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The pleasure of correcting hyperopia
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 Hyperopic cataract patient |
Cataract surgery is a pleasure because it restores vision to our patients and is technically an enjoyable procedure for the surgeon. When high degrees of hyperopia are corrected at the same time, it becomes almost magical.
This patient has suffered from cataracts for years, achieving just 20/100 vision with his current prescription of +6.5 D for distance correction. Because his eyes are otherwise normal, cataract surgery will not only restore clarity to his vision, but it will correct his high degree of hyperopia. And these patients are the ones who are the most appreciative because they go from using strong glasses for all activities, all day long, to using glasses just occasionally, such as for reading.
There are, of course, additional surgical challenges when performing cataract surgery on highly hyperopic patients. The IOL calculations can be less accurate because a slight change in axial length or effective lens position can markedly alter the postop refraction; there is less room in which to operate while performing cataract surgery; the shallower anterior chamber can make the capsulorrhexis more difficult and result in more corneal endothelial cell loss; and there's a higher risk for rare complications such as choroidal hemorrhage. For the IOL calculations, I recommend using the Holladay 2 method and the Hoffer Q equation because I find them to be more accurate in these short eyes.
But these additional challenges are a small hurdle to overcome when we consider the postoperative possibilities: clear vision, correction of the hyperopia and the best vision of the patient's life.