An optician pointed out his poor vision and his previous doctor prescribed glasses, but he was not satisfied with how he saw, and he first visited us hoping that cataract surgery would relieve the bother.
Both eyes were short, about 22 mm, but the left eye had become myopic due to an advanced nuclear cataract of about grade 3.5 nuclear hardness, with posterior subcapsular opacity as well, so uncorrected vision had fallen to 0.08, and even corrected vision to 0.1. The right eye had a mild cataract of about grade 2 and was hyperopic, about +1.5, but vision was still good at 0.9 uncorrected and 1.2 corrected. We therefore told him that single-eye surgery on the left eye alone was also possible, in which case, to avoid anisometropia (a large difference in power between the eyes), we recommended a monofocal lens set for distance or the insurance-covered segmental refractive bifocal lens LENTIS Comfort.
Preoperative slit-lamp photo Preoperative fundus photo
He had already researched lens types extensively himself, and had been considering surgery with LENTIS Comfort so that he could see clearly at distance, as he did not mind using reading glasses. Because the right eye had become hyperopic, its uncorrected near vision had fallen to 0.1, so there seemed to be almost no disadvantage to operating with LENTIS Comfort even now; after discussion, also seeing as an advantage that the best power could be chosen without worrying about the right eye, he wished for surgery on both eyes.
He said he had no history of trauma, but the cataract was asymmetric, pathologically advanced in the left eye only, so we operated carefully, watching for complications; to bring out 100% of the lens's characteristics, we also thoroughly removed the posterior subcapsular opacity by polishing the posterior capsule with a tip fitted with a capsule polisher, and the surgery was completed without problems.
After surgery he was delighted with good vision at both distances, 1.5 distance / 1.0p near uncorrected. The measured values seemed sufficient, but he wished to see near a little more comfortably if possible, so the right eye's target refraction was shifted slightly toward near.
After right eye surgery too, vision was good at both distances with no refractive error, 1.2 distance / 1.0 near uncorrected; objective refraction was 0.625 D more toward near than the left eye (0.375 D subjectively), but fortunately distance vision did not drop and the result was as hoped.
Postoperative retroillumination photo Postoperative fundus photo
He works as an editor, looking at quite small print for long hours, so one month after surgery he had near glasses made; with +0.75 D right / +1.00 D left he said he could see both his smartphone and computer screen well. In other words, had we set the targets 0.75–1.00 D further toward near, those distances could have been covered, but then distance vision would probably have been about 0.5–0.6, a result that would not have met his wishes. Whether to prioritize distance or near differs from person to person, so clearly telling your doctor your wishes before surgery is essential for postoperative satisfaction.
He even took the postoperative survey home so that he could fill it in in detail, and submitted it later, so if you are considering LENTIS Comfort, please do refer to this assessment of vision that only someone who has actually had the surgery can give.
At our clinic patients wear an eye patch for only one night after surgery, fixed with skin-colored tape so as not to stand out. He wrote that he was "surprised by how it looked," probably because the skin-colored tape made it look as if his eye had disappeared. Indeed, one never sees anyone wearing a skin-colored mask, and both at the university hospital and when our clinic first opened we used white tape, so tape in a noticeable color may be better, also as a way of alerting others. We will take this into account. Thank you for your valuable feedback.
2022.01.12