Dysphotopsia After Monofocal Cataract Surgery: Clinical And Macular Optical Coherence Tomography Predictors

Dysphotopsia is a common postoperative visual disturbance following cataract surgery, even in eyes implanted with monofocal intraocular lenses (IOLs). Although symptoms are often attributed to IOL optics, retinal pathology is frequently investigated during evaluation. This study aimed to determine whether structural macular abnormalities on optical coherence tomography (OCT) or clinical ocular comorbidities are associated with dysphotopsia in patients implanted with monofocal and enhanced monofocal IOLs.

Retrospective observational study conducted at a tertiary academic ophthalmology referral center. Patients presenting with dysphotopsia after cataract surgery were routinely referred to a retina specialist to exclude macular pathology as part of the standard diagnostic workup.

Patients evaluated for dysphotopsia after uncomplicated cataract surgery with monofocal IOL implantation were included. Thirteen patients with dysphotopsia were matched to 13 asymptomatic controls based on IOL type. Demographics, ocular comorbidities (dry eye disease, glaucoma, Fuchs dystrophy), and postoperative outcomes were recorded. Preoperative spectral domain OCT images were re-evaluated by a retina specialist blinded to patient group assignment to assess central macular thickness, foveal contour, ellipsoid zone integrity, outer retinal integrity, epiretinal membrane, vitreomacular traction, and RPE changes. Continuous variables were analyzed using Mann–Whitney U and categorical variables using Fisher exact or chi-square tests.

Twenty-six eyes were included (13 dysphotopsia and 13 matched controls). All patients had monofocal IOLs, and groups were paired by lens type. Dry eye disease was significantly more prevalent in the dysphotopsia group compared with controls (85% vs 15%, p=0.004). Age, sex, glaucoma, Fuchs endothelial dystrophy, and postoperative refractive outcomes were not significantly different between groups. OCT analysis showed no significant differences in central macular thickness, ellipsoid zone integrity, outer retinal integrity, epiretinal membrane, vitreomacular traction, or other macular structural abnormalities between groups.

Dysphotopsia following cataract surgery with monofocal intraocular lenses appears to be more strongly associated with ocular surface disease than with macular structural abnormalities. Despite routine retinal evaluation to exclude macular pathology, no consistent OCT biomarkers of dysphotopsia were identified. Matching patients by IOL type suggests that symptoms are unlikely to be primarily related to lens optics. These findings highlight the importance of ocular surface evaluation when assessing dysphotopsia after cataract surgery.