Myopia After Cataract & Lens Implant Operation

Question: I am 66 years old, a fit sailor and had cataract surgery on my left eye 4 weeks ago with a multifocal lens implant. My distance vision is not good and my cataract surgeon says I now have myopia-I didn't before! She doesn't know how it happened but still wants me to go ahead with the second eye, using a monofocal lens implant instead of the multifocal as she said it could happen again! This wasn't what I signed up for. As a keen motor-boater, I wanted clear near and distance sight-very important to me. I had laser eye surgery several years ago and the cataract surgeon knew this. She now thinks the changes to the cornea from the laser eye surgery are to blame for the myopia. I don't-not when she tested me prior to the cataract operation. What can I do now?

Answer: Patients who have had previous Laser Eye Surgery such as LASIK, and now have a Cataract and are contemplating Cataract Surgery need to understand that previous corneal surgery of any type can often make the precision and accuracy of the measurements and calculations for Lens Implants for Cataract Surgery considerably more unpredictable. In order to minimize the likelihood of a "refractive surprise" after Cataract Surgery, it is important for patients to provide the Cataract Surgeon with as complete a set of records as possible from prior to their Laser Eye Surgery, including if possible, a full set of measurements taken as part of the preoperative evaluation, such as corneal curvature measurement, corneal thickness measurements, manifest and cycloplegic refractions and corneal topography data.

With these measurements, along with more sophisticated imaging and measurement instrumentation at the Cataract preoperative evaluation, it is usually possible to mitigate the risk of a "refractive surprise" to a great extent for most-but not all patients. In your case, the measurement errors are further compounded by the need for exquisite precision as you have elected a Multifocal Lens Implant which require absolute accuracy in order to have it perform properly. Now, you have a couple of options to deal with the myopia at this time.

First, you can do nothing and depending on the degree of myopia, you might very well achieve a state of monovision correction after having the Monofocal Lens Implant in the right eye, allowing you to function as you described above.

Second, you can simply wear glasses.

Third, it may be possible to correct the residual myopia with a Laser Eye Surgery procedure like you had before.

Fourth, you could have a Lens Exchange whereby your Cataract Surgeon removes and replaces the Multifocal Lens Implant with the appropriate power to achieve the best distance correction, now that she knows what that actually is. Which of these choices is best, really depends on the degree of myopia, the overall health of the cornea and your eyes in general as well as the risk/benefit analysis of a second surgery on the left eye. Now-if you are at all uncomfortable with the advice and recommendations being provided by your Cataract Surgeon it is NEVER inappropriate to get a second opinion. If you do elect to get a second opinion you should consider someone who is both a Cataract Surgeon as well as a LASIK or Refractive Surgeon and perhaps even a Corneal Specialist, who is accustomed to dealing with both complex refractive and eye surgery measurements and situations.

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