The Patient Refuses Refractive Correction!

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This 75 year old patient needs cataract surgery because her best corrected vision is 20/50 and it is becoming increasingly difficult for her to do her daily activities. She currently wears contact lenses to adjust the right eye to plano and the left eye to about -1.25 in order to provide a degree of monovision. Doing cataract surgery is a perfect opportunity for us to correct the opacity of the visual axis but also to correct her myopia and astigmatism and permanently give her monovision without the hassle of contact lenses. But she refuses. Why?

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Sometimes it is due to financial considerations because there is an additional cost for the toric IOL and also any associated refractive services. But in this case, the patient is financially very comfortable and her purse costs more than the refractive services for both eyes. This patient explained that she has worn green-colored contact lenses for the past many years and she is known among her friends for her strikingly-hued eyes.

Since we are in Los Angeles and our surgery center is in Beverly Hills, perhaps we have more patients who are overly concerned with beauty and appearance. I always figured that seeing well is better than looking good, if forced to make a choice. But then again, as an ophthalmologist, that is our way of thinking. So I offered to make her plano in one eye and -1.25 in the other and then she could return to wearing the green contacts (in a zero power) purely for cosmetic reasons.

Again, she refused and adamantly stated that she wanted to remain at her current prescription of about -4 D of myopia. On occasion, she finds it useful to have the very close focal point of 25 cm that is provided by the -4 D (focal point = 1/-4D = 0.25 meters = 25 cm) in order to pluck her eyebrows or glue on her fake eyelashes. What could else could I say? I respected her wishes and did the surgery as she desired. That’s LA.

click below to see the video of her surgery (highly efficient in 4 minutes):

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