13. Prescribing for patient with cataract and myopic shift

After examining her eyes you find that your patient's cataracts are getting worse. But she is happy with her current prescription. What do you prescribe?

Scenario

Jennifer Roberts, aged 84, comes to you for a routine eye examination. She rarely goes out and is not having any problems with her vision. She is retired and does not drive.

You previously saw her 14 months ago when you told her she had some cataract in both eyes, but it was not bad enough to refer her at that stage. She has no remarkable history, although she did have a fall a few months ago which resulted in her bruising her arm as she tried to save herself. She is in good health, although she has early Parkinson’s disease. Jennifer tried bifocals many years ago but never got on with them. She reads a lot but lost her reading specs some time ago, but feels that her current (distance) specs seem to be OK for everything. 

Previous findings were:
R -2.75/-1.00 x 75 VA 6/7.5- L -3.25/-1.25 x 100 VA 6/9
Reading add +2.50 

Today you find:
VA with previous: R 6/18- L 6/24- 
Refraction: R -4.00/-1.25 x 75 VA 6/9+ L -5.25/-1.25 x 100 VA 6/9 Reading add +2.75 gives N5 binocularly. 

Ocular media show nuclear sclerosis cataract in both eyes. CDRs are R 0.45 and L 0.5 with healthy rims. IOPs are R 17 and L 16mmHg by NCT and central visual field testing is full. Jennifer is orthophoric for distance, and you estimate she has 10D of exophoria for near. There is no slip on the Mallett unit for distance or near. Her maculae look normal, and Amsler chart shows no distortion in either eye. 

You tell Jennifer that her cataracts have got a little worse and have caused her to go more short sighted. She is not keen on having cataract surgery at the moment as she is happy with her vision. 

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