Incidence Of Negative Dysphotopsia In Eyes With Scleral Fixated Iols

There appears to be a disconnect between clinical manifestation and optical laboratory modeling of Negative Dysphotopsia (ND); the latter describes the "Illumination Gap Theory" as causal of ND. In an attempt to gain further insight regarding the etiology of ND, patients with scleral fixated IOLs (SFIOLs) in the absence of the lens capsule remnant were surveyed for the incidence of ND in that cohort.

Private Practice and Surgery Center in Los Angeles, California

A retrospective chart review of cases in a single practice with either scleral sutured or intrascleral haptic fixated posterior chamber IOLs was performed.Subsequently, a live telephone interview of qualified patients who were supplied wuth a clinical example of ND was completed. Rigerous exclusion criteria were applied in order to avoid including false negative and false positive case examples.

203 cases of scleral fixated IOLs were discovered on chart review; 118 were exclded with optic neuropathy, history of retinal detachment, CVA, BCVA less than 20/50, iris or pupil abnormalities, etc. Of the remaining cases 47 met the rigid inclusuin criteria and were available for telephone interview. None of the 47 cases had evidence for chronic ND (persisting beyond 3 months) athough one case may have had transient ND symptoms. Assuming a 3% incidnece of ND after surgery, 45 eyes were requird to properly power the investigation.

Although SFIOLs sit in an anatomic similar position to standard "in the bag" IOLs, the incidence of ND appears to be far less common in the SFIOL group. This suggests that curent "Illumination  Gap Theory" of optical modeling for ND might not be universally correct, perhaps because it fails to image the lens capsule.