Straylight appears to be useful indicator for capsulotomy

This prospective study found that straylight can be a sensitive, additional indicator for capsulotomy referral, especially in less severe cases of posterior capsule opacification (PCO).

The authors evaluated the effect of PCO morphology and severity on visual acuity, contrast sensitivity and straylight (logarithm of the straylight (log{s}) in 240 pseudophakic eyes with PCO and capsulotomy indicated, and 99 pseudophakic eyes without PCO.

Postcapsulotomy visual field improvement was related to precapsulotomy visual field values, with improvement being largest in cases with substantially impaired precapsulotomy visual field parameters.

Visual function deterioration was related to PCO severity rather than PCO morphology. PCO severity assessed with retroillumination had a progressive, linear relation with log(s) and a curvilinear relation with logMAR. The precapsulotomy cutoff value was ≥ 1.44 for log(s) and ≥ 0.21 for logMAR. Reflected light examination tended to overestimate functional PCO severity.

They conclude that capsulotomy referral should be based on subjective symptoms, visual field parameters and slit-lamp retroillumination. A clinical guideline for the prediction of beneficial capsulotomy should be based on parameters relating to both visual acuity and straylight. In cases of slight PCO, straylight is more valuable than visual acuity because of its susceptibility to low PCO severity scores.