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Friday, April 13, 2007

Visual Changes AFTER Cataract Surgery

Photo Credit: Bill Lloyd, MD

Most people with healthy eyes who undergo cataract surgery report a dramatic improvement to their vision: brighter, clearer, more colorful. It’s great to be around these patients when they discover how well their ‘new eyes’ can see – one of the most rewarding aspects of being an eye surgeon.

For a minority of patients cataract surgery makes vision better but also different. Yes, uncomplicated cataract removal and intraocular lens implantation significantly boosts visual acuity, but some folks experience other changes that were never present before surgery. There is enormous variability. Some people describe halos, ghosting, slight overlapping of images (not double vision) and unexpected flashes of light. The medical term for all these changes is dysphotopsia.

As a result of uncomplicated surgery it appears that patients replace one type of visual symptom with an entirely different (and annoying) problem.

In the past eye surgeons often dismissed these symptoms as temporary optical phenomena that could be expected to disappear once healing is complete. New information published in the American Journal of Ophthalmology contradicts those assumptions.

55 healthy patients undergoing routine cataract surgery were enrolled in this volunteer study. All of the surgery was performed with no complications and all experienced satisfactory recovery of good postoperative vision. It is important to note that 18 patients (roughly one-third of the group) observed dysphotopsias after their surgery and these visual distortions persisted one year after surgery. Halos and starbursts were the most frequently reported symptom. Repeat exams revealed no anatomic explanation for the dysphotopsias such as mild corneal edema or clouding of the posterior lens capsule. There was no correlation between dysphotopsia and patient age, final visual acuity, or contrast sensitivity.

So, how does this information apply to the individual patient? The report suggests that far more people endure postoperative vision changes following uncomplicated cataract surgery than originally believed. Equally important, since one-in-three may experience unwanted photopsias after cataract surgery the decision to perform surgery ought to be postponed until visual performance truly interferes with daily activities.

SOURCE: American Journal of Ophthalmology 2007; 143:522-524

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Posted by: Bill Lloyd MD at 2:15 pm

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