Surgical management of positive dysphotopsia: US perspective

Purpose: To evaluate clinical outcomes of intraocular lens (IOL) exchange for intolerable positive dysphotopsia (PD). Setting: Private practice, Advanced Vision Care, Los Angeles, California, USA. Design: Retrospective review, case series. Methods: Fifty-six eyes of 46 pseudophakic patients requiring surgical management of PD between 2013 and 2019 were reviewed. Thirty-seven eyes had PD alone and 19 had combined negative dysphotopsia and PD. Inclusion criteria: corrected distance visual acuity of 20/30 or better without significant corneal, retinal, or optic nerve pathology. Exclusion criteria: corneal, macular, or optic nerve disease and multifocal dysphotopsia alone (defined patterns of concentric multiple halos or spider web patterns when looking at a point source of light). Primary outcome measure was improvement or resolution of self-reported PD symptoms by 3 months postoperatively. Secondary outcome measures included analysis of intraocular lenses (IOLs) that induced PD for IOL material, index of refraction, and edge design. Results: IOL materials successful in the alleviation of PD symptoms were as follows: 20 (87.8%) of 33 silicone, 15 (76.2%) of 21 copolymer, and 2 poly(methyl methacrylate) (100%). However, when considering IOL exchange for an acrylic to silicone optic or acrylic to collamer optic, the percentages of improvement are indistinguishable at 87% and 88%, respectively. Conclusions: PD symptoms might be improved by changing the IOL material and, therefore, index of refraction. Although edge design plays an important role in etiology, changing the IOL material to a lower index of refraction may prove to be an effective surgical strategy to improve intolerable PD. Copyright (c) 2020 Published by Wolters Kluwer on behalf of ASCRS and ESCRS