There is a reason why I recommend that you do NOT aim for a plano outcome in highly myopic eyes. The IOL power estimation is not as accurate as you think and the chance of over-correcting these eyes and making the patients uncomfortably hyperopic is significant. In addition, these patients often enjoy a bit of residual myopia since it provides a wider range of vision for more routine daily tasks that are primarily indoors. Also with mild myopia, being outside in the bright sunlight gives pupillary constriction which improves the distance vision. This video goes through my full thought process for refractive targeting in highly myopic eyes. My best surgical pearls are revealed here and they will certainly help your patients.
Dear dr Devgan,
Thanks for sharing this pearl for ulta myopia. I wonder if you did surgery on both eyes. I do have a similar case with a myopia S-18,00 with axial length of 29,81 mm. My patient was diagnosed with only cataract on her right eye. During the counseling she had a wish to just only operate on the right eye with a target refraction of S-18,0. So i aimed for S-17,31 with an implantation of an IOL with 25,50 diopter power. After the surgery she was really more than satisfied with the result. She loves her microscopic vision and did not want to get rid of it. In the end a good counseling is crucial for a happy patient and most of the time it is more important what a patient wishes for than our own vision of perfect vision.