Open access peer-reviewed chapter

Pseudophakic Dysphotopsia

Written By

Emely Zoraida Karam Aguilar

Submitted: August 3rd, 2019 Reviewed: September 24th, 2019 Published: November 7th, 2019

DOI: 10.5772/intechopen.89884

From the Edited Volume

Intraocular Lens

Edited by Xiaogang Wang and Felicia M. Ferreri

Chapter metrics overview

601 Chapter Downloads

View Full Metrics

Abstract

Pseudophakic dysphotopsia is an unwanted entoptic phenomenon caused by intraocular lenses. Dysphotopsias have been classified as positive (brightness, streaks, haze, or glare) and negative (temporal arc or half-moon crescent) in the visual field. These visual phenomena seem to be well tolerated cause in the case of positive dysphotopsia, but not as well in the negative cases that sometimes discomfort to the patient. The incidence of dysphotopsia ranges from 20% to 77.7%, and the prevalence seems not to be altered by the type of intraocular lens. Pseudophakic dysphotopsia continues to be enigmatic over time; however, many efforts are being made in order to resolve the mystery. In this chapter, the evolution of the dysphotopsia, possible causes, and proposed treatments will be described.

Keywords

  • pseudophakic dysphotopsia
  • negative dysphotopsia
  • positive dysphotopsia
  • dysphotopsia
  • half-moon crescent

1. Introduction

Cataract surgery has been one of the great ophthalmological contributions to the worldwide prevention and treatment of blindness.

The first cataract surgery was performed by an Indian surgeon, Sushruta, in the fifth century BC. [1, 2, 3]. Over time, improvements in cataract surgery led to many advances, such as the replacement of the opaque crystalline lens with an intraocular lens (IOL). The first IOL implant was performed by Sir Harold Ridley on November 29, 1949, at St. Thomas Hospital, London [4, 5]. Thanks to the contributions of many scientists and surgeons, techniques improved as well as IOL design. However, with the use of new technologies, complications or unwanted side effects may also arise. Dysphotopsia secondary to IOL [6, 7], is the reason for this chapter.

Advertisement

2. Pseudophakic dysphotopsia

Dysphotopsias are visual phenomena caused by light in phakic and pseudophakic patients. The term was introduced by Tester et al. [6] in the year 2000, and included all entoptic phenomena triggered by light (glare, halos, and dark arc). These phenomena frequently bother the patient, producing a certain degree of dissatisfaction, even in circumstances where there is good visual acuity (20/20 or better).

Dysphotopsia in phakic patients may improve with correction of the refractive error [8], special lenses [9], sunglasses [10], lenses with filters [11] and other techniques. In patients with significant cataracts, surgery is the option [6]. Before the advent of IOLs, aphakic patients (without IOL) who were placed in contact lenses reported glare phenomena [11]. The first report was by Koetting and Von Gunten in 1969 [12]. Subsequently, with the emergence of IOLs, patients with pseudophakia began to experience visual phenomena more emphatically than they did before surgery [13]. However, the benefit of improvement in visual acuity generally compensated for problems with dysphotopsia. A number of clinicians and researchers have tried to determine the causes of dysphotopsia [13].

Initial reports considered causes including the pupil, the intraocular lens, and the posterior capsule. This is reflected in one of the initial publications by Doden in 1984 [14]. This author studied the pupillary changes observed in 2500 eyes operated on cataract by extra capsular technique and phacoemulsification. He associated glare with the optical irregularity caused by the pseudophakia “per-se” or the opacities affecting the posterior capsule. Subsequently, sophisticated techniques were employed, refining the studies and reducing the number of causative factors to IOL as well as opacity of the posterior capsule [1, 12, 13, 15].

Between 1994 and 1995, the 6 mm and 5.5 mm acrylic IOL were introduced, which allowed patients to have calm eyes in the postoperative period, that is, with less chance of developing anterior uveitis and cystoid macular edema. They also found that these lenses caused less fibrosis and opacities of the posterior capsule, with lower capsular contraction, reduction of optical precipitates, and good optical centering [16]. Based on this, it was postulated that the square edge of the intraocular lens was the primary reason for the above findings [15, 17, 18]. In the laboratory, Nishi [15] confirmed that the edge of the IOL acted as a barrier to cell migration within the posterior capsule independent of the material. Unfortunately, the edge also caused a new undesirable visual phenomenon resulting from internal reflection due to the angle of incidence of oblique light. This was often referred to by the patient as a dark shadow in a half moon shape or an arc in the temporal field. The effect was more annoying than previously reported, proving even difficult to predict which patient could develop this symptomatology [15, 17, 19, 20].

