Objective:

To assess whether restoring habitual myopia could relieve persistent dizziness and visual discomfort after cataract surgery in a patient with strong visual dependence.

Approach:

• Case and evaluation: A 79-year-old woman developed blurred vision, dizziness, and a floating sensation after bilateral cataract surgery targeted for distance vision. Eye examination, brain MRI, and neurologic evaluation did not explain her symptoms; balance and vestibular tests su…
• Refractive intervention: A trial of +3.5 D contact lenses in both eyes approximated her habitual myopic state and improved symptoms within one week. She then chose bilateral IOL exchange, targeting approximately −2.61 D in the right eye and −2.05 D in the left.
• Follow-up: Symptoms, visual acuity, balance measures, and vestibular findings were assessed after exchange, with follow-up through 26 months.

Key Findings:

• After IOL exchange, the patient reported immediate relief from blurred vision and the floating sensation and resumed daily activities without corrective lenses.
• At 10 months, several stabilometry measures improved, neural-network-estimated probability of abnormality fell from 100% to 22%, and vestibular-evoked myogenic potential findings improved.
• Vision remained stable without symptom recurrence through 26 months.

Interpretation:

The authors proposed that the abrupt shift from longstanding myopia to near emmetropia may have disrupted visual-vestibular compensation. In this case, restoring habitual refraction was associated with symptom relief and improved balance measures.

Limitations:

• This was a single-patient report, so a causal relationship between refractive change and vestibular symptoms cannot be established.
• The authors noted limited generalizability of the stabilometry findings and no outcomes beyond 26 months.

Conclusion:

The authors stated that vestibular dysfunction with strong visual dependence may warrant consideration when persistent dizziness or visual discomfort follows otherwise successful cataract surgery without an explanatory ophthalmic abnormality. Larger studies are needed to assess whether restoring habitual refraction is effective in a broader population.

Sources:

• American Journal of Ophthalmology Case Reports (source named in provided context)