Managing Cataracts in High Myopia: Options for Balanced Vision

High myopia cataract

Hello, I am a person with high myopia (suffering from floaters) and have cataracts in my right eye (currently unable to measure accurate refractive error; previously, vision was the same as my left eye).
My left eye has a refractive error of -9.00 diopters (corrected vision is 20/20, but I cannot undergo laser correction for myopia and can wear contact lenses).
I would like to know whether to choose monofocal or multifocal intraocular lenses for surgery on my right eye, whether to retain some degree of myopia, and how to address the significant disparity in vision between my two eyes to achieve balance.
I am currently working in the arts and am 46 years old.
Thank you.

Cui, 40~49 year old female. Ask Date: 2024/07/09

Dr. He Jianxian reply Ophthalmology

Dear Ms.
Tsui,
The choice between single vision or multifocal lenses depends entirely on your work and lifestyle.
Neither option has an absolute advantage, and both come with relative disadvantages.
Given your situation, I recommend not retaining any prescription after the surgery.
You can wear contact lenses in your left eye right after the procedure, which will help avoid any issues with visual disparity.
However, if you are unable to wear contact lenses and must use regular glasses, it is essential to retain a prescription in that case.
The disparity between the two eyes should be kept within 400 degrees, with the ideal situation being within 200 degrees to minimize the risk of visual coordination issues.
Sincerely,
Dr.
He Jianxian
Ophthalmology Department, Nantou Hospital

Reply Date: 2024/07/09

More Info

Managing cataracts in individuals with high myopia presents unique challenges, especially when considering options for balanced vision. Given your situation, where you have high myopia in your left eye (900 degrees) and cataracts in your right eye, it is essential to approach this with careful consideration of your visual needs, particularly since you are engaged in artistic work.

Understanding Your Condition
High myopia, or severe nearsightedness, can lead to various ocular complications, including cataracts, retinal detachment, and vitreous degeneration. The presence of floaters (or "flying flies") is common in individuals with high myopia due to changes in the vitreous gel inside the eye. Cataracts, which cloud the lens of the eye, can further complicate vision, especially in a myopic eye where the lens may already be under stress.

Surgical Options
When it comes to cataract surgery, you typically have two primary options for intraocular lenses (IOLs): monofocal (single-focus) lenses and multifocal (or accommodating) lenses.

1. Monofocal Lenses: These lenses provide clear vision at one distance (either near or far). If you choose a monofocal lens, you may need to wear glasses for either distance or near vision, depending on your choice. Given your high myopia, a monofocal lens could be set for distance vision, which might help balance your vision with your left eye, but you may still require glasses for reading or close work.

2. Multifocal Lenses: These lenses are designed to provide clear vision at multiple distances (near, intermediate, and far). For someone in your profession, where visual acuity at various distances is crucial, multifocal lenses might be beneficial. However, they can sometimes lead to visual disturbances, such as halos or glare, especially in low-light conditions, which may be a concern given your artistic work.

Addressing Visual Discrepancies
The significant difference in refractive error between your two eyes (the right eye with cataracts and the left eye with high myopia) can lead to visual imbalance, known as anisometropia. This condition can cause issues with depth perception and overall visual comfort. Here are some strategies to address this:
- Surgical Planning: Discuss with your ophthalmologist the possibility of targeting a specific refractive outcome for your right eye during cataract surgery. For instance, if your left eye is corrected for distance, you might consider setting your right eye for a similar distance vision, which could help reduce the visual disparity.

- Contact Lenses: After cataract surgery, if you opt for a monofocal lens, you might find that wearing contact lenses in your left eye can help balance the vision between both eyes. This could be particularly useful for your artistic work, where precise visual acuity is essential.

- Visual Rehabilitation: Post-surgery, working with a vision therapist or an optometrist specializing in binocular vision can help you adapt to any changes in your visual system and improve coordination between your eyes.

Conclusion
Ultimately, the decision between monofocal and multifocal lenses should be made in consultation with your ophthalmologist, considering your lifestyle, visual needs, and the potential for visual disturbances. Given your age and profession, it is crucial to weigh the benefits of enhanced near vision against the possibility of visual side effects. Regular follow-ups and a tailored approach to your visual rehabilitation will also be essential in achieving balanced vision post-surgery.

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