At the 2026 ASCRS conference in Washington, DC, Thomas A. Oetting, MS, MD, clinical professor of ophthalmology and visual sciences at the University of Iowa, presented a tough case of dysphotopsia. Below is a transcript of his conversation with Ophthalmology Management, edited for clarity.

Hi, this is Tom Oetting from the University of Iowa. I had a great experience at the ASCRS meeting this year during the “Quicksand Chronicles” portion of the meeting. This is a really interesting idea led by Liz Yeu, MD, and Nicole Fram, MD, in which ophthalmologists talk about cases that were tough for them. It’s almost like a counseling session. I really enjoyed it. My case was specifically aimed to thank Nicole for all the work she’s done on dysphotopsias.

As you know, dysphotopsias are a constant struggle for us, where patients present with unusual phenomenon following cataract surgery. Sometimes it’s an area that’s missing, sort of dark on the side, which is called negative dysphotopsia. And sometimes it’s more positive, with interesting phenomena of light around our patients.

This has been a real puzzle for us, trying to figure out what to do about it. Nicole and her partner, Sam Masket, MD, have most of the literature on this topic. That’s why I was so excited to present my case to Nicole at the meeting. I had a patient with negative dysphotopsias that were really bothering her after post cataract surgery. She described it as having horse blinders on. After waiting appropriately per her cataract surgeon’s advice, she decided that she wanted to do something about it. So, using the literature from Nicole and Sam, I did the next step, which was to take the optic and prolapse it forward so it was in the reverse optic position, and the patient’s symptoms went away immediately. It’s very exciting when patients talk about how different their situation is while we’re wheeling them out of the room.

In this case, it went on and on and got more complicated, because we ended up doing the other eye, starting off right away with this reverse optic capture position. But then the patient had some fluid buildup behind the lens, and a myopic shift, it got complicated. I had a sort of fun counseling session with Nicole and Liz.

But there was a little surprise at the end. A similar case came in the same day, a patient complaining of negative dysphotopsia with a very distinct edge where she was not seeing. I was so fortunate that I had a wonderful resident with me, because the tendency might be to just charge through that and sign them up for surgery and do the same thing we did with this other lady.

But this resident, Lindsay De Andrade, was very careful; she listened to the patient and found out that this phenomenon was present even before the cataract surgery. It turned out, after a very careful examination by Lindsay, to be a pituitary tumor that was eventually removed by a neurosurgery service.

So, I wanted to take everybody through this sort of rollercoaster ride that I had been on over a few days: First, helping a patient with negative dysphotopsia by following the algorithm and treatment that Nicole had outlined so well for us in many papers; then finding how you can get tricked sometimes by patients with other pathology, if you’re not careful. You have to really think it through carefully.