e‑Delphi sets myopic cataract consensus
- An international panel organized by AAPPO and APMS published a two-round e-Delphi consensus on highly myopic cataracts, treating them as a distinct surgical problem. (sciencedirect.com) - The panel included 30 experts from 14 countries and used a 75% agreement threshold, backing combined IOL formulas, hydrophobic acrylic lenses, and 3-month retinal follow-up. (sciencedirect.com) - It matters because these eyes get cataracts 10 to 20 years earlier and carry higher refractive and retinal risk than routine cases. (visualize.jove.com)
Cataract surgery is usually one of the most standardized operations in medicine. Highly myopic eyes are the exception. These are long eyes, often structurally stretched, and the(sciencedirect.com)a new international consensus matters — not because it invents a new operation, but because it tries to turn a messy, high-variance problem into a shared playbook. A two-round m(sciencedirect.com)e Asia-Pacific Myopia Society just did that. (sciencedirect.com)(visualize.jove.com)urgeon even starts. That changes the goal from “remove cataract, hit target refraction” to “remove cataract without triggering a refractive miss or missing retinal disease that will cap vision anyway.” (visualize.jove.com) ### Why was a consensus needed? Because the literature has been broad, but the workflow has be(sciencedirect.com)lder IOL calculations in long eyes often pushed patients hyperopic after surgery, and even newer formulas do not erase the underlying anatomic variability. A consensus helps by saying which precautions are no longer optional. (pubmed.ncbi.nlm.nih.gov) ### What did the panel actually do? The group ran a two-round modified e-Delphi process with 30 cataract experts from 14 countries and territories. They defined consensus as at least 75% agreement(visualize.jove.com) is stronger than it is. (sciencedirect.com) ### What were the big takeaways? The most important move was conceptual: the panel endorsed highly myopic cataract as a separate disease category, not just ordinary cataract in a nearsighted patient. The group also backed combined IOL formula calculations rather than overreliance on a single fo(pubmed.ncbi.nlm.nih.gov)tinal review at 3 months after surgery. Those are practical decisions — measurement, lens choice, and retina surveillance. (visualize.jove.com) ### Why is biometry such a headache here? Because long eyes fool measurement systems in ways that (sciencedirect.com)fractive surprise. In a routine eye, one formula and one clean axial length reading may be enough. In a highly myopic eye, posterior staphyloma, fixation issues, and extreme axial length can distort the estimate, so averaging or cross-checking formulas becomes less belt-and-suspenders and more basic safety. (pubmed.ncbi.nlm.nih.gov) ### Why does the retina get so much attention? Because the cataract may not be the main thing limiting vision(visualize.jove.com)d on preop retinal assessment and postoperative surveillance. (doaj.org) ### Does this change resident-level practice? Basically, yes. The checklist gets stricter. Long axial length is no longer just a note in the chart — it triggers a different preop workup, more caution in formula selection, and a lower threshold for retina input. Programs that already teach this will feel validated. Programs that do not now have a consensus document pushing them there. (visualize.jove.com) ### What is the real bottom line? The news is not that surgeons discovered high myopes are risky. Everyone knew that. The news is that an international panel has now drawn a clearer line around what “careful” should me(doaj.org) they can fool you, and never assume the lens is the whole story. (visualize.jove.com)
