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To the Editor:
—In the July 1953 Archives (page 16) appeared an article by Dr. Alfred Cowan entitled "Monocular Aphakia." Dr. Cowan is an authority on optics, and his opinions carry great weight. My knowledge of optics is limited, but I have had considerable experience with aphakic patients. I believe a little of the other side of the picture should be presented. Dr. Cowan does not mention in his article what occurs to an eye in which the cataract is allowed to go to hypermaturity. The eye will almost always become exotropic, and this starts as convergence insufficiency, long before the cataract matures. If the eye is allowed to diverge, it will never come back into line, so that if eventually both eyes are operated on the patient will either alternate or suppress. The other unpleasant complication that occurs in eyes with hypermature cataract is secondary glaucoma, due to toxic
Goar EL. MONOCULAR APHAKIA. AMA Arch Ophthalmol. 1953;50(6):779. doi:10.1001/archopht.1953.00920030790013