Issues seems to be Positive dysphotopsia PD after Cataract Operation

Eye care
1

Hello

I’m 46 years old , I went through Cataract operation, 2 months ago, My IOL is for far distance , and the IOL is Alcon AcrySof model SA60AT which is power 12D, length 13.00 mm, optic 6.00 mm and square-edged,

I have some questions as it seems to have PD especially in room light , something like flash , web-spider but very annoying , so if anyone face this and can help , it will be great:

  • Does any doctor say that you really have positive dysphotopsia (PD) , anyone can physical examine that ? as I went to 3 doctors and all of them said they can’t see anything and everything seems OK.
  • My symptoms mainly in the room light (strong room light), I feel as someone use reflective mirror and reflect the light to my eye , by searching and reading I have concluded this is PD, but still no doctor confirm that this is PD, so I’m thinking is there any issue can cause this symptoms aside of the PD ? How to make sure it is PD
  • If it is PD, does anyone suggest to you to change the IOL size in the second eye, as per my reading this problem may come because the pupil size is large , so should I use IOL larger than 6mm in the second eye ?
  • PD are very annoying , does anyone know any info if it is harmful to they eye , retina and cornea , I mean if I managed to stay with it and don’t take any action , does it hurt my eye in the future or it does not have any bad effect ?
  • Doctor till me that using glasses that will improve the astigmatism may help , I did but it does not help, should I keep using them, is this considered a technique for neuro-adaptation ?

I’m sorry for the many questions, but I really need to find out what is the problem before going for the second operation

Thanks alot

2

I have not heard of any harmful effects, as it were of the visual phenomenon of them. Perhaps, the off-putting nature of them initially, can disrupt and all that goes with that, but this is adjusted to, over time.

I experience the gamut of Positive Dysphotopsias (concentric semi-circle(s) which radiate, Maddox rod effect, starbursts and glare) and they can be severe. Currently, at ~5.9 months post-op, I have neuro-adapted a bit of it away and have become largely desensitized to the rest, thus far.

A large IOL lens was put in my eye.

I have found it best to keep facing light combination(s) / scenario(s) which cause them, in day to day. To not want to consciously remove them when viewed, let them flow, not pay much mind to them as best I can and let things run their course.

I have found any physical eyeglass lens on top, initially altered (made them a bit scrunched down / compressed within the eyeglass lens dimensions) the Dysphotopsias, some, to me. I have nearly adjusted to this, and they are similar now to when I do not have a physical eyeglass lens on top.

While I did have some cataract surgery induced astigmatism (I presume; was told I had some astigmatism after surgery), I did trial a Toric contact lens for a very short time and did not notice an impact on visual acuity (nor Dysphotopsias), in my case. Perhaps those with true near life-long astigmatism, which requires correction, have a different experience. I have ceased trial of this lens.

It will get a bit better, over time; hang in there.

3

What you are experiencing sounds like PD. I do not know of any harmful effects on the eye. Mainly it is thought to be annoying and distracting.
I have heard that doctors can prescribe drops to constrict the pupils to make them smaller so that you are less likely to experience PD. I am surprised you weren’t offered the drops by the three doctors that you saw.
If an IOL is not perfectly centered then you could be experiencing PD even if the 6mm optic is large enough. Since three doctors have told you that it looks fine, then it is probably centered and your pupil size is the issue. Younger people have larger pupils. So yes, using a different IOL in the other eye is a good idea. While most IOLs have a 6mm optic, some have a thicker edge that is more likely to cause PD.
Where do you live? In Europe there is a HumanOptics Aspira-axA XL IOL with a 7mm optic.

4

I had a hard time finding credible details on that AcrySof SA60AT lens. As best as I can figure it out, it appears to be an older non blue light filtering and non aspheric correcting lens from Alcon. I have a newer AcrySof IQ SN60WF which is blue light filtering and aspherical. However those differences are not likely significant to what your issue is. I do have some flashes of light but in very different conditions. I only see them in a very dark room when there is a light in another room off to the side. I suspect my pupils are wide open and the light from the side is reflecting off the edge of the lens. It happens so infrequently that it is not an issue for me. I have a newer design Alcon Clareon in my other eye, and I see the same thing.
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Your issue seems a bit different as you say you see it in strong light conditions, where your pupil should be closed down. For that reason I would expect going to a larger diameter lens would not help. They are also very uncommon. 6mm is the standard.
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Unfortunately there is no way for doctors to see this effect which makes it so hard to diagnose and correct. The exact causes are also not well understood. My thoughts would be that it must be due to the position of the lens in your specific eye. There are some theories that this is caused by the thickness of the lens. The AcrySof lenses have a higher refractive index and are thinner. Silicone lenses if you can find them have a lower refractive index and end up being thicker. They may be a possible solution. There is also some information that if a piggyback lens is implanted in front of the capsule it can focus the light in front of the IOL and avoid the reflections. You would have to do some investigation into whether or not that would be an option. If you have any residual error in your refraction including astigmatism the piggyback lens may also be able to reduce that.

5

Do the flashes of light appear on the sides of your eyes or center of eye?

6

whats the size of your iol?

do you see PD at a certain angle or position from a light source? do you have any light rays during the day (maybe less obvious)?

7

Optic Diameter is 6mm.
I see certain ones head-on and others at angles.
Daytime, nighttime, indoor and outdoor. As neuro-adaption has taken place, thus far, daytime outdoor has become (significantly) less but can still be triggered and certain ones, indoor, have become a bit less.