Dysphotopsia and neuroadaptation problems

[mmrudy]

I found this article: http://www.slackbooks.com/excerpts/68593/68593.asp

It may help to explain, in part, some of the difficulties with halos, glare, starbursts, etc. associated with multi-focal IOL's. I believe the author is a Chicago area opthamologist who favors custom IOL's for many patients. So read it with a grain of salt, but don't dismiss it as unfounded please.

If you find this interesting, take a look at the book, "Mastering Refractive IOL's" on Amazon. A different chapter is presented discussing the benefits of Crystalens and who is not a good candidate.

I took this chapter to heart as I would love to be glasses free, but with moderate guttata am not a candidate for adaptive/multifocal IOL's at this time.

[John C Hagan III, MD, FACS, FAAO]

Tecnis is one of the finest IOLs in the world. I would suggest:
1. Get a second opinon. Problem could be posterior capsule cloudy, IOL displacement, macular edema, corneal problems.
2. A first class refraction (glasses recheck) and a pair of  wave front glasses like the Zeiss iteligence system may take care of the problem.
3. Even with lesser quality IOLS these symptoms usually get better over 6-12 months.

JCH MD

[egb123]

I have severe positive dysphotopsia after receiving a monofocal (Tecnis) lens.  It corrected my near vision, but the glare is unbearable.  Everything I've read says "encourage the patient to adapt."  How do you adapt to chronic starbursts at night?

[John C Hagan III, MD, FACS, FAAO]

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[JodieJ]

Thank you for posting these links.  Dr. Kevin Waltz practices in Indianapolis and consults for AMO.  If you search the archives of this site, you'll discover that he has successfully explanted the multifocal IOLs of more than one person posting on this forum.  (A couple of people have traveled from the East Coast to see him.)  His patients praise his surgical skills.  He has Array multifocals (an early version of ReZooms) in his own eyes.

[John C Hagan III, MD, FACS, FAAO]

It's something I have noticed in my practice or in people posting here.

JCH MD

[mmrudy]

What's your take on the author's suggestion that the near-sighted notice dysphotopsia more often than the far-sighted because it (halos, glare, etc.) isn't part of their visual vocabulary? (to mix a metaphor)

[John C Hagan III, MD, FACS, FAAO]

So for those of you that don't have time to read it if you wait 3 years of putting up with halos and difficulty driving at night it might get better (but it might not)  versus a monofocal IOL and glasses where most people are halo free within a week or two.

JCH MD