Thank you for this video. It is very well edited and presented. I recently saw a ND presentation at ASCRS by prakyhat Roop MD whose team presented a ring shaped ND ring device that fits into sulcus. I think your patient must have had a strange shadowing interaction due to iris and capsule positioning considering it recurred. Would be interested to see if dilation resolved vf defect prior to iolx. I would have loved to try this ND ring device on her with the original panoptix lens. Very interesting case. I applaud you for your dedication and surgical insight and skills. I tend to steer patients away from refractive lens exchange.
Such a deep defect on the sensitivity map of her visual field involving the center is very strange. And why would it disappear and then come back after 2 weeks? Something doesn't make sense here. Rule out nonorganic vision loss before doing any more surgery. Try tangent visual fields in the office to look for a tunnel defect and find someone to do goldmann perimetery to look for overlapping isopters. Would personally get a neuroophth consult here!
Was a macular ganglion cell analysis done as well? Curious if there would be a corresponding vertical related defect in the GCL that would match patient’s VF defect.
Expectant attitude. Most patients stop perceiving ND in the first few months due to a neuroadaptation mechanism. It also decreases with progressive opacity of the anterior capsule. Temporary pupillary dilation.
Very interesting case. Preop to the exchange did she report less ND with dilation? To me this element of preop diagnostic assessment completes the ND diagnosis (dark temporal arc, present since surgery, resolves or abates with dilation). I recall the LI61AO has a sharp edge for reduced PCO at least on the posterior optic edge; anterior may be somewhat rounded. Even in the best of hands some patients will still have ND but the mainstay of treatment is surgical with positioning of the optic edge anterior to the capsule as you have done here. I always blunt any enthusiasm with stating that usually it is significantly improved but may not be gone. Please do keep us all informed. Very interested to know outcome. Thank you and your patient.
Great work Dr. Krad. Very interesting. Does supra nasal placement of the superior haptic help in these cases ? Also which single piece IOL you think works best for Negative Dysphotopsia.?
I have one pt with Münchausen syndrome (diagnosed by psych, not me)…just a thought in case the variable / non-localizing field defects return. That being said, I don’t fully understand ND (although I’ve heard multiple competing theories), so perhaps there is a non-functional explanation… In any case, thx so much for sharing! I continue to learn from your channel, Dr. Krad. I admire ur dedication to ur pts, Ur surgical skills, ur video making skills, etc. Not to mention ur a fellow BJJ player! 😉👍🏻
50 yo. Refractive lens exchange. 2 subsequent surgeries for ND. I’d hit the stop button on any additional procedures, and the next best medicine is reassurance. Followed by neuro-ophth. And then more reassurance
Too much is being made of the negative dysphotopsia. If you do surgery only on people who have a debilitating cataract, instead of treating eye surgery like plastic surgery, your rate of complaints with ND will go down immensely.
Thanks for showing such unusual cases , this will really help many young opthalmologists around the world to learn something new.. thanks alot drkrad
I hope so! 🙏
Wow. That is insane case. Kudos.
Thank you for this video. It is very well edited and presented. I recently saw a ND presentation at ASCRS by prakyhat Roop MD whose team presented a ring shaped ND ring device that fits into sulcus. I think your patient must have had a strange shadowing interaction due to iris and capsule positioning considering it recurred. Would be interested to see if dilation resolved vf defect prior to iolx. I would have loved to try this ND ring device on her with the original panoptix lens. Very interesting case. I applaud you for your dedication and surgical insight and skills. I tend to steer patients away from refractive lens exchange.
Such a deep defect on the sensitivity map of her visual field involving the center is very strange. And why would it disappear and then come back after 2 weeks? Something doesn't make sense here. Rule out nonorganic vision loss before doing any more surgery. Try tangent visual fields in the office to look for a tunnel defect and find someone to do goldmann perimetery to look for overlapping isopters. Would personally get a neuroophth consult here!
Was a macular ganglion cell analysis done as well? Curious if there would be a corresponding vertical related defect in the GCL that would match patient’s VF defect.
Expectant attitude.
Most patients stop perceiving ND in the first few months due to a neuroadaptation mechanism.
It also decreases with progressive opacity of the anterior capsule.
Temporary pupillary dilation.
Very interesting case. Preop to the exchange did she report less ND with dilation? To me this element of preop diagnostic assessment completes the ND diagnosis (dark temporal arc, present since surgery, resolves or abates with dilation).
I recall the LI61AO has a sharp edge for reduced PCO at least on the posterior optic edge; anterior may be somewhat rounded.
Even in the best of hands some patients will still have ND but the mainstay of treatment is surgical with positioning of the optic edge anterior to the capsule as you have done here. I always blunt any enthusiasm with stating that usually it is significantly improved but may not be gone.
Please do keep us all informed. Very interested to know outcome. Thank you and your patient.
Great work Dr. Krad. Very interesting. Does supra nasal placement of the superior haptic help in these cases ? Also which single piece IOL you think works best for Negative Dysphotopsia.?
VERY EDUCATIVE.. IF THE DYSPHOTOPSIA RETURNS ARTISN IOL IN AC ,MAY BE, WILL HELP
I have one pt with Münchausen syndrome (diagnosed by psych, not me)…just a thought in case the variable / non-localizing field defects return.
That being said, I don’t fully understand ND (although I’ve heard multiple competing theories), so perhaps there is a non-functional explanation…
In any case, thx so much for sharing! I continue to learn from your channel, Dr. Krad. I admire ur dedication to ur pts, Ur surgical skills, ur video making skills, etc. Not to mention ur a fellow BJJ player! 😉👍🏻
I tried No GI like yourself and it's certainly easier on the fingers!
50 yo. Refractive lens exchange. 2 subsequent surgeries for ND. I’d hit the stop button on any additional procedures, and the next best medicine is reassurance. Followed by neuro-ophth. And then more reassurance
Nice surgery..did not understand why she had so poor vision before surgery with not so much refractive error
The negative dysphotopsia is very annoying and very disappointing
Has it happened to you or someone you know?
@ritiksurana9178 I have had negative disphotopsia for 4 years
50 yo plano presbyopia...crazy stuff like this is why I tell them to put cheaters on
I am strongly suspicious about peripheral local retinal detachment . that can behave like that. Dr. Yusuf Türkyılmaz
Thank you Yusuf. Fortunately her Retina is ok and so far she's doing well :)
Too much is being made of the negative dysphotopsia. If you do surgery only on people who have a debilitating cataract, instead of treating eye surgery like plastic surgery, your rate of complaints with ND will go down immensely.