The physician could say, “We don’t know the true incidence, but there’s about a 50% chance that this could happen in the other eye,” Dr. There are a couple of ways to approach this. “If you have a big difference between the eyes or anisometropia, you want to move on to the other eye.” Some patients are cautious about moving on to the other eye, and that’s where you get into a predicament, she said. Fram said, is explaining to patients that it’s unknown whether or not it will happen in the other eye. The hard part with negative dysphotopsia, Dr.

Olson said he tells patients that this is something that will go away on its own. “The angriest are those who have been led to think they’re crazy.” Dr. “Most of the patients I see, by the time they get to me, have been told they should be happy with their vision, and it’s an uncommon complication,” he said. “I let them know ahead of time that these IOLs are smaller than our own lens, things can happen, but these things are normal,” he said. Olson stressed that it’s important not to tell patients that you don’t know what it is or that it’s a rare complication. Randall Olson, MD, agreed that this is an issue that’s often seen in the first couple of weeks after surgery, though he also sees a lot of patients who have been referred to him with a persistent problem.įor the majority of patients, it’s not a big issue. 2 That’s very encouraging to the patient, she said. Osher’s research found that 97% of cases resolved within a year. “If it’s not always there or only there in certain lighting, I’m optimistic that the patient will adapt and not require an intervention,” she said. Fram said it’s important to ask if this issue is always there or it comes and goes. However, she doesn’t mention the word “dysphotopsia.” Instead, she explains that the intraocular lenses used have the potential to cause glare or shadowing, and if this a problem, she can help.ĭr. Fram said that she mentions that this is something that can occur, particularly in patients needing a high power IOL or who have a large angle kappa. In talking to patients before surgery, Dr. 2 The working theory of negative dysphotopsia based on ray tracing is that some light rays are bent by the lens and some are missed, 3 which creates an illumination gap on the nasal retina causing a dark shadow temporally. Fram said Robert Osher, MD, reported that the percentage of patients with negative dysphotopsia on postop day 1 is approximately 15%. “The first thing you want to do is reassure the patient that you know what it is,” she said, adding that it’s also important to rule out any retinal or neurological pathology such as a retinal tear or detachment.ĭr. However, they may see a dark shadow off to the side temporally. The patient often has had perfect cataract surgery and is seeing 20/20. Nicole Fram, MD, noted that this is a complication that can happen with any type of lens. “What we showed in our paper is as you adjust the lens and make that gap bigger and various things in the eye different, you can make that crescent move more temporally, and you can make the thickness wider or thinner by how much larger that gap is between the rays that miss the lens and the rays that pass through the lens,” he said. “That gap appears as a dark crescent or circle where the rays are missing on the retina. “There are no rays that make it into the eye that can get between the crystalline lens and the iris,” Dr. There’s not a gap before surgery with the natural crystalline lens, Dr.

Negative dysphotopsia is caused by a gap in rays that pass through the lens that miss the lens. Holladay said he tries to stress to physicians how important these identifying measures are in helping to recognize high-risk patients preoperatively.

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