How to approach a complex cataract case

When teaching my ophthalmology residents, I find that going through an entire case from initial consultation to postoperative care is a great way for them to learn how to approach a complex cataract case. This method requires them to put together a wide range of skills including detecting subtleties on the slit lamp microscope exam, determining lens power calculations, handling intraoperative challenges and managing the postoperative course.The patient in this case is a relatively young man of 45 years who has a lifelong history of high myopia, retinal detachments and poor vision. He had bilateral scleral buckles performed in another country decades ago with a good result in the right eye but with the development of phthisis bulbi in the left eye. He is therefore monocular and relies on his right eye for all of his daily tasks, which include computer work during the day and playing in a music group in the evenings. He used larger fonts on his computer previously but now notices that in the past year or so this is insufficient, and he is unable to function because his best corrected vision is now 20/200.