Age-related objective and subjective dysphotopsia

Purpose : Dysphotopsia including glare and haloes is the most common cause of dissatisfaction post cataract surgery with implantation of multifocal intraocular lenses (MIOLs). The aim of this prospective study was to determine the relationship between objective measure and subjective complaints which could be used to identify those most likely to experience post-operative problems. The normal range of subjective/objective grade (the glare effect ratio) was determined over a wide age range.

Methods : Measurements were acquired monocularly and binocularly from 141 healthy participants (range 18 to 82 years). A bespoke halometer gave an objective measure by quantifying the extent of the glare area in 8 meridians. The C-Quant objectively assessed the amount of straylight falling on the retina using the compensation comparison method. Grading of subjective dysphotopsia was performed using simulated images (Photographic Images of Photic Phenomena plates).

Results : Monocular glare areas (median: 4.87 cm²; range 1.97 to 20.87 cm²) were larger than the binocular glare areas (median: 3.77 cm²; range 1.64 to 12.11 cm²) with halometry (P < 0.001). Binocular glare area increased with age (r = 0.673, r² = 0.453, P < 0.001). Objective findings explained only a small percentage of the variance in subjective measures; halometer glare area vs subjective complaints r = 0.287, r² = 0.082, P < 0.001; C-Quant vs subjective complaints r = 0.228, r² = 0.052, P = 0.007. The normal range for the glare effect ratio was calculated for both halometry (median: 0.77; range 0 – 2.52) and for C-Quant (median: 3.45; range 0 – 10.62).

Conclusions : Binocular summation was evident with binocular halos being smaller than monocular halos, suggesting halometry should be performed binocularly. The lack of a strong relationship between subjective and objective measures highlights the difficulties in predicting a patient’s likely subjective complaints from an objective measure alone. The normal range of the glare effect ratio could be used for screening purposes pre-refractive surgery, as individuals with the highest ratios may be the most likely to complain of subjective dysphotopsia symptoms.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.