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Why Haloes and Glare Occur After Premium IOL Surgery and How They Resolve

1 min read

Haloes and glare are the most commonly cited fears about premium IOLs. They are real, predictable for some lens designs, and almost always resolve. Understanding why they occur, and what does and does not predict their persistence, separates informed consent from marketing reassurance.

Why They Occur

Diffractive multifocal and trifocal IOLs split incoming light between focal points. Light not focused at the dominant focal point is perceived as a halo, a soft ring of secondary light around point sources, particularly at night.¹ EDOF lenses produce smaller, more diffuse light disturbances. Even monofocal lenses can produce dysphotopsia in eyes with dry surface, posterior capsular changes, or residual refractive error.²

The Resolution Timeline

In most patients, haloes and glare are most prominent in the first 4-6 weeks after surgery and become progressively less perceptible as the visual cortex adapts to the new optical input. By 6 months, the majority of patients describe haloes as either absent or unobtrusive. By 12 months, persistent symptomatic dysphotopsia affects a minority.³

What Predicts Persistence

Three factors are reproducible: untreated dry eye disease, residual refractive error (sphere or astigmatism), and patient personality profile. Two of these are correctable. The third is identifiable before surgery, and informs lens selection.

The Clinical Position

Haloes are not a property of the lens alone. They are a property of how a particular eye and brain interpret split light. Patients who are warned about them, screened for them, and supported through neuroadaptation are largely untroubled by them. Patients who are not warned are blindsided by them.

References

  1. Davison JA, Simpson MJ. History and development of the apodized diffractive intraocular lens. J Cataract Refract Surg. 2006;32(5):849-858.
  2. Hu J, Sella R, Afshari NA. Dysphotopsia: a multifaceted optic phenomenon. Curr Opin Ophthalmol. 2018;29(1):61-68.
  3. Tester R, Pace NL, Samore M, Olson RJ. Dysphotopsia in phakic and pseudophakic patients: incidence and relation to intraocular lens type. J Cataract Refract Surg. 2000;26(6):810-816.

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About Blue Fin Vision®

Blue Fin Vision® is a GMC-registered, consultant-led ophthalmology clinic with CQC-regulated facilities across London, Hertfordshire, and Essex. Patient outcomes are independently audited by the National Ophthalmology Database, confirming exceptionally low complication rates.