She first visited us because the vision in both eyes had declined rapidly after a traumatic subarachnoid hemorrhage. She came all the way from Maebashi, Gunma, referred by someone who had had surgery at our clinic, seeking a second opinion on her cataracts.
She had extreme myopia exceeding −20 D and quite advanced grade 4 nuclear cataracts, but there was no obvious macular abnormality and cataract surgery could be expected to improve her vision, so we recommended surgery.
She is a writer who prioritizes desk work in daily life, and myopic optic neuropathy was also suspected, so we recommended surgery with monofocal lenses focused for near. However, she seemed reluctant to give up on multifocal lenses, so we proposed mild monovision, making use of the original difference between her eyes.
Besides high myopia, trauma might have accelerated the cataracts, and there was a risk of weak zonules, but the surgery went without particular problems. After surgery she was very satisfied to see both far and near, like with multifocal lenses, despite monofocal lenses. During surgery she complained of slight pain here and there, probably ciliary pain from iris (the colored part of the eye) movement (a heavy pain like stepping suddenly from a dark place into bright light). Highly myopic eyes are longer than usual and so are structurally more prone to pain from iris movement; our clinic operates with low infusion flow and low eye pressure to minimize the burden on the eye, but please understand that sensitivity to pain varies between individuals.
Postoperative uncorrected distance vision, right 0.5p and left 1.0p, may look quite different, but the actual difference in refraction is only 1.0 D, so it causes no dizziness and is a difference at which glasses can be worn without difficulty. Uncorrected near vision is also good, right 1.2p and left 0.9, and she now lives without glasses. Not everyone can adapt to monovision, but judging candidacy according to each patient's characteristics can bring benefits, so please feel free to consult us.
Cataract Surgery Cases / Case
Monofocal IOL
Case #22: Woman in her 50s from Maebashi, Gunma (extreme myopia: monofocal lenses, monovision)
This is an English translation of the original Japanese case report. If the two differ, the Japanese version takes precedence. Visual acuity is shown in decimal notation (1.0 ≈ 20/20).
Change in visual acuity (decimal; corrected values in parentheses)
Right eye: pre-op → post-op
- Far
- 0.01(0.2)→0.5p(1.5)
- Near
- —→1.2p(n.c.)
Left eye: pre-op → post-op
- Far
- 0.05(0.3)→1.0p(1.5)
- Near
- —→0.9(n.c.)
2019.02.03
Patient questionnaire
Answers translated from Japanese.
- What was your condition before surgery?
I could hardly see and daily life was difficult. It was especially inconvenient changing trains, and even walking I couldn't see signs and the like.
- What led you to have surgery?
My vision kept getting worse, and I thought surgery might let me live seeing well.
- Which did you choose, a multifocal lens or a monofocal lens?
I had problems not only with myopia but also with my optic nerves, and on the doctor's advice I chose monofocal lenses.