Pseudophakic dysphotopsia was presented for the first time by Olson, MD, at the XVIth Congress of the European Society of Cataract & Refractive Surgeons, in Nice, France, on September 1998 [7]. Initially, it was thought that this visual phenomenon was transitory. Overtime the visual effect persisted as a souce of visual compliants, resulting in a number of procedures to attempt to reduce or solve the problem. In 2000, Davidson [7] divided these dysphotopsia phenomena according to the symptoms into positive and negative.

Advertisement

3. Dysphotopsia classification

3.1 Positive dysphotopsia

Positive dysphotopsia refers to the brilliant, lines or = stripes that emanate from a central point of a light source sometimes creating diffusion and strong glare, described by the author as “hazy glare.”

Few reports exist regarding positive dysphotopsia. Shambhu et al. [11] used a questionnaire to compare three different types of acrylic IOLs. In this study, 15 patients with severe dysphotopsia (negative and positive) were reported, but apparently, positive dysphotopsia (particularly the glare phenomena) was not severe enough to require the change of IOL. In a study conducted by Radford et al. [21], follow-up of 61 patients with Akreos Adapt and SN60-AT intraocular lenses found that dysphotopsia declined by 8 weeks in 31.3% for positive dysphotopsia and 20.7% for negative ones.

Recently, publications showed in vitro evaluations that IOL designs with round optic edge curvature and full functional optics demonstrated the lowest level of glare-type photic phenomena. Clinical studies are necessary to demonstrate this observation [22].

My personal opinion is that positive dysphotopsia is caused by the wavelength of light as it interacts with the pseudophakic lens. Intraocular lens still permits significant transmission between 350 and 400 nm. Most intraocular lenses provide a reasonable imitation of the spectral characteristics of the natural lens, but probably, the exact balance to the natural lens has not been achieved [23, 24].

In relation to the type of dysphotopsia, it seems that positive dysphotopsias are better tolerated than negative ones; the reason is for this unknown. That’s why conservative treatment or observation is generally recommended. However, some authors recommend correcting the refractive error with conventional or contact lenses, while also treating coexisting ocular pathology such as the opacity of the posterior capsule requiring it, and intraocular lens decentralization or large pupil size [25].

Chandramani A et al. relate positive dysphotopsia with the square edge of IOL. The authors reported that a patient with previous refractive surgery and persistent positive dysphotopsia after the insertion of a square-edge IOL responded well when they inserted a zero-power 3-piece silicone IOL in the sulcus, in order to maintain the refractive efficacy of the original IOL. It was thought that the symptoms decreased because the rounded edge of the silicone optic masked the aberrant reflections and refractions of the square edge of the acrylic IOL [25].

3.2 Negative dysphotopsia

Negative dysphotopsia is characterized by an arc-shaped shadow, usually located in the temporal field. Visible with or without frame lenses, the problem can be monocular or binocular and may affect near and far vision as well as occur in internal or external environments (lighting or gloom), mobile or not. Negative dysphotopsia generally appears 1-2 days postoperatively. Over time, some of them disappear and in others remain.

Various approaches to negative dysphotopsia were made in search for possible solutions [7, 13, 19, 20, 26, 27, 28, 29, 30, 31, 32, 33] as reflected below:

  1. 1. Related to the intraocular lens:

    • Anterior and posterior lens surface

      • Reflections associated with the anterior and posterior surface of the lens due to the high refractive index of the lens material

      • Reflections generated by the high index of the bright optical edge material

    • Intraocular lens edge

      • Straight or round

    • Reflections generated by the high index of the bright and straight optical edge material

    • Diameter

    • Number of lens parts

      • One to three pieces

  2. 2. Manufacturing:

    • Optical defect during the manufacturing process

    • Central optical defect during the folding process

  3. 3. Surgeon:

    • Incomplete capsulorhexis with optical overlap

    • Reflection of the capsulotomy of the anterior border projected into the nasal peripheral retina

    • Temporal clear corneal incision

  4. 4. Patient: visual system or psychological factors:

    • Complex interaction of a predisposed and vulnerable pseudophakic visual system

    • Dark irises

    • Prominent eyeballs

    • Deep orbits

    • Post negative image phenomenon

    • Neural adaptation

A program with a three-dimensional model eye was used to study the edges (straight or truncated and/or round) of IOL, through an analysis of ray tracing emanating from the light. The rays that reach the straight edge cause reflection of the light at an angle greater than 30 to 40–90° or more, maximizing the intensity of the reflexes, since they reach very close to each other and reflect on the opposite side of the peripheral retina as a dark shadow described by the patients as an arch or crescent (negative dysphotopsia). At the round edges, the rays cause significant dispersion and are reflected before 30°, not causing this temporary penumbra [7, 19, 20, 33].

It was shown that the round edge decreased the image in the form of an arc (negative dysphotopsia) by 87–91% in relation to the square edge [19]. Additional evidence of absence of positive dysphotopsia phenomena (light flashes) but not negative when the edges were compared with opaque lens was also found. Lenses with textured or opaque edges as a replacement or as a primary lens in the second eye suppose a decrease in the occurrence of positive and negative dysphotopsias. This type of design (textured or opaque border) creates the same type of light scattering as the nasal periphery of the translucent capsule, reduces the internal diffusion of light from the straight edge by scattering, but still allows the presence of positive dysphotopsia and does not make the negative ones disappear [16, 30, 34].

The opaque edges of the AcrySof SA30 IOL were compared with the bright edges in the AcrySof MA30 BA (Alcon) and AcrySof MA60BM (Alcon) intraocular lens models [7], but the negative dysphotopsia did not disappear.

The diameter of the IOL does not significantly reduce the occurrence of dysphotopsia as Davidson reported when two types of lens diameters of 5.5 and 3.60 mm were compared; the occurrence of negative dysphotopsia was similar (80%) in both groups [7].

In relation with the lens material, Tester et al. compared two types of acrylic intraocular lenses of different diameters (5.5 and 6 mm) with a control group (no acrylic IOL); the authors found that acrylic lenses produce more dysphotopsia than nonacrylic IOL. The authors concluded that patients who received an acrylic IOL with flattened edges were at increased risk of experiencing images associated with edge reflections [6]. Holladay et al. found that only the square-edged design concentrated the light into a well-formed arc on the retina. Round-edge designs tended to disperse the stray light over a much larger portion of the retina, suggesting that its visual consequences fall below a perceptible threshold [13, 19].

Radford et al. compared two types of acrylic IOL (AcrySof SN60-AT IOL (Alcon) and the Akreos Adapt (Bausch & Lomb) IOL. The results of this study showed that patients with SN60-AT IOL reported more undesired images than patients with the Akreos Adapt IOL. It was more significant during the first week postsurgery, but at 8 weeks, the incidence of this negative dysphotopsia decreased in 20.7%; the cause of this phenomenon was not clarified by the authors [21].

The anterior surface of the AcrySof MA30 BA and AcrySof MA60 BA lenses with a 5.5 D curve was studied; the remaining power was found on the posterior surface. Because these surfaces are highly reflective, it could make lenticular reflections complex enough to cause negative dysphotopsia. The optical inversion or reversion of the anterior-posterior diopter surface (posterior surface flatter than the previous one) as observed in the AcrySof MA30 AA and AcrySof SA30 AL lenses did not solve the problem [7].

The incision in the temporal area of clear cornea has been implicated by Osher [35] as a cause of transient negative dysphotopsia due to a broad clear base and incisional edema in the cornea that interferes with the oblique light projected into the distant peripheral field; however, it does not explain permanent dysphotopsia. Nasal, upper, and lower incisions and scleral tunnel showed no difference between the presence of transient and permanent negative dysphotopsia [36].

One-piece lenses in a posterior chamber with horizontally placed haptics make the edge of the lens more peripheral when the “shoulder” of the haptic is inserted into the optics; this would imply that the “shadow” would move more previously, reflecting with less amplitude, but this proposal would have to be supported by the ray tracing program [29, 37, 38].

A manufacturing defect should be evident in other intraocular lenses of the same batch used in patients, but this did not occur [7].

