Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia

Jeong Ah Kim; Ah Nul Ha; Ji Won Kwon; Won Ryang Wee; Young Keun Han

doi:10.3341/jkos.2014.55.5.669

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Kim, Ha, Kwon, Wee, and Han: Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia

Original Article

J Korean Ophthalmol Soc 201;55(5):669-678.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.5.669

Clinical Characteristics and Patient's Satisfaction in Pseudophakic Negative Dysphotopsia

Jeong Ah Kim, MD^1,², Ah Nul Ha, MD^1,², Ji Won Kwon, MD, PhD³, Won Ryang Wee, MD, PhD^1,², Young Keun Han, MD, PhD^1,⁴

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Laboratory of Corneal Regenerative Medicine and Ocular Immunology, Seoul Artificial Eye Center, Seoul National University Hospital, Biomedical Research Institute, Seoul, Korea

³Department of Ophthalmology, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea

⁴Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea

Address reprint requests to Young Keun Han, MD, PhD Department of Ophthalmology, Seoul Metropolitan GovernmentSeoul National University Boramae Medical Center, #20 Boramae-ro 5-gil, Dongjak-gu, Seoul 156-707, Korea, Tel: 82-2-870-2411, Fax: 82-2-870-2826 E-mail: eye129@paran.com

Received 24 August 2013 Revised 14 November 2013 Accepted 15 March 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the clinical characteristics of patients with pseudophakic negative dysphotopsia after cataract surgery and to analyze the risk factors of pseudophakic negative dysphotopsia as well as the postoperative effects on patient's satisfaction.

Methods

This study included 1,020 eyes of 690 patients who underwent phacoemulsification and posterior chamber lens insertion between January 2010 and March 2012. Retrospective chart review was conducted to evaluate the prevalence of negative dysphotopsia according to the site of clear corneal incision during cataract surgery and the type of implanted intraocular lens (IOL). The clinical outcome of Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser anterior capsulotomy in negative dysphotopsia patients was evaluated. Using a telephone survey, patients were asked to subjectively answer 18 questions regarding satisfaction after cataract surgery, the severity of visual symptoms and the effect of negative dysphotopsia in their daily life.

Results

Negative dysphotopsia developed in patients who underwent uneventful cataract surgery and successful implantation of IOL in the bag. The patients’ vision was corrected up to 20/20 (0.00 log MAR) and HVF P60-4 showed no abnormality in their visual field. There were significantly more patients with the SN60WF IOL who reported negative dysphotopsia but no other factors associated with the prevalence of negative dysphotopsia. During the telephone survey, patients complained of difficulties in their daily life related to the negative dysphotopsia symptoms and reported decreased satisfaction after cataract surgery.

Conclusions

Although negative dysphotopsia can decrease the patient's satisfaction after cataract surgery, the genesis of negative dysphotopsia and an objective method to test for negative dysphotopsia is necessary. Therefore, a prospective large study should be conducted to evaluate the cause and treatment of negative dysphotopsia.

Keywords: Cataract surgery, Negative dysphotopsia, Patient's satisfaction, Pseudophakia

References

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Figure 1.

Negative dysphotopsia seen by patient in the temporal field. (A) Case 1 complained of a temporal dark shadow in her left eye 1 week after cataract surgery. (B) Case 7 complained of a semicircular shadow in her both eyes 1 month after cataract surgery.

Figure 2.

Prevalence of negative dysphotopsia according to implanted intraocular lens. Prevalence of negative dysphotopsia was different among the groups (p = 0.039, Fisher's exact test). Subgroup analysis showed that the prevalence of negative dysphotopsia in the group 3 is statistically higher than that of group 1 (p = 0.025, Fisher's exact test). However, there is no statistically significant difference of prevalence of negative dysphotopsia between the group 2 and group 3, and between the group 1 and group 2 (p = 0.122, 0.268, respectively, Fisher's exact test). Group 1 : who have never complained of negative dysphotopsia (Toric IOL, HOYA YA-60BB, HOYA PC-60AD, or Tecnis ZA9003); Group 2: who were implanted with Akreos Adapt AO; Group 3: who were implanted with Acrylsof® SN60WF.

Table 1.

Comparison of demographics according to symptom of negative dysphotopsia

	No negative dysphotopsia group (1007)	Negative dysphotopsia group (13)	p-value
Sex (M:F)	338:669 (33.6%:66.4%)	2:11 (15.4%:84.6%)	0.239^*
Age at operation (years)	70.13 ± 22.66 (19-71)	63.77 ± 6.41 (54-75)	0.312^†
Follow-up period (months)	7.72 ± 7.18 (1-28)	18.63 ± 10.98 (3-37)	<0.01^‡
Laterality (Right:Left)	486:521 (48.4%:51.6%)	6:7 (46.2%:53.8%)	1.00^†

Values are presented as mean ± SD.

^* Fisher's exact test;

^† Analyzed with independent t-test;

^‡ Mann-Whitney U-test.

Table 2.

Clinical characteristic and course of patients with negative dysphotopsia

Case	Age(years)	Sex	Laterality	Negative dysphotopsia	Onset of negative dysphotopsia	ACD before surgery	Site of CCI	IOL type	HVF P60-4	Nd:YAG laser anterior capsulotomy	Resolution after treatment	Spontaneous resolution^*
1	69	F	Right	^†	^†	2.58	T	Akreos	Normal	^†	^†	^†
			Left	Temporal dark shadow	1 week	2.58	T	Akreos	Normal	^‡	^‡	No
2	65	F	Right	^†	^†	1.83	T	Akreos	^§	^†	^†	^†
			Left	Semicircular shadow	1 week	2.00	T	Akreos	^§	Yes	No	No
3	54	F	Left	Semicircular shadow	1 week	3.39	T	Akreos	Normal	Yes	No	No
4	70	F	Left	Semicircular shadow	1 month	2.28	T	Akreos	^§	^‡	^‡	Yes (6 months)
5	66	F	Right	^†	^†	2.66	T	Akreos	^§	^†	^†	^†
			Left	Semicircular shadow	1 week	2.72	T	Akreos	^§	^‡	^‡	Yes (12 months)
6	59	F	Right	temporal dark shadow	1 week	2.47	T	SN60 WF	^§	^‡	^‡	No
			Left	Temporal dark shadow	1 week	2.61	S	SN60 WF	^§	Yes	No	No
7	61	F	Right	Semicircular shadow	1 month	2.67	T	Akreos	Normal	^‡	^‡	No
			Left	Semicircular shadow	1 month	2.65	T	Akreos	Normal	^‡	^‡	No
8	57	F	Right	Semicircular shadow	1 week	1.69	S	Akreos	^§	^‡	^‡	No
			Left	Semicircular shadow	1 week	1.87	S	Akreos	^§	^‡	^‡	No
9	75	M	Right	Temporal dark shadow	1 month	2.56	T	SN60 WF	Normal	^‡	^‡	Yes (3 months)
			Left	Temporal dark shadow	1 month	2.58	T	SN60 WF	Normal	^‡	^‡	Yes (3 months)

BCVA = best corrected visual acuity (log MAR); ACD = anterior chamber depth; CCI = clear corneal incision; IOL = implanted intraocular lens; HVF P60-4: Humphrey visual field analyzer peripheral 60-4 SITA-standard strategy; Nd:YAG = Neodymium:yttrium-aluminiumgarnet; T = temporal clear corneal incision; S = superior clear corneal incision; SN60WF = Acrylsof SN60WF (Alcon, TX, USA); Akreos =Akreos Adapt AO (Bausch & Lomb, Inc., Rochester, NY, USA).

