Concentric ring scanning laser ophthalmoscope artifacts and dysphotopsia in diffractive multifocal pseudophakia.
A 67-year-old woman had decreased visual acuity in her left eye and disturbing concentric ring dysphotopsias after bilateral implantation of ReSTOR (SN60D3; Alcon Laboratories, Inc., Fort Worth, TX) diffractive multifocal intraocular lenses (IOLs). Monochromatic (820-nm infrared and 488-nm red-free) scanning laser ophthalmoscopy (SLO) documented central retinal concentric ring patterns resembling the patient's drawings of her dysphotopsia, prompting investigation of the relationship of these phenomena. Similar SLO findings were present in four eyes of three additional ReSTOR pseudophakes without dysphotopsia, but absent in monofocal pseudophakes or phakic individuals. Optical analysis shows that concentric ring SLO imaging artifacts can be caused by coherent reflection of monochromatic laser radiation off the diffractive optical element on the IOL's anterior surface, whereas concentric ring dysphotopsias are due to diffraction or projection of broad spectrum light sources in ordinary environments. Thus, the IOL's diffractive optics is the origin of both concentric ring dysphotopsia and SLO artifacts, but diffraction or projection causes the visual phenomenon, whereas coherent reflection produces the imaging anomaly.
Ventura County Retina Group, Ventura, California, USA.
Jeffrey K
JK
Luttrull
Paul J
PJ
Dougherty
Huawei
H
Zhao
Martin A
MA
Mainster
D000368:Aged; D016477:Artifacts; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular / Q000009:adverse effects; D007908:Lens, Crystalline / Q000601:surgery; D008028:Light Coagulation; D018613:Microscopy, Confocal; D019721:Ophthalmoscopes / Q000009:adverse effects*; D009887:Ophthalmoscopy; D019591:Pseudophakia / Q000150:complications*; D012167:Retinal Perforations / Q000150:complications / Q000601:surgery; D014786:Vision Disorders / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology