Negative dysphotopsia: Causes and rationale for prevention and treatment

Abstract

To determine the cause of negative dysphotopsia using standard ray-tracing techniques and identify the primary and secondary causative factors. Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA. Experimental study. Zemax ray-tracing software was used to evaluate pseudophakic and phakic eye models to show the location of retinal field images from various visual field objects. Phakic retinal field angles (RFAs) were used as a reference for the perceived field locations for retinal images in pseudophakic eyes. In a nominal acrylic pseudophakic eye model with a 2.5mm diameter pupil, the maximum RFA from rays refracted by the intraocular lens (IOL) was 85.7 degrees and the minimum RFA for rays missing the optic of the IOL was 88.3 degrees, leaving a dark gap (shadow) of 2.6 degrees in the extreme temporal field. The width of the shadow was more prominent for a smaller pupil, a larger angle kappa, an equi-biconvex or plano-convex IOL shape, and a smaller axial distance from iris to IOL and with the anterior capsule overlying the nasal IOL. Secondary factors included IOL edge design, material, diameter, decentration, tilt, and aspheric surfaces. Standard ray-tracing techniques showed that a shadow is present when there is a gap between the retinal images formed by rays missing the optic of the IOL and rays refracted by the IOL. Primary and secondary factors independently affected the width and location of the gap (or overlap). The ray tracing also showed a constriction and double retinal imaging in the extreme temporal visual field.