nothing there.
Of the 2, negative dysphotopsia (ND) is generally considered the more
serious, as it tends to be more bothersome to the patient. It's also a par-
ticularly frustrating and time-consuming complication for the surgeon,
because it doesn't present as any abnormality; it's strictly a patient-
reported outcome. Therefore, solving the problem requires a "diagnosis
of exclusion," meaning you must first rule out any other pathway to dis-
ease.
Solving the mystery
Until recently, the etiology of ND has been something of a mystery.
Some suggested it was caused by light diversion or the corneal incision,
while others attributed its origins to pupil size, retinal shape and lens
position. Ray-tracing
analysis and clinical
findings have since
confirmed that ND
can be attributed in
part to an optical inter-
action between an in-
the-bag IOL's anterior
surface and the anteri-
or capsulotomy. The
immediate post-op
incidence of ND is in
the range of 15% of
IOL patients. In most
cases, the condition
resolves on its own
relatively quickly,
9 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U N E 2 0 1 7
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