Clinical Scorecard: IOL exchange associated with improvement in postcataract dizziness in one case

At a Glance

Key Highlights

• A 79-year-old woman developed blurred vision, dizziness, and a floating sensation after bilateral cataract surgery targeted for distance vision.
• Ophthalmic examination, brain MRI, and neurologic evaluation did not identify an explanation; vestibular testing supported left-sided dysfunction with strong visual dependence.
• A contact lens trial approximating her habitual myopic refraction was followed within 1 week by reported symptom improvement.
• After bilateral IOL exchange targeting myopia, symptoms and objective balance measures improved, with no recurrence reported through 26 months.
• The single-patient report cannot establish causality or determine effectiveness in a broader population.

Guideline-Based Recommendations

Diagnosis

• The authors suggest considering vestibular dysfunction with strong visual dependence when persistent dizziness or visual discomfort after otherwise successful cataract surgery is unexplained by ophthalmic findings.
• In this case, stabilometry and vestibular testing, including vestibular-evoked myogenic potentials and video head impulse testing, supported the assessment.

Management

• The case used bilateral +3.5 D daily disposable contact lenses to approximate habitual refraction before treatment options were considered.
• Options discussed included continued contact lens use, laser-assisted in situ keratomileusis, an add-on IOL, and IOL exchange; the patient elected bilateral IOL exchange.
• This single case does not establish IOL exchange as effective beyond the reported patient.

Monitoring & Follow-up

• The case assessed symptoms, visual acuity, stabilometry, and vestibular test findings after refractive correction and IOL exchange.
• Symptoms remained absent through 26 months of follow-up in the reported patient.

Risks

• A single case cannot establish a causal relationship between refractive change and vestibular symptoms.
• The authors noted limited generalizability of the stabilometry findings and lack of outcomes beyond 26 months.

Patient & Prescribing Data

One 79-year-old woman with preoperative myopia of approximately −2.0 D and persistent symptoms after bilateral distance-targeted monofocal IOL implantation.

A bilateral +3.5 D contact lens trial was followed by symptom improvement. Bilateral IOL exchange targeted spherical equivalents of approximately −2.61 D in the right eye and −2.05 D in the left; the patient reported relief and resumed daily activities without corrective lenses.

Clinical Best Practices

• When persistent postcataract dizziness or visual discomfort is unexplained by ophthalmic findings, the authors suggest considering vestibular dysfunction with strong visual dependence.
• In this case, a contact lens trial approximating habitual refraction preceded the decision to pursue IOL exchange.
• Interpret the reported symptom and balance improvements cautiously because evidence is limited to one patient.

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