Large pupil and positive dysphotopsias

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I'm 47 year old and need cataract surgery in my right eye (left eye does not currently show any cataract). While reading this form, I learned that people with large pupils have trouble with positive dysphotopsias even with monofocal lenses. Since my mesopic pupil size is 6.6mm, I'm really worried about this. In particular, I have the following questions:

  1. Given that my pupil size is larger than the optics of most IOLs (6mm), is it almost certain that I will have these issues? Would love to hear from people with large pupils who do or do not have dysphotopsias.
  2. Would it make sense for me to go for a lens with a 7mm optic? As far as I see, the only real option would be the ASPIRA-aXA from HumanOptics. This one looks actually pretty good but it is hydrophilic acrylic, which seems to increase my chances for PCO compared to hydrophobic acrylic.
  3. If I don't go for the 7mm lens, which 6mm monofocal lens would you recommend? My surgeon says that enVista should be pretty good for people who do not want to have any trouble because it is aberration-free and hence a bit more resilient to being slightly out of position. But then again I read here that a silicone lens such as the Sofport might be better for large pupils because of the lower refractive index, but I'm not sure how much of a difference this really makes once your pupils are larger than the optics anyways.


I have been somewhat myopic since I was about 15:

R: sph -1.25, cyl -0.75 @160

L: sph -1.75, cyl -0.25 @ 10

Since I would like to avoid dysphotopsias as much as possible my plan is to go for a non-toric monofocal targetting -0.5 in my right eye (the surgeon aims to reduce astigmatism by placing the incisions accordingly). This will leave me with about 1.25D of monovision, which I seem to be able to tolerate really well.

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33 Replies

  • Edited

    This was a duplicate reply, sorry.

  • Edited

    sorry for having to deal with this at 47. mine was at 41 and then at 46. i am 48 now. my mesopic was 5.5 to 6mm. i struggled with severe PD and got the iol exchanged after 5 years which addressed the PD. i seriously considered the aspira axa for a long time. ultimately panoptix worked for me. no glow from lights. at night i dont have edge glare from the exchanged eye. in the first time panoptix eye i see lens edge arc in very dark environments. the arc is smaller. with symfony it was complete circle and much larger in size. i find it better to use astigmatism (-0.75) correction glasses while driving.

    i was told the disadvantage with large pupil is that your near vision with monofocal / eyhance will suffer more than those with small pupil. with symfony my near vision was terrible. i was less myope than you. around -2.25 in both eyes. good luck to you.

    • Posted

      Hi Soks,

      if you have severe PD issues, why did you exchange for multifocals (the panotix)? i thought thatvwould cause more PD issues.

      What PD were you seeing before the exchange?

    • Posted

      because my exact symptoms were being experienced by zcb00, synergy and eyhance recipients. the common denominator was Technis. Tecnis does not work for me. i think the multifocals give you great vision at all ranges. drawback is contrast loss at night. i dont think the rings are really an issue. i did consider the eyhance but was told because of large pupil i would not get any near advantage. sofport was top recommended but one famos doctor asked what does your gut feel tell you. other famos doctor just said get panoptix and yag your symfony and move on.

    • Edited

      Sam, you have to keep in mind that the term PD gets used for very different issues. There are issues caused by the EDOF features of the lens which stretches the focal point, and is more prone to cause halos around lights at night. With multifocal lenses there are different overlapping images given to the eye to get a multi focal range of vision. These can not only cause halos, but also a starburst effect, and combined some describe them as a spiderweb pattern.


      The light flashing effect you have is very different. It is most likely caused by reflections off the edge of the lens, or the lens position in the eye combined with the size of the pupil. This can happen with any lens, and does not have to be an EDOF or MF lens.

    • Posted


      What about the light streaks that i see which are always in the direction from 2 o-clock to 8 o-clock? that's can happen in any IOL too?

    • Posted

      A potential cause is a wrinkle in the capsular bag that holds the lens. I think that can happen with any lens. It may be a matter of bad luck. Your surgeon and optometrist should be able to see if there is a wrinkle in the capsule or not.

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