Unexplained Accelerated Myopic Shift

[NSanDiegan]

Have always been highly myopic, but for 25 years my mono-vision contact prescription of -7.0 (dominant left) and -6.0 (right) remained constant.  Had cataract surgery on the right eye 6 years ago and it left me at +3.0 which could not be effectively corrected for close vision as previously, so we switched the mono-vision so that my left was now corrected for close.  In the past few years I've gone in twice to have the left re-refracted as it was becoming more myopic.  It is now -14.0 (!) for crummy far vision (we thought reverting to this for the dominant eye might help) and has become more myopic in just a few weeks.  I do have an incipient cataract on this eye but nothing to the extent that would cause such rapid myopic shift.  During this whole period I've seen my ophthalmologist twice yearly for glaucoma checks (pressure totally under control with drops) and had yearly visual field tests (no problems either). He has no idea why my myopia is shifting so rapidly. Another doc in the same practice saw me and is referring me to a retinal specialist for an OCT test, but, given my history, I don't think this will prove to be the culprit.  I've found almost nothing on line that duplicates my experience.  Anyone with any ideas?


This discussion is related to Myopic shift.

[NSanDiegan]

Thanks Dr. Oyakawa,

I'll certainly check re: axial length and corneal curvature since both eyes were measured when I had my surgery six years ago.  As to a piggyback lens, that option was raised a number of times, but every Doc. concurred that it wouldn't be any different than wearing a contact lens to make the same correction--which I've done. (I've worn hard/gas permeable contacts in both eyes for 53 years so it's my "natural" state).  Do you disagree?

I'm beginning to come to the same conclusion as your 30+ years experience has demonstrated--that with an eye as myopic as mine even a small cataract can cause a large/rapid myopic shift.  Because of my bad experience with the refractive error in the first surgery, which has very much limited the visual flexibility (focusing on different points in both the horizontal and vertical plane) in that eye, I'm very wary about surgery on the other eye, especially since increased myopia seems to go hand in hand with refractive IOL errors, but I guess I may have little choice as the cataract progresses.

[Ray T Oyakawa, MD]

You can have a piggy back IOL for your right eye to decrease the hyperopic result.  The main reasons for increase in myopia is first, progression of cataract, second (unlikely) increase in axial length and finally steepening of the cornea also unlikely.

You should have a record of your axial length in this eye from the biometry done when you had your right eye cataract done since most doctors measure both eyes.  Also, the corneal curvature would have been recorded.  I have seen many similar case over the past 30 + years where a highly myopic eye has a very significant myopic shift with a mild nuclear sclerotic cataract.

Dr. O.