Night Vision Disturbances Following Refractive Surgery: Causes, Prevention, and Treatment

Bidgoli, Sina; Alió, Jorge L.

doi:10.1007/978-3-319-60561-6_21

Cited by 4 publications

(7 citation statements)

References 28 publications

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“…4,21,22 This large cohort includes patients with night myopia (eg, uncorrected myopia), refractive errors (eg, irregular corneal astigmatism, and hyperopia), multifocal and other IOL designs, cataracts, keratoconus, and peripheral corneal imperfections from refractive surgeries (eg, laser-assisted in situ keratomileusis [LASIK], photorefractive keratectomy [PRK], radial keratotomy [RK]). [23][24][25] In many of these cases, DLD can be mitigated by miosis, where the smaller pupil blocks the unfocused, peripheral aberrant rays of light, selectively allowing passage of the more centrally focused rays 26 or obviates internal reflections resulting from a square edge IOL design. 6 A miotic change in the pupil size can be achieved by modulating one of two or both opposing sets of muscles -the iris sphincter muscles controlled by the cholinergic nervous system and the iris dilator muscles controlled by the adrenergic nervous system.…”

Section: Introductionmentioning

confidence: 99%

Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial

Pepose¹,

Hartman²,

DuBiner³

et al. 2021

OPTH

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Section: Introductionmentioning

confidence: 99%

Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial

Pepose¹,

Hartman²,

DuBiner³

et al. 2021

OPTH

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“…Night vision or dim light vision disturbances (DLD) encompass photic phenomena, including glare, halo, and starbursts, which can result from ocular aberrations, ocular scatter, and superimposed retinal images in the case of multifocal intraocular lenses [ 1 ]. Millions of patients who suffer from DLD have difficulty with night vision due to the physiologic dilation of the pupil that occurs in dim lighting conditions.…”

Section: Introductionmentioning

confidence: 99%

“…laser-assisted in situ keratomileusis [LASIK], photorefractive keratectomy [PRK], and radial keratotomy [RK]), multifocal or depth of focus intraocular lenses (IOL), or increased ocular scatter (e.g. cataract, dry eye, and corneal scars) [ 1 – 6 ]. DLD can have a significant impact on quality of life.…”

Section: Introductionmentioning

confidence: 99%

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A randomized phase 2 clinical trial of phentolamine mesylate eye drops in patients with severe night vision disturbances

Pepose

Brigell

Lazar³

et al. 2022

BMC Ophthalmol

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Purpose Dim light vision disturbances (DLD) comprise a wide range of symptoms affecting the quality of vision at low illumination including glare, halos, and starbursts. This exploratory study investigated 1.0% phentolamine mesylate ophthalmic solution (PMOS) as a treatment to improve vision and image quality for patients with DLD. Methods In this placebo-controlled, randomized, double-masked clinical trial, 24 adult patients with severe DLD were randomized in a 2:1 ratio to receive either one dose of PMOS or placebo. Subjects were eligible if they reported experiencing severe night vision difficulty that was not eliminated by distance spectacle correction and scored ≥0.3 log units below the normal range of contrast sensitivity assessed under mesopic conditions with glare at ≥2 spatial frequencies. Key efficacy outcomes were change from baseline in pupil diameter, contrast sensitivity, and visual acuity. Safety measures including intraocular pressure, conjunctival hyperemia, and systemic effects were also assessed. Results Eight subjects were randomized to placebo (63% female; mean age 47 years) and 16 were randomized to PMOS (75% female; mean age 42 years). Mean (SD) pupil diameter of PMOS-treated subjects decreased significantly − 1.3 mm (0 to − 2.8 mm) with p < 0.0001. Mean contrast sensitivity with glare in PMOS-treated subjects improved significantly post-treatment at spatial frequencies 3, 6, 12, and 18 cycles per degree (p ≤ 0.03). PMOS also demonstrated improvements in the numbers of letters read for mesopic and photopic, high- and low-contrast visual acuity (LCVA). Importantly, a statistically greater proportion of PMOS-treated eyes registered mesopic LCVA 5 letter (69% vs. 31%, p = 0.029) and 10 letter (34% vs. 6%, p = 0.04) improvement, with a trend at 15 letters (19% vs. 0%, p = 0.16). PMOS was well tolerated with the only reported side effect being a mild increase in conjunctival hyperemia. Conclusion PMOS was well tolerated and effectively reduced pupil size with improvements in contrast sensitivity and visual acuity in adults with severe DLD. Future Phase 3 studies should be conducted to further evaluate its potential to treat DLD. Trial registration The trial registration number is NCT04004507 (02/07/2019). Retrospectively registered.

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“…Postoperative visual symptoms are a major factor for causing decreased visual satisfaction after refractive surgery (Bidgoli & Alio 2018). Night vision disturbances, such as haloes and glare, were reported with the highest prevalence after ICL V4c implantation (Siedlecki et al.…”

Section: Introductionmentioning

confidence: 99%

Comparison of visual outcomes after non‐toric and toric implantable collamer lens V4c for myopia and astigmatism

Wei

Niu

et al. 2020

Acta Ophthalmologica

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Purpose To evaluate the visual quality of myopic patients after non‐toric versus toric implantable collamer lens (ICL and TICL, respectively) V4c, and to investigate the potential risk factors of postoperative night vision disturbances. Methods This prospective cohort study included 42 eyes of 21 patients treated with ICL and 46 eyes of 23 patients treated with TICL. Refractive parameters and ocular aberrations were examined before and 6 months after surgery. Subjective quality of vision was scored by a validated questionnaire. Results The efficacy index at 6 months was 1.14 ± 0.20 for ICL and 1.17 ± 0.16 for TICL; the safety index was 1.20 ± 0.17 for ICL and 1.20 ± 0.19 for TICL. The root mean square of total higher‐order aberrations (HOAs) and trefoil was significantly increased, and no statistical differences between groups were detected in HOA changes. Many patients reported haloes (85.7% for ICL and 100% for TICL) and glare (76.2% for ICL and 65.2% for TICL), but most (94.4% for ICL and 95.5% for TICL) were satisfied or very satisfied with visual outcomes. Implantable collamer lens (ICL) toricity was the risk factor for frequency (OR = 2.81, p = 0.01), severity (OR = 3.85, p = 0.003) and bothering effect (OR = 2.89, p = 0.01) of haloes. Conclusions Implantable collamer lens and TICL provided comparable efficacy, safety and predictability, induced acceptable level of HOAs and achieved high satisfaction in correcting myopia and myopic astigmatism. Although not severe, haloes and glare have a non‐negligible prevalence and ICL toricity is a potential risk factor of haloes.

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Night Vision Disturbances Following Refractive Surgery: Causes, Prevention, and Treatment

Cited by 4 publications

References 28 publications

Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial

Phentolamine Mesylate Ophthalmic Solution Provides Lasting Pupil Modulation and Improves Near Visual Acuity in Presbyopic Glaucoma Patients in a Randomized Phase 2b Clinical Trial

A randomized phase 2 clinical trial of phentolamine mesylate eye drops in patients with severe night vision disturbances

Comparison of visual outcomes after non‐toric and toric implantable collamer lens V4c for myopia and astigmatism

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