Expert Panel Develops First Consensus-Based Dysphotopsia Classification System

Halos, glare and shadows have long defied standard reporting. A new framework aims to change that.

Ophthalmology has long had reliable tools for measuring what patients can see. Measuring how well they can tolerate what they see after surgery has been another matter.

A new consensus study published in Ophthalmology Glaucoma introduces the first standardized classification system for dysphotopsia reporting, giving clinicians and researchers a common framework for documenting visual disturbances following cataract surgery, refractive procedures and laser peripheral iridotomy.*

The reporting problem 

Dysphotopsias are among the most common sources of postoperative dissatisfaction, yet reporting has varied widely across the literature. Some studies refer to “visual disturbances,” others to “light artifacts” or “visual symptoms,” and questionnaire designs have differed enough to make cross-study comparisons difficult.* 

According to the authors, this inconsistency has limited efforts to systematically evaluate dysphotopsia and understand its impact on patient outcomes.*

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Building a common language 

To address the gap, researchers conducted a systematic review of 5,059 publications and a Delphi consensus process with 20 international ophthalmic specialists across cataract and refractive surgery, cornea and glaucoma. Of those publications, 142 studies met inclusion criteria and revealed striking variation: 34 unique dysphotopsia symptoms, 35 separate questionnaires and 76 individual questionnaire items.*

Through two rounds of structured surveys, experts reviewed and voted on proposed items, with consensus defined as at least 80% agreement. Of 63 items proposed, 53 reached consensus, forming the foundation of the DYsphotopsia Symptom Questionnaire and Outcomes (DYSQO).*

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What made the cut 

The final framework captures nine dysphotopsia symptoms across two categories:*

• Positive dysphotopsia: lines/streaks, ghosting, flashes/sparkles, distortion, double vision, flare/haziness and central shadow
• Negative dysphotopsia: peripheral crescent/shadow and tunnel vision

Beyond symptom identification, DYSQO assesses severity and frequency using standardized measures, along with environmental triggers—bright sunlight, nighttime conditions, artificial lighting, lighting transitions and screen use.* 

The framework also evaluates quality-of-life impact, psychological distress and response to interventions ranging from optical aids and ocular surface treatments to laser procedures and refractive surgery.*

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Beyond the symptom 

The authors noted that patients may achieve excellent visual acuity yet remain dissatisfied due to persistent disturbances that interfere with driving, reading or screen use—and that severe symptoms can contribute to anxiety, depression and reduced quality of life.* 

DYSQO’s integration of symptom burden, mental health and functional impact aims to provide a more patient-centered picture of postoperative outcomes.

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Limitations 

The study’s expert panel was weighted toward North America, with limited representation from Asia. The framework is also consensus-based and has not yet been prospectively validated across diverse patient populations.*

The takeaway  

Ophthalmology now has a shared vocabulary for something patients have long struggled to articulate and clinicians have long struggled to compare. 

Whether DYSQO becomes the field’s standard will depend on validation and uptake, but the framework is a meaningful step toward making the patient experience as measurable as the Snellen line.

*Huang RS, Verhoeff N, Balas M, et al. Standardized classification system for dysphotopsia reporting. Ophthalmol Glaucoma. ePub ahead of print: June 15, 2026. 

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