Addressing Visual Discomfort After Cataract Surgery in High Myopia Patients

Q: Addressing Visual Discomfort After Cataract Surgery in High Myopia Patients

Hello Mr. <br>Lee： <br>1. <br>If you are referring to uncorrected vision, having 200 degrees of myopia with a visual acuity of 0.3 can be considered normal. <br>However, if your corrected vision is also 0.3, it may be affected by the presence of a macular fold in your right eye,

Undergoing cataract surgery on the right eye alone may lead to issues with fusion?

Hello Doctor: I have high myopia (approximately -750 diopters in the left eye and -900 diopters in the right eye, with macular folds).
Earlier this year, my right eye worsened to -1200 diopters, and after a professional ophthalmological examination, I was diagnosed with cataracts.
After approval from the National Health Insurance Administration, I underwent cataract surgery on my right eye in early July (with a monofocal aspheric lens, leaving a reserve of 225 diopters).
Currently, in my daily life and work, I wear -650 diopter contact lenses in my left eye and have a naked vision of -200 to -225 diopters in my right eye.
I feel a lack of depth perception, and the images appear somewhat floaty; I need to focus slightly to adapt better.
Subsequently, I got multifocal glasses (left eye -650 diopter contact lenses, right eye -200 diopters for myopia, and +200 diopters for presbyopia), but I have been experiencing issues with image fusion, a sensation of image fluctuation, and occasional dizziness, imbalance, and nausea.
I would like to ask:
1.
The cataract surgery on my right eye left a reserve of 200-225 diopters, but my vision is barely 0.3.
Is this normal?
2.
I am currently wearing multifocal glasses (left eye -650 diopter contact lenses, right eye -200 diopters for myopia, and +200 diopters for presbyopia), but I still have issues with image fusion and fluctuations.
Will I eventually get used to wearing these glasses?
3.
My left eye cataract has not yet reached the surgical stage.
If I can undergo surgery in the future and choose not to leave any diopter reserve (0 diopters), I would be able to see both near and far, but with a disparity of 200-225 diopters between my two eyes.
Will this cause fusion problems and discomfort?
4.
Following up on the previous question, if I need to retain some diopter reserve during the left eye cataract surgery, how much should I retain to avoid wearing glasses while still being able to manage daily activities (like driving with sufficient distance vision)? Thank you, Doctor~

Mr. Li, 50~59 year old female. Ask Date: 2022/08/31

Dr. Gao Pilin reply Ophthalmology

Hello Mr.
Lee:
1.
If you are referring to uncorrected vision, having 200 degrees of myopia with a visual acuity of 0.3 can be considered normal.
However, if your corrected vision is also 0.3, it may be affected by the presence of a macular fold in your right eye, which could impact your vision.

2.
Since you are wearing contact lenses in your left eye and the difference between your two eyes is not significant, there should not be any issues with fusion.
It is possible that you are still adjusting, and this may improve over time.

3.
A difference of 200 degrees in refractive error typically does not lead to fusion issues.
As mentioned, it may take some time to adapt.

4.
If you wish to maintain your current prescription, about 100 degrees of myopia is generally manageable for daily activities, although you may experience some blurriness while watching television.
If this is not a concern for you, then keeping a prescription of 100 degrees is acceptable.

Reply Date: 2022/08/31

More Info

Addressing visual discomfort after cataract surgery, especially in patients with high myopia, can be quite complex due to the unique challenges posed by their specific visual needs and the anatomical changes that occur during and after surgery. Here’s a detailed response to your concerns:
1. Post-Surgery Visual Acuity: It is not uncommon for patients to experience less than optimal visual acuity immediately following cataract surgery, especially when a significant degree of myopia is involved. The fact that your right eye, after surgery, is achieving a visual acuity of 0.3 (which is equivalent to 20/60 in the U.S. vision standard) may be within the expected range, particularly if the surgery involved a monofocal intraocular lens (IOL) that was set to provide clear distance vision. However, the degree of myopia you had prior to surgery and the specific lens power chosen can influence the final outcome. It’s important to have a follow-up with your ophthalmologist to assess the healing process and determine if any adjustments or further interventions are necessary.

2. Multifocal Glasses and Fusion Issues: The sensation of visual instability, such as the "floating" images and difficulty in achieving a single, clear image, can be attributed to several factors, including the adaptation to multifocal lenses. It is common for patients to experience some degree of visual discomfort when transitioning to multifocal glasses, particularly if there is a significant difference in prescription between the two eyes. This adaptation period can take several weeks to months. If the discomfort persists, it may be beneficial to consult with your optometrist or ophthalmologist to explore alternative lens options or adjustments to your current prescription.

3. Surgery Considerations for the Left Eye: If you decide to undergo cataract surgery on your left eye in the future and choose not to retain any myopic correction (0.0 D), you may indeed face challenges with binocular vision due to the significant difference in refractive error between your two eyes (200-225 D). This disparity can lead to difficulties in fusion, resulting in symptoms such as double vision or visual discomfort. It’s crucial to discuss these potential outcomes with your surgeon, who can help you weigh the benefits and drawbacks of different lens options based on your lifestyle and visual needs.

4. Retaining Prescription for the Left Eye: If you opt to retain a certain degree of myopia in your left eye during surgery, the specific power to retain will depend on your visual goals. Many patients find that retaining a small amount of myopia (for example, -1.00 D) can help them achieve a balance between distance and near vision, allowing for better overall functionality without glasses for most daily activities. However, the exact power should be tailored to your individual needs, and a thorough discussion with your ophthalmologist will help determine the best approach.

In summary, navigating visual discomfort after cataract surgery, especially with high myopia, requires careful consideration of your individual circumstances and ongoing communication with your eye care professionals. Regular follow-ups are essential to monitor your recovery and make any necessary adjustments to your treatment plan. Additionally, patience is key as your visual system adapts to the changes brought about by surgery and new optical devices.

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