Subjective complaints after cataract surgery: common causes and management strategies

To describe the common causes of, and management strategies for, nonrefractive subjective visual complaints after cataract surgery.

Over the past decade, clinical observations and ray-tracing models have greatly increased our understanding of positive and negative dysphotopsias after cataract surgery. The primary factor behind positive dysphotopsias is the use of high refractive index square-edge intraocular lenses (IOLs). Primary and secondary factors that underlie negative dysphotopsias are now better characterized, which has led to successful interventions including IOL exchange and Nd:YAG laser anterior capsulotomy.

Positive and negative dysphotopsias occur after implantation of monofocal IOLs, and can rarely be disabling to patients. Visual complaints after multifocal IOL implantation are more common than after monofocal IOL implantation, but still rarely require significant intervention. A better understanding of the risk factors and optical causes of dysphotopsias will allow for IOL design and patient selection that maximize satisfaction after cataract surgery.