Reduced Incidence of Negative Dysphotopsia With Scleral-Fixated Intraocular Lenses

Purpose: To determine the incidence of negative dysphotopsia (ND) in eyes with scleral-fixated intraocular lenses (SFIOLs) absent the capsular bag remnant. Setting: Private ophthalmology practice Design: Retrospective observational study Methods: Consecutive cases of patients undergoing SFIOL without a capsule bag remnant were reviewed. Patients were excluded if they had conditions that could impact visual field testing, iris or pupil abnormalities, best-corrected visual acuity worse than 20/50, or clinically significant corneal pathology. Eligible patients were contacted via email and if they agreed to participate, a telephone interview with a novel questionnaire was completed after the patient reviewed a representative image of an ND scotoma. Results: Of 206 identified scleral-fixated IOL cases, 50 patients met inclusion criteria and agreed to complete the novel questionnaire. None of the 50 patients reported symptoms of ND at any time following surgery. Conclusions: Negative dysphotopsia was not observed in this cohort of SFIOLs without a capsule bag remnant. These findings support the hypothesis that ND occurs primarily with “in-the-bag” IOLs and that the lens capsule, in some fashion, may play a role in the development of ND and suggest that existing optical modeling tests alone may be insufficient to explain the etiology for ND.