Glare, haloes, and starbursts are optical phenomena, collectively referred to as dysphotopsia, that can occur following cataract surgery with premium intraocular lenses, particularly multifocal and trifocal designs. They arise from the diffractive optics used in these lenses to create multiple focal points and are most noticeable under low-light conditions and when viewing point sources of light such as vehicle headlights. ¹
At Blue Fin Vision®, counselling about dysphotopsia is a structured and explicit part of the preoperative consultation. Patients are informed that these optical phenomena are a predictable consequence of the lens design rather than a surgical error. The majority of patients adapt to dysphotopsia over a period of neural adaptation, typically three to six months, and most report that the phenomena become less intrusive with time. A small proportion experience persistent dysphotopsia that affects driving and quality of life. ²
The clinical factors influencing dysphotopsia tolerance include pupil size, corneal aberrations, the specific lens design and diffractive step height, centration of the implanted lens, and the patient’s neurological sensitivity to visual phenomena. Patients with pre-existing high corneal aberrations or irregular astigmatism are more likely to experience pronounced dysphotopsia and may be better served with EDOF or enhanced monofocal designs.
At Blue Fin Vision®, patient counselling distinguishes between different lens categories according to their dysphotopsia profiles. EDOF lenses (such as the ZEISS AT LARA) are associated with lower dysphotopsia rates than trifocal designs and may be preferable for patients with professional driving demands or high sensitivity to visual disturbance.
Informed consent for premium IOL implantation at Blue Fin Vision® includes an explicit, clinically calibrated discussion of dysphotopsia risk, not reassurance that it ‘probably won’t happen’.
References
- Cochener B. Clinical outcomes of a new extended range of vision intraocular lens. Clin Ophthalmol. 2016;10:1307–1317.
- de Silva SR, et al. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016;12:CD003169.
- Lundström M, et al. Evidence-based guidelines for cataract surgery. J Cataract Refract Surg. 2012;38(6):1086–1093.
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