• Resolution has also been

attributed to “neuro-adaptation”

Pseudophakic Dysphotopsia

• Perception of dysphotopsia may be a learned

phenomenon

• 44% of patients with dysphotopsia in one eye also

had it in the contralateral eye, regardless of IOL

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Pseudophakic Dysphotopsia

Pearl 4: Patients become sensitized

• Don’t blame the dysphotopsia on the

IOL and promise that a different IOL in the contralateral eye will prevent problems in the second eye

• For the affected eye: once

dysphotopsia has appeared and persists, in-the bag-IOL exchange with a different IOL type often fails

Pseudophakic Dysphotopsia

• Anterior optic-posterior iris

distance might be a factor: consider sulcus placement or reverse optic capture (prolapse the optic forward

• ut of the bag)

Pseudophakic Dysphotopsia

Pearl 5

• Prevention?
• Is light reflected from

uninterrupted temporal lens edge the problem?

• Prospective trial placing haptic-
• ptic junction at the

inferotemporal location in each eye

• POD1: 5% dysphotopsia in

inferotemporal group vs 14% of vertical group

• 1 week and 1 month: no

difference

Pseudophakic Dysphotopsia

Pearl 5

• Read the literature

carefully!

1. Listen to the patient 2. No pilo 3. Be patient 4. Once experienced, the patient is sensitized: no guarantees 5. Three R’s: Round edge, Reverse optic capture, Rotate