Advice needed - Cataract Surgery Lense Dilemma (after a vitrectomy)
Posted , 8 users are following.
First, thank you in advance for any advice or experience you might be able to share. Eight months ago, I underwent emergency eye surgery for a detached retina (vitrectomy).The retina has healed but I've now developed a cataract.I've seen two highly regarded cataract surgeons. One referred to me by my eye surgeon (retina specialist) and the other referred by a number of local optometrists. Both cataract surgeons have recommended two different plans! One surgeon recommends removing the cataract and inserting a lens for improving distance vision. My "good" eye would need Lasik surgery two weeks or so later though. Otherwise, I'm told, my eyes will be in "conflict" with each other and glasses won't remedy the problem. He believes this plan will provide me with a chance to be free of glasses, except for needing readers. The other surgeon recommends inserting a near distance lens for close up vision. I would then not need surgery on the "good" eye. Since I have been nearsighted all my life and have worn glasses/contact lenses to correct my vision, the close up lens makes sense to me. Close up vision is what I'm used to and I only have the one eye with a cataract. Everyone who has had cataract surgery seems to go with distance lenses though - and who wouldn't want to be free of glasses? What would you do? Has anyone had experience with the near vision lens? This is all so nerve wracking and I sincerely appreciate advice!
0 likes, 36 replies
Sue.An mjcg
Posted
Hi mjcg
Both plans sound like good options. It will come down to your preferences.
Although mist surgeons (and people) go for a standard monofocal lens targeted for best distance there are people that prefer having it targeted for nearer (intermediate) vision. This provides very usable vision where you can see tour computer car dashboard and iPhone. There are a few who have opted for that here on the forums. If you reach out to BellaD she went with that set up and just wears glasses for TV and driving and quite enjoys that result.
You don't mention your age as that may okay a factor down the road if you don't need readers now for your good eye.
If going with a lens targeting distance why would you be considering lasik and not a contact lens? issue with lasik is that it is more difficult later when you need cataract surgery for that eye for surgeons to calculate the correct power (even if they have your pre-lasik calculations. Before going that route I would suggest you experiment with a contact lens instead.
There is a 3rd option you could consider and that is a premium lens. There are EDOF (extended depth of focus) lenses now that allow you to see all distances. I went with the Symfony lens and am glasses free since surgeries. As with anything to do with cataract surgery there is a compromise though with premium lenses and that is there tends to be more night vision issues with them (halos).
Wishing you the best as you consider all your options.
mjcg Sue.An
Posted
Hi Sue.An thank you for your reply! I am 63 years old. I already wear progressive lenses. I'm not able to wear contacts like I used to because of dry eyes (I've just started Restasis).I will reach out to BellaD for sure. The surgeon who recommended the close up vision procedure talked about Symfony but it's at a price of $3,000/eye and I need both eyes done to see properly (insurance doesn't cover the lens unfortunately). Halos wouldn't bother me much since I've dealt with that pretty much all my life. I remember thinking how odd it was that people could see lights perfectly shaped (without glare or halos). I would certainly LOVE to be glasses free. Again, thank you so much for responding. I'm so glad I found this forum and I hope I can become a contributor down the road (and explain a successful outcome!).
Sue.An mjcg
Posted
I had cataracts both eyes and needed the surgery last year at 53. I too always dealt with glare and this got worse with the cataracts so what I see now at night is so much better. I do drive at night and don't find the halos too distracting. I fortunately live in Canada so surgeries were completely covered by our medicare system regardless of lens selection. Paid $900 per Symfony lens so this was very affordable for me. Working full time it really is a blessing to be glasses free. I too was near sighted since 12 . Hadn't yet had to have progressives so thought of losing near vision especially didn't sit well for me.
Sounds like you would prefer to have mid to near range vision over distance. I am sure BellaD would be happy to share her story with you. It isn't an easy decision so if you have time take it to research your options.
Just my opinion - I wouldn't personally do lasik on an eye at 63. It will not correct your near vision and could likely cause an issue when it comes to cataract surgery.
One other thing you may want to ask your surgeon: often when there is too much of a difference between your eyes the surgeon can perform cataract surgeon on 2nd eye to balance them out. In Canada it is grounds to have it covered under medicare so perhaps your health plan might be same?
Good luck to you - hope it all works out.
mjcg Sue.An
Posted
Love Canada! I'm in Michigan - so I'm a neighbor 😃You are so young to have had cataract surgery, but I'm glad to hear all has been successful for you. They say the surgery has a 98% success rate - of course, I focus on the 2% (what went wrong?!).
I'm not enthusiastic about doing lasik on my good eye at all. I do just want to see again, if at all possible, when I put my glasses on (or not). The only reason I'm considering the distance lens with lasik is because how great it would be to NOT wear glasses. As I'm writing this, it's snowing out. You know how you're outside walking in the snow or rain and the dang glasses get all covered and wet... or they fog up. Hate when that happens!
Still... I do have my sight. Something many people tend to take for granted. Not me, not any longer! 😎
Sue.An mjcg
Posted
we have had our first snowfall already and it was minus 18 this morning. expecti g 10 to 15 cms of snow tomorrow. Going to be a long winter.
Just something to be aware of. You'll likely see more negative outcomes/comments than positive ones on the forums. I think more people search and post if something is wrong (makes sense). If someone didn't research ahead of time and everything turned out fine, doubt they'd post. So keep things in perspective. I was blindsided by diagnosis of cataracts so I went online right away to research. Although 98% satisfaction rate good to realize no 2 eyes are alike and not even the surgeon can guarantee glasses free - even with premium lenses. It's unfortunate that IOLs come in .50 diopters whereas contacts and glasses come in .25 and that IOL shifts back and forth before settling - so the margin of error can be .25 to .50 either way. surgery itself can also bring on astigmatism so throw that into the mix. Inform yourself as much as you can and choose a good reputable surgeon who will work with you and everything should turn out fine.
Also think about tour preferences (also where you spend more time at) - helps in making choice of whether to target distance or intermediate range.
Glad BellaD reached out. She was one of the first that I recall opting for intermediate range. If I had even known it was an option vs distance it may have tipped the scales towards a standard lens. All turned out well with Symfony so no regrets but it is nice to know there are more options being discussed/considered now.
mjcg Sue.An
Posted
I've been doing a lot of research about cataract surgery. I didn't have that chance with a vitrectomy since it was emergency surgery. I knew nothing and knowing so little was frightening. No one could offer much advice because the healing process is different for everyone. Sounds like it similar with cataract surgery too. I have to remind myself to be patient and to weigh all my options. Still not sure what to do!!
Sue.An mjcg
Posted
hopfully with cataracts you will have time. Even though it was a surprise diagnosis and my eyesight couldn't be corrected better than 20/60 in right eye and 20/50 in left i had a 7 month wait between diagnosis to surgery (Canada has a great medicare system but unless emergency you wait). Maybe a good thing too as I waffled back and forth with lens selection.
I am confident you will come to your own decision about what works best for you. There isn't a perfect solution so it is more a decision of what compromise you want to make.
michael74313 mjcg
Posted
Sue - just some feedback for all here - my doctor would never recommend anything but a mono focal lens on a "compromised eye." Since, they had a detached retina and vitrectomy, I would recommend doing a lot of research before even considering anything other than a mono focal lens.
mjcj - you haven't listed your age so it's difficult to provide better feedback. We also don't know which eye is your dominant eye. It sounds like the doctor wants to do lasik because otherwise you'll have mono vision; is this correct? In general, I would also strongly research lasik since the older you are, the less likely your "good eye" will see well at all ranges and it can bring up other issues when it's time to do cataract surgery on an eye that has had lasik. I can see the predicament you are in.
You might want to consider a lens mid range as an option. Then you might use glasses for distance and in the future if/when you get cataract surgery on the good eye, you can have that set for distance. Given that your eye and/or eyes might be compromised, I would talk to your doctor and research your options carefully. I went with a mono focal for both my eyes set for distance. My left eye is set just slightly in only 1/2 diopter for slightly better near and I almost never wear glasses.
My concern with lasik is whether it could compromise your vision and/or options in the future if/when you might need cataract surgery on the good eye. I would be more inclined to go with either glasses or a contact lens in the good eye because it sounds like your doctor is saying you will have mono vision if they set the IOL for distance. But, you could consider setting that eye for a mid range lens. Also, we don't know your age or which eye is your dominant eye. It might not matter too much depending on the settings of the IOL and possible IOL in the future. They do recommend the dominant eye being set for distance if possible. It did not work out that way for me but I guess because my dominant eye was set only 1/2 diopter in, it doesn't seem to have mattered.
The last option of course is considering when you might need cataract surgery on your other eye. Again, we don't know your age and all cataracts progress at different rates depending on the individual. But, in general, common thinking today is to do it sooner rather than later. My second eye that I did about 3 weeks later only had a mild cataract but we decided to just get it done anyways since it was only going to get worse. Check with your doctor.
Good luck to you.
Sue.An michael74313
Posted
Hi Michael - thanks for the comments. I may be wrong (and surgeons often provide conflicting info - as dies the internet). I was informed EDOF lenses were not any different than monofocal lenses in how they ate made/implanted. Younger patients are more at risk for detached retina due to the surgery itself vs lens selection.
But I could be misinformed. They do however come with more night time artifacts which not everyone will want.
mjcg michael74313
Posted
Hi Michael - thank you for taking time to respond!! I'm so relieved to find this help here. I'm 63 (64 in January). My left eye, the one I had the vitrectomy done on, is my dominant eye. My right eye (good eye) has taken over doing all the work now. It was quite a struggle for me the first couple of months but I think the good eye now thinks it's dominant.I've changed my eye prescription 3 times since the surgery. Currently my left eye prescription is -7.25 (used to be -4.25 at the time of the surgery) My right eye is -5.00. And my left eye sight is already blurry again. The retina detachment was caused by the vitreous fluid tugging on the retina causing a tear and then a detachment. I was "lucky" in that I didn't wait around when I saw a "black blob" blocking the vision in the corner of my eye. I went to the ER and within 24 hours was in surgery. The retinal surgeon told me I'd get a cataract within 6-24 months. Both cataract surgeons don't think I'll need cataract surgery in the good eye until I'm far into my 80's (if I make it that long). I definitely don't want mono vision because I tried that with contacts once and it didn't work for me at all. I wear progressive glasses, ok. Again, contacts I can't wear long because of dry eyes. Sorry for rambling... I've been a bit crazy since the original surgery. I knew getting old would mean aches and pains, but I never expected my vision to be at risk. I'm thankful they were able to save my sight - the surgery was only new in the 70's. Before then I would have likely lost my sight. I keep trying to remind myself of that. Still doesn't make another surgery decision any easier.
michael74313 mjcg
Posted
MJCG - just to follow up and add to my comments I too was near sighted all my life. Let me tell you, getting everything "flipped around" with your vision can psychologically be quite a shock at first. I could easily read things up close with no problem and my brain automatically knew where to hold the phone (about 5 inches from my eyes) and where to be when looking at a thermostat or looking at anything else up close. All of the sudden, that "sweet spot" changes and it takes getting used to. I'm glad it all worked out for me.
With that said, you could possibly ask your doctor to provide you a mid range "test" contact lens for your eye with the cataract to test/get a feel for what your vision would be like seeing in that range. Let me say though, I also used a test lens and my vision was a LOT better after surgery with the IOL than the test lens. This is due to the fact that the cataract just makes vision worse at ALL distances. But, a test lens might at least give you some idea. My doctor provided with with two different soft test lens to try at home about a week before my surgery. In the end, I decided against mono vision and my IOLs are only 1/2 diopter apart for "mini mono vision."
Hope that helps
mjcg michael74313
Posted
This is all good information, thank you! I did think that it would make sense to go with a close up lens since that's what I was used to. I wore contacts since I was 15. When I started needing readers (multi focal contacts never worked) and my eyes started getting dry, I just gave up and went to progressive glasses. I don't really like glasses which is why I'm tempted to get both eyes done for distance. But if I don't need surgery in the "good" eye, I should probably leave it be.
soks mjcg
Posted
hi mjcg
Sorry for the RD. Did it happen due to accident or just like that. If just like that or due to sugar chances are high that there will be RD in other eye as well followed by a cataract. In such cases the best decision is to go with monofocals like your surgeons are suggesting. Also not doing any lasik now would be recommended if it is at risk of RD and subsequent cataract surgery.
What is your prescription for the good eye? I have had cataract surgery in one eye and my other eye is about -2.5. Wearing glasses with 0 on operated eye and -2.5 on the good eye is very difficult. It makes me off balance. especially outdoors. But -2.5 on good eye and no glass on the operated eye works. I do not know if this approach works for higher refraction error on good eye.
Good luck and let us know what you decide to do.
mjcg soks
Posted
Hi Soks! The retina detachment came out of nowhere (though being nearsighted increases your chances I've been told). What do you mean by "due to sugar" - is that a cause of retina detachments? I am a sugar addict for sure... though I'm not overweight, my blood pressure is low, I exercise and am in fairly good health. -5.0 in the good eye and -7.0 in the bad eye. Both used to be around -4.25. I think my second surgeon opinion plan is to insert a lens that will equalize the sight between both eyes. I'll still need to wear glasses to get good overall vision.
soks mjcg
Posted
It seems you are a high myope with -4.25 and that could be the result of retina detachment. By sugar I meant are you a diabetic? I have a coworker who had a RD out of the blue. He was advised and got a RD in the 2nd eye two years later. Both eyes were repaired for RD ASAP and he was told he would get cataracts in them but he hasn't had the cataracts so far for 5+ years now. Another coworker got RD in one eye only due to Glaucoma. And third coworker got vitrectomy done with his cataract surgery as he has Glaucoma and diabetes. He chose monofocal lenses for distance and can see clearly 3 feet out to infinity.
I think both your options (distance or near sighted) are good ones. I would probably stay away from multifocals after RD or other visual complication. I have been near sighted for most of my life. I myself got a Symfony and I don't think my near vision is that great up to 18 inches and I see IOL edge glare at night in the dark. Also since my other eye is still good I can compare it with my natural vision and my IOL vision albeit clear is still short of natural vision.
mjcg soks
Posted
No, I'm not a diabetic. My RD was apparently just one of those things, most likely age related (sigh).I never did well with multifocal contact lenses, so I'm guessing Symfony won't work for me.Plus my surgeon said it would be a $3,000 expense per eye and it's not covered by insurance. Though if you don't need glasses after the surgery, that's a savings in the long run. Progressives are expensive and I usually get a new pair every year. Again, I GREATLY appreciate your input. I'm a nervous wreck about all this!