1674: IOL choice in a teenager

This young patient presents with dense posterior subcapsular (PSC) cataracts in both eyes which is severely limiting the vision. The only way to restore the vision is to perform cataract surgery but which IOL will you choose in this case? The young human lens has a large accommodative amplitude of about 10 diopters but any FDA-approved IOL that we can implant has essentially no accommodation. Would you choose a monofocal IOL aimed at emmetropia in both eyes (plano in both eyes) with the patient then forced to use reading glasses for all computer, reading, and cell phone use? Or perhaps you would do some monovision but then what about the decreased depth perception when this young patient plays sports? Or would you do an EDOF or trifocal IOL design? One thing that we often forget is that young patients have much better retinal sensitivity and function than 50, 60, or 70 year old patients. Does that play a role in your IOL selection? Leave a comment below and let me know your choice of IOL (before watching the video to see what I did).

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  1. I think that a monofocal IOL aiming for emetropia in the dominant eye and an EDOF in the non dominant eye, will be a good choice for this young patient, what do you think?

  2. Symphony set for emmetropia in dominant. If near better than expected same in non dominant. If near still a little lacking -.75 in non dominant.

  3. I think that the patient will lost a lot of far vision if you will implant an EDOF with mini monovision ( i mean EDOF with .,75 in non dominant eye), no ?

  4. If it’s unilateral cataract then would prefer monofocal iol, if it’s bilateral cataract then trifocal panoptic

    1. i agree here. If the other lens is still perfect, a monofocal does a very good job in the cataract eye. They will quickly adapt and use the other eye for reading, without issues

  5. Did you find a reason for such dense bilateral post.subcapsular cataract in such a young age?

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