Of the overall cataract surgery volume, perhaps less than 1% of those patients are truly monocular and maybe less than 5% are relatively monocular (where the bad eye has at least some functional vision). Relatively monocular cases are those where one eye may have suffered from wet macular degeneration and lose macular function or something similar while truly monocular cases are usually from trauma or sudden severe disease. This patient suffered from acute angle closure glaucoma and was unable to see treatment for an extended period of time. By the time the ophthalmologist examined the eye, the optic nerve was pale and atrophied with a resultant vision of just light perception. This leaves the patient just the one good eye.
The dilemma for these truly monocular patients is: when do you take the tiny (but real) risk of cataract surgery on your only seeing eye? Waiting until the cataract is very dense means more years of suffering with poor vision and also a higher risk of intra-operative complications. These patients are often far more nervous or anxious than other patients and we need to understand where they are coming from. For your perspective as the surgeon, what should you do differently? What IOL options are best? Any special precautions? This video gives you all of my best pearls.
