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E W NEWS & OPINION 30 tism. But when that is corrected, she is symptomatic from her strabismus because she is now emmetropic in that eye, combined with the fact her vision is improved after the removal of the cataract." "So, what to do now? Obvi- ously, glasses with prism is the easiest, but that leaves her in glasses, which she had avoided for 30 years and now with implantation of expensive MF lenses, she probably would be very disappointed with that. Another option would be to induce monovision in her left eye by making that eye more myopic. Back in the days of the original +4 add ReSTOR, there were reports of suc- cessful use of mono or blended vi- sion in the nondominant eye, giving the patient better intermediate vision and seriously increasing the effective near add. She could try this in contacts to see if it works and if she likes it, then perform laser vision correction to correct her cylinder as well as her diplopia (assuming she liked it)." "Of course, you could have her see a muscle specialist to see if the diplopia can be resolved with surgery. I would probably try this first. Whenever I see someone with strabismus before cataract surgery who is interested in refractive cataract surgery, I always have t hem evaluated before cataract/ IOL to see if their diplopia can be resolved surgically." "If she did not like the monovi- sion contact lens trial with the ReSTOR, and muscle surgery is not an option, and she refuses glasses, t hen you could do a lens exchange with either a toric or Trulign (Bausch + Lomb, Rochester, N.Y.) leaving her with blended vision." I agree with Drs. Kim and Horn fundamentally here, however, I don't believe it's likely that the patient had a fourth nerve paresis given her ability to fuse on down g aze. More likely, due to years of wearing monovision in her contact lenses she had a phoria decompen- sate into a tropia. Since she had a multifocal contact in the OD, how- ever, this eye was potentially able to fuse for reading with the OS (which was set up for near vision when she had monovision in her CLs), and March 2014 Double continued from page 28 T he corneal topography OD and OS Source (all): Steven G. Safran, MD continued on page 34 18-47 News_EW March 2014-DL2 copy_Layout 1 3/6/14 2:46 PM Page 30