Managing Cataracts in High Myopia: Solutions for Better Vision

Q: Managing Cataracts in High Myopia: Solutions for Better Vision

Hello Jo： <br>1. <br>Long-focus intraocular lenses can meet over 90% of the visual needs for intermediate to long distances without relying on reading glasses, such as when using a desktop computer, watching television, cooking, cleaning, driving day and night, and for outdoor ac

High myopia with unilateral cataract?

Hello Doctor: I have high myopia, with a prescription of -2200 degrees in my right eye and -1000 degrees in my left eye.
I also have presbyopia and dry eye syndrome.
An examination revealed cataracts in my right eye.
I am concerned about the potential for significant visual disparity if I only undergo cataract surgery on my right eye, and I do not plan to have refractive surgery on my left eye due to my dry eye condition, which prevents me from wearing contact lenses for extended periods.
Therefore, I can only wear regular glasses.
My work requires me to look at a computer for long periods and read a lot of small print documents at close range.
I hope to achieve better intermediate and near vision without experiencing glare at night, and I would prefer to wear only one pair of glasses without needing to switch to reading glasses.
I have read that a long-focus intraocular lens can provide better vision at distance, intermediate, and near ranges without the drawbacks of multifocal lenses.

I have a few questions:
1.
Can a long-focus intraocular lens meet my needs? Will I still experience visual disparity similar to that of a monofocal lens with my left eye remaining at -1000 degrees? If there is a disparity, can the long-focus lens be adjusted to retain some myopic power, and can the prescription for my left eye be reduced to minimize the difference between the two eyes?
2.
Alternatively, if I choose a monofocal aspheric lens for my right eye and retain some myopic power to reduce disparity, what range of difference is generally more tolerable for the human eye? Between monofocal and long-focus lenses, which one provides better visual quality?
3.
The natural lens can adjust for distance and near vision; will I still be able to adjust using the ciliary muscle after replacing it with an artificial lens?
4.
If my eyes are light-sensitive and I don't feel the need for blue light-blocking lenses, are there "photochromic" lenses available? Or is the only solution to wear sunglasses or full-vision lenses?
Thank you for taking the time to respond, and I wish you all the best!

Jo, 50~59 year old female. Ask Date: 2021/11/19

Dr. Gao Pilin reply Ophthalmology

Hello Jo:
1.
Long-focus intraocular lenses can meet over 90% of the visual needs for intermediate to long distances without relying on reading glasses, such as when using a desktop computer, watching television, cooking, cleaning, driving day and night, and for outdoor activities.
As for adjusting the prescription, it is best to discuss this in person with the surgeon.
If possible, it would also be advisable to replace the left eye with an appropriate lens for better quality of life in the future.
2.
The difference in prescription between the two eyes should ideally not exceed 250 diopters.
If the left eye has a prescription of -1000 diopters and does not undergo surgery, the right eye may need to remain at -750 diopters of myopia, which would render the long-focus intraocular lens less effective, and single-focus lenses might be considered instead.
This would likely require at least two pairs of glasses for distance and near vision, or the use of multifocal glasses.
3.
It is not possible to adjust the prescription; it relies on the optical properties of the lens, which is why we have single-focus or long-focus options.
4.
The lens does not change color; however, there are now blue light-filtering intraocular lenses that are yellow.
If there is light sensitivity, wearing sunglasses or full-vision lenses is necessary.

Reply Date: 2021/11/19

More Info

Managing cataracts in patients with high myopia presents unique challenges, especially when considering the need for optimal vision correction post-surgery. Your situation, with significant myopia in both eyes and the presence of cataracts, requires careful consideration of various options to ensure the best possible outcomes.

1. Long-Focus Intraocular Lenses (IOLs): Long-focus IOLs can indeed be a suitable option for your needs. These lenses are designed to provide a broader range of vision, allowing for improved clarity at distance, intermediate, and near ranges. However, the presence of significant myopia in your left eye (1000 degrees) may lead to a disparity in visual acuity between the two eyes after surgery. This is often referred to as "anisometropia." If you choose a long-focus IOL for your right eye, it may be beneficial to consider leaving some myopic correction in that eye or adjusting the left eye's prescription slightly to minimize the visual difference. The goal is to achieve a balance that allows your brain to adapt to the differences in focus between the two eyes.

2. Single-Focus vs. Long-Focus IOLs: When comparing single-focus IOLs to long-focus IOLs, the latter generally provides better versatility for various distances. However, single-focus lenses may offer superior optical quality and less distortion, which can be particularly important for tasks requiring high visual acuity, such as reading small text on documents. The degree of visual disparity that is tolerable varies among individuals, but typically, a difference of 1.00 to 1.50 diopters is manageable for many people. It’s essential to discuss with your ophthalmologist the specific degree of difference that you might experience and how your visual needs can be best met.

3. Accommodation with Artificial Lenses: Unlike natural lenses, which can change shape to focus on objects at varying distances (a process known as accommodation), artificial lenses do not have this capability. Once an artificial lens is implanted, it remains in a fixed position. This means that while you may achieve good vision at certain distances, you will not be able to adjust focus as you could with your natural lens. Therefore, it’s crucial to select an IOL that aligns with your primary visual needs, especially given your work requirements.

4. Light Sensitivity and Lens Options: If you experience light sensitivity, you may want to consider options that can help mitigate this issue. While anti-blue light coatings are available, they may not be necessary for everyone. Photochromic lenses, which darken in response to sunlight, can be an excellent choice for those who are sensitive to bright light. These lenses can provide comfort without the need for sunglasses in many situations. However, if you find that photochromic lenses do not meet your needs, traditional sunglasses or polarized lenses may be the best alternative.

In conclusion, managing cataracts in the context of high myopia requires a tailored approach. Discussing your specific visual needs and lifestyle with your ophthalmologist will help determine the best course of action. They can provide guidance on the most suitable IOL options, taking into account your work requirements and personal preferences. Regular follow-ups post-surgery will also be essential to monitor your recovery and visual outcomes.

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