^* Period after cataract surgery;

^† No symptom of negative dysphotopsia;

^‡ Patient who didn't have Nd:YAG laser anterior capsulectomy;

^§ Patient who didn't have HVF P60-4.

Table 3.

Implanted intraocular lenses and prevalence of negative dysphotopsia

Model	Eyes (%)	Configuration	Optic Design /Size (mm)	Materials	Optic edge design	No negative dysphotopsia group (1007, 98.72%)	Negative dysphotopsia group (13, 1.27%)	Prevalence (%)
SN60WF	146 (14.31)	1 piece	Aspheric/6.0	Hydrophobic acrylic; blue-light filtering	Square	142	4	2.74
Toric IOL	50 (4.90)	1 piece	Aspheric/6.0	Hydrophobic acrylic; blue-light filtering	Square	50	0	0
YA-60BB	69 (6.76)	3 pieces	Aspheric/6.0	Hydrophobic acrylic with PMMA haptics: blue-light filtering	Square	69	0	0
PC-60AD	5 (0.49)	3 pieces	Aspheric/6.0	Hydrophobic acrylic with PMMA haptics	Square	5	0	0
Akreos	656 (64.31)	1 piece	Aspheric/6.0	Hydrophobic acrylic	Square	647	9	1.20
ZA9003	94 (9.26)	3 pieces	Aspheric/6.0	Hydrophobic acrylic	Square posterior; modified anterior	94	0	0

SN60WF = Acrylsof SN60WF (Alcon, TX, USA); Torio IOL = AcrySof® Torio IOL (Alcon Laboratories, Inc., Fort Worth, USA); YA-60BB = HOYA YA-60BB (HOYA Corporation, Tokyo, Japan); PC-60AD = HOYA PC-60AD (HOYA Corporation, Tokyo, Japan); Akreos = Akreos Adapt AO (Bausch & Lomb, Inc., Rochester, NY, USA); ZA9003 = Tecnis ZA9003 (Abbott Medical Optics Inc., Santa Ana, USA); PMMA = Polymethylmethacrylate.

Table 4.

Results of the question

Case	Age (years)	Sex	Spontaneous resolution	Category 1^‡				Category 2^§	Category 3^π
				Q1	Q2	Q3	Q4	Q1	Q1	Q2	Q3	Q4	Q5	Q6	Q7	Q8	Q9	Q10	Q11	Q12	Q13	Q14
				(5)	(2)	(5)	(5)	(5)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)	(3)
1	67	F	^*	5	^*	5	5	^*	0	0	0	0	1	1	0	t	^†	^†	^†	1	^†	^†
			No	4	1	4	4	4
2	65	F	^*	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
			No	-	-	-	-	-
3	54	F	No	3	1	1	1	5	1	1	1	1	0	0	1	1	1	1	0	0	0	0
4	70	F	Yes (6 months)	4	1	4	4	4	1	1	1	1	1	1	1	1	^†	^†	^†	^†	^†	^†
5	66	F	^*	5	^*	5	5	5	0	0	0	0	1	1	0	^†	^†	^†	1	1	^†	^†
			Yes (12 months)	4	1	4	4	5
6	59	F	No	4	1	4	4	4	0	0	0	0	0	0	0	^†	0	0	0	0	0	1
			No	4	1	4	4	4
7	61	F	No	3	1	3	3	5	1	1	1	0	0	0	1	0	0	0	0	0	^†	^†
			No	3	1	3	3	5
8	57	F	No	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-	-
			No	-	-	-	-	-
9	75	M	Yes (3 months)	4	1	5	5	4	0	0	0	0	0	0	0	0	0	0	0	0	1	1
			Yes (3 months)	4	1	5	5	4
Total									3	3	3	2	3	3	3	2	1	1	1	2	1	2

^* No symptom of negative dysphotopsia;

^† Patient explained that they never had such activity after cataract surgery;

^‡ Satisfaction;

^§ Severity of negative dysphotopsia and need for treatment;

^π Functional disturbance.

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