SV vs PAL in a unilateral aphakic patient younger than 40

[afsana]

Has anyone prescribed to this type of patient and had issues?

Ideally needs a SV in one eye and a progressive on aphakic eye. She is 36.

[drk]

Two PALs.

[Tallboy]

Two PALs.

Would you use alternate adds? Maybe a much longer corridor in the emmatropic eye, shorter one in the aphakic?

[luka]

We would probably need more info to help you out. For example, is she newly aphakic? If not then see what she's currently wearing - why mess with a good thing (if it's working for her!). Otherwise you'd want to consider reducing the iseikonia as much as possible. Do you need PALs, over a bifocal?

[drk]

I think the poster meant "pseudophakic". If the patient is truly "aphakic" then we need a contact lens.

[AndyOptom]

Agreed with drk on this one.

The anisometropia of a truly monocular aphakic patient would probably be best managed using contact lenses.

For a monocular pseudophakic (with the IOL presumably correcting fully for distance clarity), also concurring with drk that bilateral PAL is the best approach.

And yes, equal addition for both eyes, following the addition required on the operated eye. The unoperated eye can relax whatever accommodation remains to live with the ordered add, the pseudophakic eye can't accommodate at all.

Just be careful if you're ordering PAL like the Rodenstock Impression, Shamir Autograph Intelligence, or other such supposedly biometric calibrated lenses. Those probably assume an ordered Rx of almost Plano and a higher addition (as with most normal post-op pseudophakic eyes corrected for distance) also has a smaller pupil, so the so called compensations may give you whacky results. And that's even before we consider how such designs try to balance the lens calculations with respect to the binocular Rx, down to the level of stuff like prism thinning. In the case of post-op eyes with Rx which are at odds with expected anatomical features, I have found that 'dumber' PAL tend to work better.

[drk]

Nice.