This patient has more than just a white cataract and you will need to step back from the slit-lamp microscope to fully appreciate it. This white cataract has been severely limiting the vision of this patient’s left eye for about 2 years. And during that time, sensory exotropia (sensory XT) developed because of the visual deprivation. The patient’s other eye is already pseudophakic with a trifocal IOL and we have good biometry from two year prior. We must warn this patient ahead of time that she will certainly have some degree of diplopia in the post-op period. This may last a day, a week, a month, or even longer as the brain tries to coordinate the eyes. In some cases if there is failure of fusion after a few months, a strabismus surgery may be needed to bring the eyes into alignment to allow for stereoscopic vision.
click to learn from this video about sensory exotropia with a white cataract: