35yo psc Cataract in one eye with high Rx both eyes, possible lens and target vision - near/int/far?

My glasses RX

OD (this has cataract): SP (-7.75) Cylinder (-0.75) Axis 160

OS (left eye, no cataract): SP (-7.25) Cylinder (-0.75) Axis 020

Visual acuity

OD - Dist (20/40) +3 ; Near 20/20

OS - Dist (20/20); Near 20/20

Does -0.75 on cylinder would mean I would need Toric lens?

Does -0.75 on cylinder would mean I would need Toric lens?

I would not want 0.75 cyl if I could be rid of it. But you don't yet know if that is from the cornea (stays) or the to-be-removed lens. But yes, on balance, many think that 0.75 cyl is not worth the extra cost, plus the doctor has to get the axis right during install. In fact, for many/most toric lenses, 0.75 is the least cyl they come in.

I did not know about whether the 0.75 is coming from lens or cornea. Is it something my optometrist would know or would it be the surgeon?

Also my optometrist for contacts prescription has "DS" for cylinder in the right eye. I am not sure what does it mean and why it is different for contact prescription vs glasses.

The surgeon/ophthalmologist would only know after special measurements. So the question would be what astigmatism (cyl) would be expected to remain after the lens was replaced with an IOL.

I don't know what the statistics would be, but I expect that the majority of the sph is from the cornea and eye shape. Those stay with you.

Thanks for very detailed inputs.

"Since you are younger you will likely have a large pupil and will benefit from an IOL where the optical area goes right out to the edge. This is the case with the Clareon, but I think there is kind of a ridge around the outside of the Eyhance lens."

I would think wearing glasses is going to be there since my other eye is -7.75. What I am worried about it constantly changing glasses. So I am not sure what would be a better target for correction. I have an appointment with surgeon coming monday and I would check with him what would be the right target and lens options. What other questions do you generally ask?

"But since you have a cataract in one eye, another is likely to develop soon in the clear eye. Even if it does not, you may want to consider cataract surgery on both eyes."

I am a kind of person more worried about surgery in general and do not want to get the lens removed on left if there is not a necessity. Also I previously has a retinal hole on left eye and was fixed with a laser freeze. So I am cautious and not change anything if it is not a must.

"So, you should ask how much residual astigmatism you will have. Normally less than 0.75 D cylinder does not warrant a toric lens."

By residual you mean something that won't be corrected by lens?

By residual you mean something that won't be corrected by lens?

He means what would be expected to remain after non-toric IOL was implanted.

Check Messages.

I think it is best to have a plan for both eyes, even if you don't plan surgery on the second eye for some time. You may find wearing a contact for correction is not that bad. I went 18 months between my first eye and the second. I used a contact for my non operated eye, to bring my eyes into a mini-monovision configuration, and did not wear glasses. First eye was corrected to distance and I used the contact to correct the non operated eye to -1.50 D. It worked fine.

.

There is a big difference between contacts. The soft contacts are the easiest to use and come in two basic types. There is the older hydrogel contacts which are thinner, more flexible, cheaper, and tend to dry out during the day. I found them impossible to handle. Then there is the newer silicone hydrogel material. They are a little less flexible which makes them much easier to handle. But they are highly oxygen permeable, and retain moisture better. I found them to be more comfortable and useable for 14-15 hours a day. I would suggest trying the CooperVision MyDay daily disposable contacts. Costco sells this one under their Kirkland brand name. Other good ones would be the Alcon Total 1, J&J Acuvue Oasys 1 day, and Alcon Precision 1. In Canada at least Costco is a good place to get contacts. They are quite liberal with free samples. Trying them is the best way to determine what works for you.

.

Be aware that if you have had retina problems that combined with a younger age, and higher myopia the risk of a retina detachment from the cataract surgery is elevated. Not much you can do about it, but you should have a plan in place in case the symptoms occur. It needs to be treated on an emergency basis. You should ask the surgeon about the risk.

.

By residual astigmatism, I mean the amount that is in your cornea and not removed along with the natural lens. You will only know that after the detailed IOLMaster and Pentacam measurements are taken. Astigmatism should not be over corrected. It varies some but the typical minimum amount of cylinder correction in an IOL is 1.50 D at the lens plane. At the cornea plane where astigmatism cylinder is normally referenced that is about 1.0 D. That means if you only have 0.50 D cylinder the minimum toric would be over correcting and is not suitable. The older AcrySof IQ lenses are available with 1.0 D cylinder (about 0.75 D at the cornea plane), but I am not sure that is available in the Clareon yet. And the minimum cylinder with the enVista is 1.25 D (0.94 at cornea).

Thanks for sharing your experience. Very encouraging to know that it PSC may or maynot progress fast.

Dist visual accuity is 20/40 in cataract eye and near VA is 20/20.

In non-cataract eye, it is 20/20 for distance and near.

"Bear in mind that single vision glasses will have to come on/off as you switch distances."

I was thinking more like I put the glasses and it is done. This would be a real annoyance and not sure how to pick glasses since my other eye would be -7.75 and this depend on near/far/int target.

I have an appointment coming monday and what would be the right questions to surgeon if I want to decide on getting it or delaying the surgery.

My optometrist mentioned he could get me 20/40 with a changed prescription if I am not ready for surgery.

In Canada I believe once you cannot correct better than 20/40 you become eligible for a healthcare covered cataract surgery. On a practical basis however, if this requires changing your eyeglass prescription every few months to maintain vision, it does start to become a pain.

.

On astigmatism the amount in your lens can be additive to what is in the cornea, or in some cases the amount in the cornea is offset by what is in the lens. After surgery only the cornea astigmatism remains. In some cases it may even go up. With my eyes I ended up with about half the amount of astigmatism after surgery, but that does not happen in all cases. When they measure with the IOLMaster and Pentacam they will get a reading on the astigmatism in the cornea and that is what you can expect after surgery without a toric lens. You will have to ask them for what it will be. In fact it is a good idea to ask for a printout of the IOL Calculation sheet. That will have all your detailed eye measurements on it, and what is expected with the various powers available to correct it. It is a valuable record to keep. 5-6 weeks after surgery when you get a refraction you will be able to compare where you really end up in comparison to what was predicted. It is kind of like a report card on the surgeon! It is also valuable in determining what formula should be used for the second eye for the best accuracy. Unfortunately we can pick targets for where we want the eye to end up, but even with the best formulas and measurements about 90% are within plus or minus 0.5 D of the target. Accuracy can be improved on the second eye, using the results from the first eye.

Thanks for insights. Is there anything I could do to help delay or avoid PCO?

With high myopia this seems like it could complicate or create retinal issues if I have to get YAG for PCO. I will check with Surgeon about pupil size and if it really doesn't help to go with eyehance I would prefer something which has lesser chances to develop PCO.

I am avoiding multifocal mainly to limit complications it may cause later for retinal issues.

If you are 20/40 in the cataract eye and 20/20 in the other (with glasses) I personally wouldn't even consider surgery right now. Technology keeps improving and with your current vision it doesn't seem like you should be significantly impaired in any way. And at 35 your eyes still have very good accommodation (ability to focus) which you will dearly miss after surgery. If you are happy enough and can do everything you need to do, what's the rush? I would wait.

this is very good advice.

there are theories but at your age you cant avoid it. it is what it is. have a retina doctor after yag and get annual check ups.

After going through all the possible complications I am now more inclined to not touch my eyes until I am impaired or until it would complicate the surgery later. Thank you very much.

Currently only right eye night vision is blurry. Only left eye is sharp and both eyes is in between. Same when watching TV with subtitles or something.

Daytime I dont see much impact or blurry vision with both eyes, it pretty much is like just seeing through the left.

I guess my next discussion with surgeon is to ask the following.

1. What stage is my right eye cataract, since it is 20/40 I am guessing it is early stage and waiting until it gets bad is would not complicate surgery later.
2. Get an update regarding what my optometrist can think of and if he can provide a better glasses for more clarity.
3. Postpone the surgery and get regular checkup and meanwhile try contact lenses to figure out if I tolerate mini-monovision or other options.

By postponing surgery, i see the benefit of not dealing with presbyopia, high chances of PCO and related issues. Also if my other eye develops, then I don't have this high low Rx issue and can just either go with mono-vision or have just distance and use pair of glasses for near vision.

I hope my PSC doesn't progress fast and hopefully gives me time to be in a better/more normal position.

I think you have a reasonable plan. It would be important to do the contact lens trial of mini-monovision before your cataract eye vision becomes to impaired to do a proper evaluation. You need vision in both eyes to see what it will be like.

.

Getting your eyes measured now is a good idea as it can be more difficult when the cataract becomes more dense. With a good surgeon they should consider these measurements at the time when you decide to go ahead with surgery. The lens refraction tends to change as the cataract develops, but the cornea measurements should remain stable as well as the overall axial length of the eye. You should ask for the IOL calculation sheet for your own records in case you end up having to go to another surgeon when the time comes.

PSC are fast moving type of cataracts so have a plan ready. they bother when they get in the field of the vision. for my right eye they were detected because left was impacted. the vision got impacted a year later in the right.

This is very helpful.

I will have the measurements done and also request a copy of IOL calculations.

Check the stage of cataract so I know if I can delay and by how much.

Try for contact lens to mimic post surgery realty.

Then proceed to surgery once time comes.

Agree, and mine on right is in the field of vision and hence it is blurry with that eye. On left, I will keep regular check ups meanwhile as it does not have a cataract and I got this checked by couple of opthalmologists.

thats great news if you have no cataract in the other eye. that buys you a lot of time to address this one.

" It would be important to do the contact lens trial of mini-monovision before your cataract eye vision becomes to impaired to do a proper evaluation. You need vision in both eyes to see what it will be like."

How do I get mini monovision contacts?

Is it having the catract eye set for -0.25 and good eye set to -1.5?

When doing a trial using contacts in both eyes, the normal practice would be to ask to be corrected to plano, or 0.00 D or as close as they can come to that in your eye planned for distance. Ideally you want the first eye to be operated on used for distance. That should give you 20/20 distance vision unless the cataract impacts the corrected vision. In the other eye you under correct it to leave you -1.50 D myopic. The contact lens fitter should be able to do that for you. Because contacts are closer to your natural lens than eyeglasses the power to correct has to be adjusted slightly with contacts from an eyeglass prescription, and then reduced by 1.50 D to leave you at -1.50 D. As an example the conversion from -7.50 D for eyeglasses would convert to -7.00 D in a contact. Then, you would reduce that to -5.50 D to leave you under corrected at -1.50 D.

.

If you decide this is the route you want to go, the normal practice with an IOL is to target -0.25 D to give a small factor of safety from going positive or hyperopic. Slightly myopic will reduce distance vision a small bit, but also increase near vision in the eye by some too. If you go hyperopic or far sighted, you will have a loss in both distance and near vision. Your surgeon should be well aware of that.

.

Then for your post surgery correction you can continue to wear the contact power that gives you -1.50 D in the non operated eye. Your will have the time from the surgery to the next surgery to make your final decision on whether or not mini-monovision is for you or not. My thoughts are that you may be very pleased with the eyeglass free vision for both near and far. But, if you do not, then you can go with distance vision in the second eye as well. In that case you will need OTC readers for close vision.