Welcome to Question of the Day #389

EyeTools Question of the Day #389

I see a lot of patients with cataract. Sometimes, it takes me a long time to get a subjective refraction result and even then I’m not sure if I have got the optimum result. What can I do?

I see a lot of patients with cataract. Sometimes, it takes me a long time to get a subjective refraction result and even then I’m not sure if I have got the optimum result. What can I do? The presence of cataract causes the patient to have blurred, misty and poor contrast vision. When asking them to compare lenses ‘Is it clearer with 1 or 2?’

it can be very difficult for them to be able to see any difference in vision between the two lenses you have presented. They are comparing one blurred and misty image with another blurred misty image and any difference between the two can be very difficult to spot. Hence the patient finds it very difficult to help you get to an optimum end point. The first thing to do is to realise that it is the cataract which is making it difficult for the patient to notice a difference and making it difficult for them to make a choice between the lens options. Patients want to give clear answers but sometimes they can’t. The second thing to do is to use lenses with a larger difference between them. So, asking the patient to compare between + and -0.50 rather than + and -0.25 both with the spherical and cylinder choices. The bigger switch between lens power and the subsequent bigger difference in the appearance of the images may help. If, with the larger lens bracketing the patient can give a meaningful choice, you may then want to manipulate the final lens choice using your clinical experience.

For example, if they accept a +0.50 sphere you may want to take into account other clinical information and only add +0.25. You also may want to take into account the current prescription and what the visual acuities are with that prescription. If the visual acuity is reasonable with the current glasses it is likely that the new prescription may be similar to the current prescription. Take your time and be patient.

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