Standardized Classification System for Dysphotopsia Reporting

Purpose: To develop a consensus-based classification system and questionnaire for the standardized assessment and reporting of dysphotopsias following ophthalmic procedures. Design: Systematic review and Delphi consensus process. Participants: Twenty ophthalmic specialists with expertise in glaucoma, cataract/refractive surgery, and cornea participated in this Delphi consensus survey. Methods: A systematic literature search was conducted using Ovid MEDLINE and Embase to identify randomized controlled trials and observational studies reporting on dysphotopsias. Reported symptoms, assessment questionnaires, and individual question items were extracted to create a comprehensive list of potential classification items. These items were refined through iterative Delphi consensus surveys involving ophthalmic specialists, who evaluated each item for inclusion, exclusion, or rewording, and could propose the addition of new items. Consensus was defined a priori as ≥80% agreement among panelists. This iterative process allowed for progressive refinement of the classification system and continued until at least 80% of all proposed items achieved consensus. Main Outcome Measures: The proportion of ophthalmic specialists who chose to include or exclude specific dysphotopsia symptoms, and additional items of the questionnaire, including baseline characteristics, environmental modifiers, quality of life, and attempted management strategies. Results: Following the screening of 5059 articles, 142 studies met inclusion criteria, identifying 34 unique dysphotopsia symptoms and 76 individual questionnaire items. Participants reached consensus on 53 of 63 items (84.1%) over 2 rounds of Delphi surveys. Items that did not meet inclusion or exclusion thresholds after the second round were excluded from the final classification system. The finalized classification system included 11 baseline clinical variables, 7 positive dysphotopsia symptoms (halos, glare/dazzle, starbursts, arcs, lines/streaks, ghosting, and flickering/shimmering), 1 negative dysphotopsia symptom (peripheral crescent/shadow), 5 environmental modifiers, 2 quality-of-life and mental health items, and 8 attempted interventions. These elements were consolidated into the DYsphotopsia Symptom Questionnaire and Outcomes intended for clinical and research applications. Conclusions: A standardized classification system for the reporting of dysphotopsias following ophthalmic procedures was developed using the Delphi consensus process. The adoption of this tool in research and clinical practice may enhance the consistency, clarity, and quality of dysphotopsia reporting, enabling comparisons across interventions and enhancing evidence-based patient care. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.