Eyeworld

42 | EYEWORLD | DECEMBER 2021 ATARACT C Contact Fram: drfram@avceye.com Holladay: holladay@docholladay.com Olson: RandallJ.Olson@hsc.utah.edu toric lens with the haptics oriented horizontally where you do not want to exchange the IOL and cannot ROC that particular IOL. Dr. Olson said that he tells patients to wait at least 6 months to give the brain time to adapt before pursuing any surgical options. He said that options for eliminating the capsule on the nasal side or moving the optic to the top of the capsule are both effective options. A piggyback can be effective, but you have to make sure you have plenty of room so you don't get pigment dispersion. The key in these cases, Dr. Olson said, is to not think of negative dysphotopsia as "abnor- mal." It's part of what lenses do. Dr. Olson concluded by stressing several key principles. Let patients know ahead of time that this is common and normal. Physicians should be able to recognize what it is so they can help the patient. Dr. Olson also tells pa- tients, "The more you're concerned about it, the harder it is for the brain to ignore." He tries to get patients to not worry too much about it be- cause it will either resolve or can be addressed if it persists. "If the anterior capsulotomy won't allow for that, we put the lens in the sulcus," Dr. Fram said. With this option, she will fixate the lens to the iris gently, so it doesn't move over time. In her research with Dr. Masket, 5 ROC worked 96% of the time, and sulcus placement worked 86% of the time. Patients should understand that after ROC procedures early fibrosis of the capsule may occur, requiring a YAG posterior capsulotomy. Piggyback lenses can also be used, as can a secondary IOL on top of the lens to help scatter light, which worked 73% of the time. Bag-to- bag exchange has not worked well in Dr. Fram's experience. Dr. Fram also mentioned a strategy reported by Folden 6 and Cooke 7 of using nasal capsulec- tomy, and her earlier research with Dr. Masket also indicated that nasal capsule was implicated in the etiology of negative dysphotopsia. How- ever, many of the strategies such as ROC and sulcus placement move the optic forward and may fit with the ray tracing theory as well. Na- sal capsulectomy has reduced rather that cured negative dysphotopsia in Dr. Fram's experience. This may be a good strategy for a patient with a continued from page 40 References 1. Holladay JT, Simpson MJ. Negative dysphotopsia: Causes and rationale for prevention and treatment. J Cataract Refract Surg. 2017;43:263–275. 2. Osher RH. Negative dyspho- topsia: long-term study and pos- sible explanation for transient symptoms. J Cataract Refract Surg. 2008;34:1699–1707. 3. Coroneo MT, et al. Off-axis edge glare in pseudophakic dysphotopsia. J Cataract Refract Surg. 2003;29:1969–1973. 4. Masket S, et al. Surgical man- agement of negative dyspho- topsia. J Cataract Refract Surg. 2018;44:6–16. 5. Masket S, Fram N. Pseudopha- kic negative dysphotopsia: Surgical management and new theory of etiology. J Cataract Refract Surg. 2011;37:1199–1207. 6. Folden DV. Neodymium:YAG laser anterior capsulectomy: surgical option in the manage- ment of negative dysphotopsia. J Cataract Refract Surg. 2013; 39:1110–1115. 7. Cooke DL, et al. Resolution of negative dysphotopsia after laser anterior capsulot- omy. J Cataract Refract Surg. 2013;39:1107–1109. ASCRS Grand Rounds is a virtual, complimentary CME offering exclusive to ASCRS members that brings the experience of a live grand rounds to your home or office. ASCRS has partnered with major academic institutions to present a series of vir tual grand rounds, each approved for 1.0 AMA PRA Category 1 Credit™. View during a pre-scheduled time to engage with the speakers or view on demand at your convenience. Visit ascrs.org to view the ASCRS Grand Rounds schedule. Terry Kim, MD Sumitra Khandelwal, MD Moderators

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