What happened to the myopia?

ByUday Devgan, MD

I walked in the exam room to see my next patient. She was young, mid-30s, and she had a face that I recognized — as I recalled, she had a history of high myopia when I last saw her a couple of years ago. I started to examine the patient while the staff was preparing her chart.

Slit lamp appearance of a phakic IOL in the posterior chamber.

Her vision was sharp, so I figured that I may have done her LASIK. On slit lamp exam, everything looked quiet and the cornea looked fine. I couldn't see the edge of the LASIK flap. Perhaps I had done PRK instead. Hmm. Then, as I peered through her pupil, I saw the slim profile of her phakic IOL. It was nicely vaulted above her crystalline lens, and it had a trace amount of iris pigment dusting, which is commonly seen in these lenses. Hidden at the far periphery of her superior iris were two tiny peripheral iridotomies.

I learned two valuable lessons. One, phakic IOLs can be very well tolerated and successful in the long term, and two, wait until the staff brings you the chart so that you know the patient's history.