He first visited us in September 2020 for consultation about cataract surgery with multifocal lenses, because for two months it had felt as if too much light was coming in and things were hard to see.
Both eyes were highly myopic, with nuclear cataracts more advanced in the right eye, and corrected vision had fallen to 0.5 right and 0.7 left. The internal aberrations in the right column of the OPD-Scan III below also show the image splitting into three and looking very smeared. In addition, he had had diabetes for more than ten years, with fundus hemorrhages and macular edema in both eyes, so we told him cataract surgery might worsen the edema, and explained that treating the diabetic retinopathy took priority over the cataracts.
<Right eye preoperative OPD-Scan III>
His eye pressure was also somewhat high and he had a history of myocardial infarction, so intravitreal injections of steroids or anti-VEGF drugs also carried risks; we therefore began with oral treatment and retinal laser treatment. By repeating laser treatment patiently and carefully, by September 2021 the macular edema had almost resolved, corrected vision had improved to 0.7 right and 1.0 left, and cataract surgery took place a year after his first visit.
The figure below shows OCT images before and after treatment: the red swollen area has shrunk, and retinal swelling has improved from 335 µm to 273 µm.
<OCT & retinal thickness before treatment>
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<OCT & retinal thickness after treatment>
As for the intraocular lens, we had explained from the start that, because of his macular disease, multifocal lenses were not suitable, which greatly disappointed him; but since he usually wore contact lenses and occasionally used reading glasses over them, we proposed surgery with TECNIS Eyhance, which has little loss of contrast sensitivity and adds an extended depth of focus effect of 0.5 D.
Because of the progressing nuclear cataract, his right eye already had about −2.5 D of residual myopia even with contact lenses, effectively a monovision-like state despite poor corrected vision, so taking Eyhance's 0.5 D add into account we proposed a target refraction of −2.0 D for the right eye. However, he wanted the desktop computer he uses at work to be clearly in focus, so we set the target slightly further at −1.75 D, and since corneal astigmatism exceeded 1.5 D, the surgery was done with the toric TECNIS Eyhance Toric.
There was the mild poor pupil dilation typical of people with diabetes, but right eye surgery was completed without problems, without the feared postoperative worsening of macular edema; besides his computer distance, as is often seen in people with high myopia, distance vision was better than expected, and he was satisfied with good vision of 0.8 distance / 0.9 near uncorrected.
<Preoperative slit-lamp photo> <Postoperative retroillumination photo>
<Preoperative fundus photo> <Postoperative fundus photo>
For the fellow left eye, since he did not mind using reading glasses for close work such as reading paperbacks, he wished to see a little further, so we proposed a target of about −1.25 D, the refraction he had with his usual contact lenses. However, he felt that uncorrected distance vision of about 0.7 would be a little unsatisfying, so the surgery was done with a slightly more distant target refraction of −1.0 to −0.75 D (micro-monovision with a difference of about 0.75 D between the eyes).
As a result, after left eye surgery too, distance vision was better than expected, and he was satisfied with good vision of 1.0 distance / 0.7 near uncorrected.
At postoperative check-ups he said very close things such as his mobile phone were hard to see, but work and daily life were no problem, and three months after surgery he was living without glasses. Another benefit is that retinal lesions that had been hard to examine through the lens opacity (cataract) can now be found without being missed, so laser treatment for diabetic retinopathy can be done more precisely, improving the quality of retinopathy management.
TECNIS Eyhance, as the postoperative retroillumination photo above also shows, has no diffractive structure like TECNIS Synergy; it is a monofocal lens whose range of clear vision is extended by 0.5 D by using aberrations. Its contrast sensitivity is reported to be almost equivalent to monofocal lenses on the same platform, so it is considered a lens with broad candidacy, though care seems needed for people who have had hyperopic LASIK, with negative corneal spherical aberration, or who have keratoconus. I think it suits people who want "monofocal plus a little extra" without losing quality of vision, so if you are interested, please feel free to consult us.
Also, as we are sometimes asked: TECNIS Eyhance is not a lens available only at a few clinics such as ours; it is an insurance-covered lens approved by the Ministry of Health, Labour and Welfare and can basically be obtained and used at any eye clinic, so if you are interested, please consult your own doctor first.
2022.02.02