September 2026 - 1
Right Pentacam: mild corneal astigmatism, Left Pentacam: severe corneal astigmatism
Author: Dr Alex Hamilton
A 63 year old woman was referred for consideration of cataract surgery. She had been told all her life she had a “lazy” left eye.
At the initial consultation she had:
- Right BCVA: 6/12 (refraction: +1.75)
- Left BCVA: 6/36 (refraction +3.75/-4.75 x 4)
- Bilateral Nuclear Sclerosis 2+ cataracts
What would you recommend?
A - Observe
Oops! Try again
B - Cataract surgery in the right eye
Oops! Try again
C - Cataract surgery in both eyes, with left guarded prognosis
CORRECT!
D - Bilateral cataract surgery expecting normal outcomes
Oops! Try again
Answer C
This case is challenging. The key issue is that the astigmatism is likely to be longstanding in the left eye and it is therefore likely that the left eye is amblyopic. Given it is impossible to know the degree of left amblyopia, it is crucial to explain this to the patient preoperatively to set their expectations.
In this case routine bilateral cataract surgery was performed. In the left eye a very strong toric intraocular lens was placed. At the 4 week post operative vision the unaided vision in the right eye was 6/6 and the left eye was 6/6-2.
This is a great result and shows that, despite presumed severe amblyopia, some patients can do remarkably well. This shows the merits of performing cataract surgery in patients who sometimes have been told there is nothing that can be done!