The central optics could be altered by folding; when folding forceps are used, an irregular line is formed temporarily, since it disappears after the operation. However, if it persists permanently, it can create defects, but they do not specifically produce negative dysphotopsia. Nowadays, with the injectors used for lens folding, no alterations have been demonstrated, even when they have been studied due to intraocular lens change [7]. Incomplete capsulorhexis with its superimposition variable is quite common; this would not explain a temporary defect of the visual field [29, 34].

Individual predisposition with a certain constellation of factors in relation to ocular anatomy, including corneal curvature, new pseudophakic state, anterior chamber depth, axial length, and intraocular lens power, can be particularly vulnerable, also be sensitive to aberration, and produce dysphotopsia. This peculiar interaction seems to vary from patient to patient [16, 33, 38].

Of all these studies, the design of the intraocular lens, specifically the edge, proved to be the source of negative pseudophakic dysphotopsia. The explanation of this enigmatic phenomenon has not been elucidated despite so many investigations [7, 34, 38].

In 2014, the author reported that the negative dysphotopsia was caused by a stimulation of the unpaired temporary crescent or “half moon” because the incidence of rays on the edge of the intraocular lenses refracts on the peripheral nasal retina outside 30° (location area of the temporary flood). The fact that some patients have it at 30° and others between 60 and 90° would explain why some patients may present them and others not, as well as unilateral or bilateral [39].

The disappearance or transientness of the negative dysphotopsia was explained by the opacification or translucency of the nasal sector of the capsule, later acting as a diffuser of the rays, in the first week or months following the surgery. The opacity of the posterior capsule causes diffusion of light and reduces contrast and retinal sensitivity. The anterior axial movement of the intraocular lens by contraction of the capsular bag maybe is another explanation that decreases the occurrence over time, since it reduces the axial space under the iris to 0.06 mm or less, causing a myopic change that is extremely rare. However, this has not made dysphotopsia disappear [38].

In relation to a persistent visual phenomenon, possible therapeutics arise such as the use of miotics [6, 21, 23, 29] but, contrary to expectations, it increases the problem and the pharmacological dilation seems to reduce it [34], anterior and posterior capsulotomies [6, 24, 34, 39, 40], smaller capsulorhexis [6, 31, 37], modifications of the intraocular lens [11, 30, 32, 34], change of intraocular lens [6, 13, 37, 40] do not solve the problem. The placement of another intraocular lens on the primary or “piggy bag” [29, 38] and reverse optical capture of the lens [34, 38] had partial or complete resolution of symptoms. The suture of the IOL-capsule complex iris bag [38] can decrease the visual phenomenon. The author used prism in the eye of dysphotopsia causing a displacement of the temporal crescent outside the visual field, with the disappearance of symptoms [39].

Henderson et al. [40] reported a 2.3-fold decrease in negative dysphotopsia symptoms early after cataract surgery when the nasal optic–haptic junction was oriented slightly super nasally (30° from horizontal) when compared with the haptic junction being oriented vertically. Henderson hypothesized that when the haptic junction was placed vertically, it exposed the nasal optic edge to reflections from temporal light. By placing the haptic junction relatively horizontal, the junction would then “block the light,” and the intraocular lens edge reflections and the resultant temporal negative dysphotopsia shadow would be avoided.

Erie et al. [41] with a ray-tracing software demonstrated how the horizontal haptic junction minimizes negative dysphotopsia.

The incidence of dysphotopsia phenomena in pseudophakic patients after uncomplicated cataract surgery varies, ranging from 20 to 77.7%, since there are only isolated reports as can be seen in the literature [6, 11, 30, 39, 42, 43, 44, 45, 46, 47, 48, 49]; however, the prevalence does not seem to be altered with the type of intraocular lens [28].

Advertisement

4. Conclusions

Pseudophakic dysphotopsia is an entoptic phenomenon induced by intraocular lenses that cause discomfort to patients. Positive dysphotopsia manifested as glare is well tolerated by patients, and negative dysphotopsia reported from the incorporation of intraocular lenses with square edges is a source of dissatisfaction in pseudophakia patients despite good visual acuity. After evaluating the different factors that could be responsible for it from the intraocular lens, manufacturing, surgical technique, surgeon, and patient, it was concluded that the square edge of the intraocular lens is responsible for the undesirable phenomenon. Multiple therapeutics have been proposed in order to solve the problem such as the use of miotic drops, piggy back, intraocular lens replacement textured or freezing lenses, etc. without finding the appropriate therapy. Additional studies with software or intraocular lens design program on schematic eye will be necessary to solve the problem.

Advertisement

Conflict of interest

The author declares no conflict of interest.

References

  1. 1. Raju VK. Susruta of ancient India. Indian Journal of Ophthalmology. 2003;51(2):119-122
  2. 2. Roy PN, Mehra KS, Deshpande PJ. Cataract surgery performed before 800B.C. The British Journal of Ophthalmology. 1975;59(3):171. DOI: 10.1136/bjo.59.3.171
  3. 3. Kansupada KB, Sassani JW. Sushruta: The father of Indian surgery and ophthalmology. Documenta Ophthalmologica. 1997;93(1-2):159-167
  4. 4. Obuchowska I, Mariak Z. Sir Harold Ridley--the creator of modern cataract surgery. Klinika Oczna. 2005;107(4-6):382-384
  5. 5. Kohnen T. How far we have come: From Ridley’s first intraocular lens to modern IOL technology. Journal of Cataract and Refractive Surgery. 2009;35(12):2039. DOI: 10.1016/j.jcrs.2009.10.019
  6. 6. Tester R, Pace NL, Samore M, Olson RJ. Dysphotopsia in phakic and pseudophakic patients: Incidence and relation to intraocular lens type (2). Journal of Cataract and Refractive Surgery. 2000;26(6):810-816
  7. 7. Davison JA. Positive and negative dysphotopsia in patients with acrylic intraocular lenses. Journal of Cataract and Refractive Surgery. 2000;26(9):1346-1355
  8. 8. Kwok LS, Daszynski DC, Kuznetsov VA, Pham T, Ho A, Coroneo MT. Peripheral light focusing as a potential mechanism for phakic dysphotopsia and lens phototoxicity. Ophthalmic & Physiological Optics. 2004;24(2):119-120
  9. 9. Sakamoto Y, Sasaki K, Kojima M, Sasaki H, Sakamoto A, Sakai M, et al. The effects of protective eyewear on glare and crystalline lens transparency. Developments in Ophthalmology. 2002;35:93-103
  10. 10. Steen R, Whitaker D, Elliott DB, Wild JM. Effect of filters on disability glare. Ophthalmic & Physiological Optics. 1993;13(4):371-376
  11. 11. Shambhu S, Shanmuganathan VA, Charles SJ. The effect of lens design on dysphotopsia in different acrylic IOLs. Eye (London, England). 2005;19(5):567-570. DOI: 10.1038/sj.eye.6701568
  12. 12. Koetting RA, Von Gunten TL. Glare-flare with contact lenses in aphakia. American Journal of Optometry and Archives of American Academy of Optometry. 1969;46(10):730-734
  13. 13. Schwiegerling J. Recent developments in pseudophakic dysphotopsia. Current Opinion in Ophthalmology. 2006;17:27-30. DOI: 10.1097/01.icu.0000193065.09499.7e
  14. 14. Doden W. Pseudophakia and the pupil. Klinische Monatsblätter für Augenheilkunde. 1984;185(3):155-157. DOI: 10.1055/s-2008-1054590
  15. 15. Nishi O, Nishi K. Preventive effect of a second-generation silicone intraocular lens on posterior capsule opacification. Journal of Cataract and Refractive Surgery. 2002;28:1236-1240
  16. 16. Davidson JA. Clinical performance of Alcon SA30AL and SA60AT single-piece acrylic intraocular lenses. Journal of Cataract and Refractive Surgery. 2002;28:1112-1123
  17. 17. Vargas LG, Peng Q , Apple DJ, Escobar-Gomez M, Pandey SK, Arthur SN, et al. Evaluation of 3 modern single-piece foldable intraocular lenses. Clinicopathological study of posterior capsule opacification in a rabbit model. Journal of Cataract and Refractive Surgery. 2002;28:1241-1250
  18. 18. Olson RJ, Mamalis N, Werner L, Apple DJ. Cataract Treatment in the Beginning of the 21st Century. American Journal of Ophthalmology. 2003;136:146-154. DOI: 10.1016/s0002-9394(03)00226-5
  19. 19. Holladay JT, Lang A, Portney V. Analysis of edge glare phenomena in intraocular lens edge designs. Journal of Cataract and Refractive Surgery. 1999;25:748-752
  20. 20. Coroneo MT, Pham T, Kwok LS. Off-axis edge glare in pseudophakic dysphotopsia. Journal of Cataract and Refractive Surgery. 2003;29(10):1969-1973
  21. 21. Radford SW, Carlsson AM, Barrett GD. Comparison of pseudophakic dysphotopsia with Akreos Adapt and SN60-AT intraocular lenses. Journal of Cataract and Refractive Surgery. 2007;33(1):88-93. DOI: 10.1016/j.jcrs.2006.09.014
  22. 22. Das KK, Werner L, Collins S, Hong X. In vitro and schematic model eye assessment of glare or positive dysphotopsia-type photic phenomena: Comparison of a new material IOL to other monofocal IOLs. Journal of Cataract and Refractive Surgery. 2019;45(2):219-227. DOI: 10.1016/j.jcrs.2018.09.017
  23. 23. van Norren D, van de Kraats J. Spectral transmission of intraocular. lenses expressed as a virtual age. The British Journal of Ophthalmology. 2007;91(10):1374-1375. DOI: 10.1136/bjo.2007.117903
  24. 24. Edwards KH, Gibson GA. Intraocular lens short wavelength light filtering. Clinical & Experimental Optometry. 2010;93(6):390-399. DOI: 10.1111/j.1444-0938.2010.00538.x
  25. 25. Chandramani A, Riaz KM. Management of positive dysphotopsia in a patient with prior refractive surgery. Canadian Journal of Ophthalmology. 2018;53(1):e27-e29. DOI: 10.1016/j.jcjo.2017.06.007
  26. 26. Marques FF, Marques DM. Unilateral dysphotopsia after bilateral intraocular lens implantation using the AR40e IOL model: Case report. Arquivos Brasileiros de Oftalmologia. 2007;70(2):350-354
  27. 27. Ernest PH. Severe photic phenomenon. Journal of Cataract and Refractive Surgery. 2006;32(4):685-686. DOI: 10.1016/j.jcrs.2006.01.024
  28. 28. Allen R, Ho-Yen GO, Beckingsale AB, Fitzke FW, Sciscio AG, Saleh GM. Post-capsulotomy dysphotopsia in monofocal versus multifocal lenses. Clinical & Experimental Optometry. 2009;92(2):104-109. DOI: 10.1111/j.1444-0938.2008.00345.x
  29. 29. Birchall W, Brahma AK. Eccentric capsulorhexis and postoperative dysphotopsia following phacoemulsification. Journal of Cataract and Refractive Surgery. 2004;30(6):1378-1381. DOI: 10.1016/j.jcrs.2003.11.029
  30. 30. Meacock WR, Spalton DJ, Khan S. The effect of texturing the intraocular lens edge on postoperative glare symptoms: A randomized, prospective, double-masked study. Archives of Ophthalmology. 2002;120(10):1294-1298. DOI: 10.1001/archopht.120.10.1294
  31. 31. Wallin TR, Hincley M, Nilson C, Olson RJ. A Clinical Comparison of Single-piece and Three-piece Truncated Hydrophobic Acrylic Intraocular Lenses. American Journal of Ophthalmology. 2003;136:614-619. DOI: 10.1016/s0002-9394 (03)00418-5
  32. 32. Aslam TM, Dhillon B. Effect on glare of texturing the truncated edge of an intraocular lens. Archives of Ophthalmology. 2003;121(9):1345. DOI: 10.1001/archopht.121.9.1345-a
  33. 33. Trattler WB, Whitsett JC, Simone PA. Negative dysphotopsia after intraocular lens implantation irrespective of design and material. Journal of Cataract and Refractive Surgery. 2005;31:841-845. DOI: 10.1016/j.jcrs.2004.12.044
  34. 34. Masket S, Fram NR. Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology. Journal of Cataract and Refractive Surgery. 2011;37(7):1199-1207. DOI: 10.1016/j.jcrs.2011.02.022
  35. 35. Osher RH. Negative dysphotopsia: Long-term study and possible explanation for transient symptoms. Journal of Cataract and Refractive Surgery. 2008;34:1699-1707. DOI: 10.1016/j.jcrs.2008.06.026
