Why long eyes are different
Nearsightedness of this degree is usually axial: the eye is longer front to back, so light focuses in front of the retina. A long eye has a larger, deeper interior, a thinner and more stretched retina, and a higher chance of retinal tears and detachment throughout life. Cataracts, particularly nuclear cataracts, develop earlier, often in the fifties. Each of these facts affects the surgical plan.
The lens calculation
Standard formulas were developed for average length eyes and tend to leave very long eyes farsighted after surgery. Modern formulas and adjustments designed for long eyes correct that, and optical biometry measures the length accurately. Very long eyes need low-power or even negative-power implants, which are stocked less commonly and are ordered in advance. Patients who have worn strong glasses all their lives are often surprised that the goal can be distance vision without them.
Protecting the retina
A dilated retinal examination before surgery identifies thin areas or tears; these can be treated beforehand by a retina specialist, which we arrange. Retinal detachment is somewhat more likely after cataract surgery in high myopes than in other eyes, so you will be told the warning signs (new floaters, flashes or a curtain in the vision) and asked to report them the same day, for months afterward. Optical coherence tomography of the macula checks for the changes of myopic degeneration that can limit the visual result.
During surgery
The deep chamber of a long eye can fluctuate during surgery, and the surgeon adjusts fluid settings and technique to keep it stable. The lens capsule can be more fragile. The surgeon adjusts technique for these eyes, and any added risk is discussed beforehand.
Choosing a lens
Because the macula may be affected by myopia, the evaluation checks it carefully before recommending a multifocal or extended depth of focus lens, which need a healthy macula to perform. Many high myopes choose a monofocal lens for distance with reading glasses, or blended vision. Toric versions correct astigmatism. Patients who prefer to keep some near vision, having read comfortably without glasses their whole lives, can be set for that instead, and this preference is worth discussing at the evaluation.
Is this right for your eyes?
Nothing on this page is a diagnosis. Whether this is what is affecting your vision is decided by a full examination at one of our 4 offices: Pasadena, Huntington Beach, Woodland Hills and Beverly Hills.
About this content: This page was written with the assistance of AI tools and reviewed for medical accuracy by Dr. Bavand Youssefzadeh, DO. It is general information, not medical advice, and does not replace an eye examination. Individual results vary. Read our medical disclaimer.
