Vitreomacular Traction and Cataract Surgery Options - Ophthalmology

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Cataract, lens?


Hello, I have myopia over 600 degrees, and my left eye's vision has decreased to 0.5, with distortion in my vision.
The doctor at the medical center said that I can undergo surgery for vitreomacular traction.
I would like to ask the following questions, thank you!
1.
Besides vitreomacular traction, could the distortion in my vision be caused by other issues, such as cataracts? However, the doctor did not mention any other problems.

2.
After a vitrectomy, if cataracts develop, can I opt for femtosecond laser surgery, and can I choose to pay out-of-pocket for an artificial lens? For example, can I choose an aspheric lens to eliminate astigmatism, or is it only possible to have a standard spherical lens covered by insurance after the vitrectomy?
3.
If I undergo vitrectomy and cataract surgery in my left eye, and my right eye has myopia of 700 degrees, I am concerned about the issue of anisometropia.
I do not want to wear contact lenses or reduce the prescription too much, and my right eye also has mild vitreomacular traction.
Can I first have cataract surgery in my right eye to address the anisometropia issue? Thank you.

s, 30~39 year old female. Ask Date: 2023/10/05

Dr. Gao Pilin reply Ophthalmology


Hello: 1.
Vitreomacular traction syndrome can indeed lead to vision loss and distortion, but it is also important to rule out other potential ocular issues, such as cataracts.
Typically, the physician will assess for other eye problems during the examination.
If the doctor did not mention other issues, it may be because conditions like cataracts are not apparent or have not progressed to a stage that requires immediate intervention.
2.
After vitrectomy, if cataracts develop, surgical options remain available, including various types of intraocular lenses, some of which may require out-of-pocket expenses.
Whether these options are suitable for you depends on the specific condition of your eyes and the recommendations of your ophthalmologist.
3.
The issue of anisometropia in the right eye can be addressed through cataract surgery, but several points should be considered: i.
Before considering surgery, consult with an ophthalmologist to ensure that the cataract in the right eye has reached a stage that necessitates surgery.
ii.
Conduct thorough vision assessments before and after the surgery to determine the post-operative refractive status and visual acuity of the right eye.
iii.
If there is also mild vitreomacular traction in the right eye, discuss potential risks and surgical outcomes with your physician prior to the procedure.

Reply Date: 2023/10/05

More Info


Vitreomacular traction (VMT) is a condition where the vitreous gel in the eye pulls on the macula, the central part of the retina responsible for sharp vision. This can lead to visual distortions, such as seeing straight lines as wavy or curved, and can significantly affect visual acuity. Given your situation, where you have high myopia (over -6.00 diopters) and a decline in vision in your left eye, it’s understandable that you are concerned about the implications of VMT and potential cataract surgery.


1. Distorted Vision and Other Potential Issues
While VMT is a common cause of visual distortion, other conditions could also contribute to your symptoms. Cataracts, for instance, can cause blurred vision and distortions, especially in advanced stages. In high myopia, the risk of developing cataracts is increased, and they may develop at an earlier age. Other potential causes of visual distortion include retinal tears or detachments, epiretinal membranes, and other retinal pathologies. It’s crucial to have a comprehensive eye examination to rule out these conditions, as they may require different management strategies.


2. Vitrectomy and Cataract Surgery Options
If you undergo a vitrectomy (vitreous removal) to address the VMT, there is a possibility that cataracts may develop post-surgery, especially in patients with high myopia. If cataracts do develop, you can consider cataract surgery, which may involve the use of femtosecond laser technology. This advanced technique can enhance precision in cataract removal and lens implantation.

Regarding the type of intraocular lens (IOL) you can receive, there are options beyond the standard spherical lenses covered by insurance. You may opt for premium lenses, such as toric lenses for astigmatism correction or multifocal lenses for presbyopia. However, these premium lenses often come with additional out-of-pocket costs. It’s essential to discuss these options with your ophthalmologist to determine the best choice for your visual needs and financial considerations.


3. Addressing Anisometropia Concerns
You mentioned that your right eye has a higher degree of myopia (700 degrees) and also shows signs of mild vitreous traction. If you undergo cataract surgery on the right eye, it could help alleviate the risk of anisometropia (a significant difference in refractive power between the two eyes), which can lead to discomfort and visual imbalance. However, it’s crucial to evaluate the vitreous condition in the right eye before proceeding with surgery. If the vitreous traction is significant, it may need to be addressed before or during cataract surgery.

In conclusion, your concerns about VMT and cataract surgery are valid, especially given your high myopia and the associated risks. It’s essential to have a thorough discussion with your ophthalmologist about your symptoms, the potential for other underlying issues, and the best surgical options available to you. They can provide personalized recommendations based on your specific condition and visual goals. Regular follow-ups and monitoring are also critical to ensure optimal visual outcomes and address any emerging issues promptly.

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