Monovision in a case of bilateral high hyperopia by refractive lens exchange with customised foldable IOL

Abstract

This case report describes about the feasibility of monovision in a case of bilateral high hyperopia for achieving spectacle independence following refractive lens exchange (RLE) A 19-year male presented with diminution of vision (DOV) since 15 years oculus uterque (OU). On examination, unaided distance visual acuity (UDVA) was 20/1000 in OU and corrected distance visual acuity (CDVA) was 20/125, N18 with a refraction of +12.25DS/+1.25DC (DS: Dioptre sphere, DC: Dioptre cylinder) @140 degrees in oculus dexter (OD) and +12.75DS/+1.50DC @25 degrees in oculus sinister (OS). Primary diagnosis was high hyperopia. Refractive lens exchange with a monofocal intraocular lens (IOL) and monovision by targeting dominant OS to emmetropia and non-dominant OD to myopia of -2.00D was planned for the patient. The IOL power was calculated by multiple formulae and we decided to implant +46.0D in OD and +47.0D in OS calculated using personalized A-constant. At post-op day 15, no complications were noted, UDVA in OD was 20/250 and in OS was 20/200 and CDVA was 20/125 OU, uncorrected near visual acuity (UNVA) was N18 OU with a refraction of -2.00DS/-2.50DC @95 degrees in OD and +0.25DS/ -1.75DC @125 degrees in OS (Monovision) which was stable even at 6 months follow up RLE in high hyperopia requires meticulous planning and biometry to give good results. Monovision can be planned in such a case to deliver spectacle independence. It can thus be a valuable tool in the armament of refractive surgeon.