The most common causes of amblyopia are related to either strabismus or an untreated refractive error, particularly in one eye more than the other. That is the case here where the patient does not have significant strabismus, but does have a life-time history of significant anisometropic amblyopia. This patient has a much higher degree of hyperopia in the right eye and this has been the case for the patient’s entire life. Other patients may have anisometropic amblyopia related to asymmetric astigmatism and less commonly, myopia.
The patient has been wearing the same glasses for about the past 10 years and has now developed symmetric posterior sub-capsular cataracts in both eyes. Her glasses show a prescription of +3 in both eyes, with the right eye lens being a balance instead of the full power. Auto-refraction and subjective refraction yield an Rx of +8.0 in the right eye and +3.0 in the left eye. IOL power calculations determine that the power for a plano outcome is +32.0 D for the right eye and +24.5 D for the left eye. The patient has excellent prior records and has never been able to correct the right eye to better than 20/200 while the left eye was 20/20 prior to cataract development. The OCT test of the macula is shown above and there is an epi-retinal mebrane of the left eye with mild macular pucker.
The questions for you are:
- Which eye gets cataract surgery first? Why?
- What are the additional risks for a monocular patient?
- Do you aim for plano OU?
- Which IOL type will you select? Monofocal, bifocal, trifocal?
click below to understand my thought process and how I proceeded: