High Myopia and Cataract Surgery

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Myopia is highly prevalent in the general population, affecting approximately 25%. It affects a larger proportion of Asians and a smaller proportion of African Americans. High myopia affects about 2% of the population. High myopia refers to a spherical equivalent of -6.00 D or less or an axial length of 26.5 mm or more. Pathologic myopia refers to a spherical equivalent of -8.00 or less or an axial length of 32.5 mm or more.[1]

According the the Beaver Dam Eye Study and the Blue Mountains Eye Study, there is an association between myopia and nuclear cataract. The Blue Mountains Eye Study also found that moderate and high myopia, especially with onset prior to age 20, are associated with posterior subcapsular cataract formation.[2]

Preoperative Evaluation

Patient Expectations

It is important to have a thorough discussion with the highly myopic patient about setting realistic goals and expectations regarding cataract surgery outcomes. If corrected for distance, patients should be advised that they will experience more difficulty with near vision. Some may opt for monovision in order to maintain the ability to see up close.[3] If the patient has undergone prior refractive surgery, it is important to evaluate the prior refractive status and obtain previous records.[2] Furthermore, increased age and axial length have both been associated with a negative effect on best corrected visual acuity. An estimated 62% of myopic eyes have some degree of myopic or age-related retinal degeneration.[4]

Risks and Informed Consent

Two of the most commonly discussed cataract surgery risks for highly myopic patients are increased risk of retinal detachment and variable postoperative refractive error. The cataract surgeon may choose to include an evaluation by a vitreoretinal specialist prior to cataract surgery, but this practice is controversial and not universally adopted.[2] Please see the section entitled Late Complications for a more in depth discussion of these risks.

IOL Calculations

One of the difficulties with preoperative calculations in highly myopic patients is the determination of axial length. As axial length increases, measurements may become less reliable. An estimated 70% of eyes with axial length greater than 33.5 are estimated to have posterior staphylomata, or localiazed ectasia of the sclera, choroid, and retinal pigment epithelium. However, almost all eyes with pathologic myopia are thought to have some degree of posterior staphylomata.[2][5]

IOL Selection

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Perioperative Period

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Intraoperative Complications

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Surgical Technique

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Postoperative Management

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Follow Up

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Late Complications

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Additional Resources

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  1. Basic Clinical and Science Course. Retina and Vitreous. 2013-14. Section 12 pg 85-86.
  2. 2.0 2.1 2.2 2.3 Dodick, JM, Kahn JB. Special Considerations for Cataract Surgery in the Face of Pathologic Myopia. In: Spaide, RF, Ohno-Matsui, K, Yannuzzi, LA, eds. Pathologic Myopia. New York, NY: Springer Science+Business Media; 2014:313-314.
  3. Devgan, U. Cataract Surgery for Patients With Myopia. Ophthalmology Management. http://www.ophthalmologymanagement.com/articleviewer.aspx?articleID=100823. Accessed September 28, 2014.
  4. Zuberbuhler B, Seyedian M, Tuft S. Phacoemulsification in eyes with extreme axial myopia. J Cataract Refract Surg. 2009;35(2):335-40.
  5. Cite error: Invalid <ref> tag; no text was provided for refs named BCSC retina

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