Eyeworld

14 | EYEWORLD | DECEMBER 2020 EYEWORLD JOURNAL CLUB ASCRS NEWS by Natacha Villegas, MD, Alejandro Arboleda, MD, MS, Malini Veerappan Pasricha, MD, and Jose Davila, MD an underestimation, as patients frequently will not report PD symptoms unless directly asked. 6 Additionally, objective evaluation of PD remains elusive, due to a lack of tools to quantify its impact on visual function. Management of PD remains challenging. Conservative management is considered first- line, including education, reassurance, and in some cases, pharmacologic miosis, which may reduce PD by decreasing the amount of light passing through the IOL. Treatment of refractive error and postoperative complications such as posterior capsule opacification can also reduce PD. If these measures fail, invasive procedures such as piggyback IOL implantation and IOL exchange may be considered. 2 However, there is limited data on outcomes of surgical approach- es to treat PD. In this retrospective case series, Masket and colleagues report outcomes of IOL exchange for PD. Study summary This is a non-randomized, retrospective review of 56 eyes from 46 patients who underwent surgical management of PD between 2013 and 2019. All patients had visual acuity of 20/30 or better as well as uncomplicated cataract surgery with a centered posterior chamber IOL (PC- IOL) and an unremarkable postoperative course other than PD symptoms. Included patients C ataract surgery is one of the most common surgeries performed annually and is only expected to increase in coming decades due to an aging pop- ulation. Despite advances in surgical technique, which have significantly improved efficiency, patient safety, and predictability of cataract surgery refractive outcomes, postop- erative visual disturbances such as dysphotop- sias continue to be a significant contributor to patient dissatisfaction, even in routine cases performed by experienced surgeons. Positive dysphotopsia (PD) was first report- ed by Masket et al. in 1993, as an undesirable optical phenomenon following cataract surgery described by patients as light streaks, bright arcs, and/or halos induced by external light. 1 This visual phenomenon was attributed to scattering of light from the edge of ovoid intra- ocular lenses (IOL). Subsequent studies have suggested numerous factors can affect incidence of PD, including IOL characteristics, surgical technique, and ocular anatomy. 2,3 Contributing IOL properties include a squared-edge design, high dioptric power, small radius of curvature, and lens refractive index. 2 Overall, incidence of positive and negative dysphotopsia (ND, a temporal dark crescent- shaped or linear shadow) has been estimated at 49% in the immediate postoperative period, decreasing to 0.2–2.2% over 12 months post- operatively. 2,4,5 This is generally thought to be Review of "Surgical management of positive dysphotopsia: U.S. perspective" continued on page 17 Suzann Pershing, MD Ophthalmology Residency Program Director Stanford University Stanford, California Pseudophakic positive dysphotop- sia can be just as bothersome as negative dysphotopsia. I invited the Stanford residents to review this large retrospective series of patients who were managed with IOL exchange. —David F. Chang, MD, EyeWorld Journal Club Editor Stanford University ophthalmology residents Natacha Villegas, MD, Alejandro Arboleda, MD, MS, Malini Veerappan Pasricha, MD, Jose Davila, MD

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