Negative dysphotopsias
Negative dysphotopsias, often described by patients as a temporal shadow in the visual field, can be one of the most frustrating sequelae of an uncomplicated cataract surgery. Patients may note that this “shadow” increases and decreases on medial and lateral gaze. While oftentimes this can be a transient phenomenon caused by temporal corneal wound edema that resolves, other times it can be permanent. Recent work has suggested that this phenomenon is a result of distance between the posterior iris and the anterior lens surface. This received much attention at the recent ASCRS meeting in San Francisco, and several treatments were offered with varying success. Most notable were:
1) IOL exchange with a three-piece bag implanted haptics with reverse optic capture anteriorly through the anterior capsuolrhexis or
2) sulcus piggyback implantation of a zero power IOL.
While IOL exchange was also successful in some cases, it was overall not as effective as the aforementioned techniques.
Several ophthalmologists have felt the incidence of negative dysphotopsias to be as high as 15%. While this phenomenon certainly improves with time in the majority of patients, it is important to recognize the patient's concerns. For those who continue to be dissatisfied with their vision post-operatively, ophthalmologists should be willing to offer a surgical solution.
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