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.