  36. 36. Cooke DL. Negative dysphotopsia after temporal corneal incisions. Journal of Cataract and Refractive Surgery. 2010;36:671-672. DOI: 10.1016/j.jcrs.2010.01.004
  37. 37. Izak AM, Werner L, Pandey SK, Apple DJ, Vargas LG, Davison JA. Single-piece hydrophobic acrylic intraocular lens explanted within the capsular bag: Case report with clinicopathological correlation. Journal of Cataract & Refractive Surgery. 2004;30(6):1356-1361. DOI: 10.1016/j.jcrs.2003.09.061
  38. 38. Holladay JT, Zhao H, Reisin CR. Negative dysphotopsia: The enigmatic penumbra. Journal of Cataract and Refractive Surgery. 2012;38(7):1251-1265. DOI: 10.1016/j.jcrs.2012.01.032
  39. 39. Karam EZ. Disfotopsia pseudofáquica negativa. Fenomeno visual no deseado ocasionado por lente intraocular. Gaceta Médica de Caracas. 2014;122(2):121-135
  40. 40. Henderson BA, Yi DH, Constantine JB, Geneva II. New preventative approach for negative dysphotopsia. Journal of Cataract and Refractive Surgery. 2016;42:1449-1455. DOI: 10.1016/j.jcrs.2016.08.020
  41. 41. Erie JC, Simpson MJ, Bandhauer MH. Influence of the intraocular lens optic-haptic junction on illumination of the peripheral retina and negative dysphotopsia. Journal of Cataract and Refractive Surgery. 2019:1-4. DOI: 10.1016/j.jcrs.2019.04.019
  42. 42. Cooke DL, Kasko S, Platt LO. Resolution of negative dysphotopsia after laser anterior capsulotomy. Journal of Cataract and Refractive Surgery. 2013;39(7):1107-1109. DOI: 10.1016/j.jcrs.2013.05.002
  43. 43. Folden DV. Neodymium:YAG laser anterior capsulectomy: Surgical option in the management of negative dysphotopsia. Journal of Cataract and Refractive Surgery. 2013;39(7):1110-1115. DOI: 10.1016/j.jcrs.2013.04.015
  44. 44. Nadler DJ, Jaffe NS, Clayman HM, Jaffe MS, Luscombe SM. Glare disability in eyes with intraocular lenses. American Journal of Ophthalmology. 1984;97(1):43-47. DOI: 10.1016/0002-9394(84)90444-6
  45. 45. Muñoz G, Albarrán-Diego C, Ferrer-Blasco T, Sakla HF, García-Lázaro S. Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens. Journal of Cataract and Refractive Surgery. 2011;37(11):2043-2052. DOI: 10.1016/j.jcrs.2011.05.045
  46. 46. Chiam PJ, Chan JH, Aggarwal RK, Kasaby S. RESTOR intraocular lens implantation in cataract surgery: Quality of vision. Journal of Cataract and Refractive Surgery. 2006;32(9):1459-1463. DOI: 10.1016/j.jcrs.2006.04.015
  47. 47. Kohnen T, Allen D, Boureau C, Dublineau P, Hartmann C, Mehdorn E, et al. European multicenter study of the AcrySof ReSTOR apodized diffractive intraocular lens. Ophthalmology. 2006;113(4):578-584. DOI: 10.1016/j.ophtha.2005.11.020
  48. 48. Mayer S, Böhm T, Häberle H, Pham DT, Wirbelauer C. Combined implantation of monofocal and multifocal intraocular lenses for presbyopia correction in cataract patients. Klinische Monatsblätter für Augenheilkunde. 2008;225(9):812-817. DOI: 10.1055/s-2008-1027604
  49. 49. Visser N, Nuijts RM, de Vries NE, Bauer NJ. Visual outcomes and patient satisfaction after cataract surgery with toric multifocal intraocular lens implantation. Journal of Cataract and Refractive Surgery. 2011;37(11):2034-2042. DOI: 10.1016/j.jcrs.2011.05.041

Written By

Emely Zoraida Karam Aguilar

Submitted: August 3rd, 2019 Reviewed: September 24th, 2019 Published: November 7th, 2019