EyeWorld Asia-Pacific September 2020 Issue

EWAP SEPTEMBER 2020 31 CATARACT Luc van Vught, BSc, Gregorius Luyten, MD, Jan-Willem Beenakker, MSc. J Cataract Refract Surg. 2020;46(7). Article in press. Purpose: Provide insight in the anatomical characteristics associated with negative dysphotopsia using quantitative clinical data. Setting: Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands. Design: Case-control study. Methods: Anterior chamber tomography and peripheral aberrometry were measured in twenty-seven pseudophakic patients with negative dysphotopsia (ND) and thirty pseudophakic controls. Based on these measurements, the total corneal power, anterior chamber depth, pupil location and diameter, iris tilt and peripheral ocular wavefront up to 30 degrees eccentricity were compared between both groups. Additionally, ray tracing simulations using pseudophakic eye models were performed to establish a connection between these clinical measurements and current hypotheses on the etiology of ND. Results: Patients with ND have a smaller (p=0.03/p=<0.01) and more decentered (p<0.01) pupil than pseudophakic controls. Additionally, an increased temporal tilted iris (p<0.01) and an asymmetric peripheral aberration profile were observed in patients with ND, of which the latter was also apparent in a number of ray tracing models. The combination of these in vivo results and ray tracing simulations indicates that patients with ND have a temporal rotated eye, which confirms the hypothesized relation between ND and an increased angle kappa. Conclusions: Patients with negative dysphotopsia have a smaller pupil and an increased angle kappa, which make them more susceptible to experience a shadow in the temporal visual field. Horizontal and inferotemporal haptic orientation, reverse optic capture, capsular fibrosis over the IOL edge, IOL material, and IOL edge design are all considerations that have been previously explored with varying success. 2–5 Newer work suggests a possible central nervous system etiology as symptoms were reduced on visual field perimetry with contralateral eye occlusion and a lack of reported symptoms in monocular patients. 8 When in doubt, Distinct differences in anterior chamber configuration and peripheral aberrations in negative dysphotopsia allowing time for spontaneous resolution can always buy some time before attempting other medical or surgical corrections. EWAP References 1. Osher RH. Negative dysphotopsia: Long-term study and possible explanation for transient symptoms. J Cataract Refract Surg. 2008;34:10: 1699–1707. 2. Holladay JT, Simpson MJ. Negative dysphotopsia: Causes and rationale for prevention and treatment. J Cataract Refract Surg. 2017;43:2:263–275. 3. Masket S, Fram NR. Pseudophakic negative dysphotopsia: Surgical management and new theory of etiology. ADVERTISER LISTING J Cataract Refract Surg. 2011;37:1199–1207. 4. Masket S, et al. Surgical management of negative dysphotopsia. J Cataract Refract Surg. 2018;44:6–16. 5. Henderson BA, et al. New preventative approach for negative dysphotopsia. J Cataract Refract Surg. 2016;42:1449–1455. 6. Davison JA. Positive and negative dysphotopsia in patients with acrylic intraocular lenses. J Cataract Refract Surg. 2000;26:1346–1355. 7. Holladay JT, et al. Negative dysphotopsia: The enigmatic penumbra. J Cataract Refract Surg. 2012;38:1251–1265. 8. Masket S, et al. Neuroadaptive changes in negative dysphotopsia during contralateral eye occlusion. J Cataract Refract Surg. 2019;45:242–243. Alcon Page 2, 34 www.alcon.com Feather Safety Page 39 www.feather.co.jp Haag-Streit Page 17 www.haag-streit.com Johnson & Johnson Vision Page 5 www.jjvision.com Oculus Page 10 www.corneal-biomechanics. com ASCRS Page 59 www.ascrs.org AUSCRS Page 7 www.auscrs.org APACRS Page 36, 51, 53, 60 www.apacrs.org