Time for a CataractQuiz and this case requires more thinking and there is no one perfect answer. This patient is about 50 years old and desires unilateral cataract surgery in this right eye. The right eye has a 20/200 cataract while the left eye corrects to 20/25+ with a myopic refraction. The pic below gives the full details of the situation. The patient desires to retain the ability to wear spectacles/glasses for correction so we need to be concerned with anisometropia and aniseikonia.
The patient is also a surgeon with a working distance for performing surgery of about 50 cm (19 inches). What would you recommend for a refractive target in this eye for cataract surgery? Comment below BEFORE you watch the video.
Sweet spot should be -2.00 OD for current and future vocational needs.
Contact lens/lenses prn for anisometropia/konia, but likely not needed.
Target -2 sphere with a toric IOL
-2.00 aim in the eye undergoing cataract surgery. They will likely head towards 2nd eye phaco in the short to medium term anyway (trace PSCC already). At the time, can make a decision re how much aniso he was managing to tolerate, to guide mini-mono versus mono vision (-2 vs -1 vs -0.5D for 2nd eye).
-2.00. -2.00 has a focal length of 50 cm which would be ideal for his working range while still be tolerable enough for the anisometropia.
Aim for -2.00 to avoid significant anisometropia
Will use a monofocal IOL with intermediate depth of focus eg PHYSIOL Isopure IOL aiming for -0.80 myopia
-2.00 would be the right working distance and not too much aniso
I’d like to know which is his dominant eye please?
I’d like to know which is his dominant eye please?
Edof iol with -0.25 target
Monofocal lens target -2.00
Wunderschönen guten Tag Professor. Minus 2 is always gut point for Presbiopic-Myopic Patients …
I had similar case for a three weeks. Also surgeon Dermatologist Kollege. Both eyes are Hyperopic ( +3,0; -0,5). But he wished to drive the car without glasses…
So I choose FRFIOL ( Przision Presbiop Ophtec) . At first left then right eye. He was very happy. So in 2 weeks right eye was made.
Do you have experience with Ophtec IOLs ?
By the way, what program do you use for edit your Op-Videos? I
Your opinion is very important for me. Thank you so much for your teaching impact!
I think it’s more important hier in Europe (Germany). Cours, you know, no one really want to teach to do surgery hier.
Thank you a lot!
The patient is myopic in the fellow eye with some cataract, so will ultimately need surgery for that eye. Putting the right eye around -2.00 prevents aniseikonic issues and leaves the way open for either monovision (distance correction) or planned mild myopia for the second eye. I’d probably use an Eyhance toric for this eye to soften the sweet spot if it’s going to be a monovision eye.