Dysphotopsia refers to unwanted visual phenomena experienced after cataract surgery that are unrelated to refractive error. Two distinct forms are recognised: positive dysphotopsia and negative dysphotopsia. Although both occur in pseudophakic eyes, they have different characteristics, different underlying mechanisms and different clinical trajectories.
Positive dysphotopsia describes the perception of light-based phenomena, halos, starbursts, arcs or streaks of light, typically experienced in low-illumination conditions or when looking at point light sources. It is most commonly associated with multifocal lens designs and usually diminishes with neuroadaptation over several months. ¹
Negative dysphotopsia is less well understood and more distressing. Patients describe a dark arc or shadow in the temporal visual field, often characterised as a curtain or crescent at the edge of vision. It occurs predominantly with square-edge monofocal lens designs and is thought to result from light distribution patterns at the lens edge interacting with the capsular bag. ² Unlike positive dysphotopsia, it does not always resolve spontaneously and can persist for months or, in some cases, indefinitely. ³
Management of persistent negative dysphotopsia ranges from reassurance and observation to, in refractory cases, lens exchange for a design with different edge characteristics. Most cases improve without intervention. ¹
References
1. Masket S, Fram NR, Cho A, Park SC. Pseudophakic dysphotopsia: review of causes and management. Journal of Cataract and Refractive Surgery. 2011;37(3):557–567.
2. Holladay JT, Zhao H, Reisin CR. Negative dysphotopsia: the enigmatic arc. Journal of Cataract and Refractive Surgery. 2012;38(7):1251–1265.
3. Henderson BA, Geneva II. Negative dysphotopsia: a perfect storm. Journal of Cataract and Refractive Surgery. 2015;41(10):2291–2312.
Related Topics:
- Assessing Suboptimal Vision After Cataract Surgery: Why It Happens, and When We Enhance
- Why Do I Still Need Glasses After Cataract Surgery?
- Laser Enhancement After Cataract Surgery: When We Recommend It
- Piggyback Lens vs Laser: Fixing Small Errors After Cataract Surgery
- Dry Eye After Cataract Surgery: Why Vision Seems Worse Than It Is
- Blinking Clears My Vision After Cataract Surgery: Is It Dry Eye?
- How We Treat Ocular Surface Disease Before Considering Enhancement
- Secondary Cataract (PCO): Cloudy Vision Months or Years After Surgery
- What to Expect From YAG Laser Capsulotomy at Blue Fin Vision®
- Cystoid Macular Oedema: Blurry Central Vision Weeks After Surgery
- When Macular Disease Limits Vision After “Successful” Cataract Surgery
- Toric Lens Rotation: When Post-Cataract Astigmatism Returns
- Lens Tilt or Decentration: How Small Misalignments Affect Premium Lenses
- Halos and Glare After Cataract Surgery: Neuroadaptation Explained
- Positive vs Negative Dysphotopsia: Weird Shadows After Lens Implant
- Blur After Cataract Surgery: Our Step-by-Step Diagnostic Pathway Before Any Enhancement
