Positive and negative dysphotopsia in patients with acrylic intraocular lenses

Purpose: To report the incidence, management, and prevention of patient rep orts of glare and streaks around a point source of light or a dark shadow i n the temporal field of vision after acrylic intraocular lens (IOL) implant ation. Setting: A private practice. Methods: Cases in which patients complained vigorously of dysphotopsia were catalogued prospectively during the implantation experience in 6668 consec utive eyes having surgery between January 1995 and June 1999. The technique s of topical-intracameral anesthesia, temporal clear corneal incisions, and phacoemulsification were used in ail cases. Alternate IOL styles were sele cted for use from July 1999 to April 2000. Results: Fourteen cases (0.2%) were identified. The complaints resolved in 1, were diminished in 1, and were tolerated without change in 7. Five eyes of 4 patients required IOL exchange with capsular bag placement of a poly(m ethyl methacrylate) (PMMA) or silicone lens for resolution of symptoms. Sel ecting alternate IOL styles reduced the incidence of dysphotopsia. Conclusions: Glare and streaks from a point source of light represent posit ive photic expressions of dysphotopsia, and temporal dark shadows represent similar negative photic expressions. Both appear to be associated with shi ny square-edge optics made of high-refractive-index acrylic polymer. Intrao cular lenses of PMMA and silicone with rounded edges, along with square-edg e acrylic IOLs with nonreflective edges, appear less likely to cause clinic ally significant pseudophakic dysphotopsia. (C) 2000 ASCRS and ESCRS.