Cataract surgery for short sighted.

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I need cataract surgery for both eyes. I'm Sph -13.5/13.25. I'd welcome feedback about surgery outcomes from other short sighted people.

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  • Posted

    Although there are some sites that talk about a higher risk of retinal detachment, some studies show that for high myopes the risk after cataract surgery isn't any higher than the already higher risk high myopes face. Regardles, even if the risk is higher for high myopes, its still overall a very tiny risk  and if there is a retinal detachment it isn't likely to occur during surgery, the average time is a few years postop. High myopes need to be aware of the risk of retinal detachment anyway, and that risk doesn't go down after surgery since your eye's internal structures that led to the increased risk are still the same. 

    The only real issue to be concerned about is that it is harder or them to get the IOL lens power choice right in someone highly nearsighted. The choice of what IOL power to use isn't based on an exact formula, but is merely an estimate based on statistical analysis of the eye measurements of past patients. There have been different groups who've come up with formulas using different methods. Some of the common scanning equipment they use like the IOLMaster will actually run a few different formulas based on the scans and print out the results so surgeons can see how the formulas compare.

    The results tend to be fairly accurate for those with low prescriptions preop, but for various reasons there is more of a risk of error for those who are highly myopic. Some of it is due to having less data since there are fewer people with such high prescriptions, but there is also some concern that there may be problems with the accuracy of some of the devices used to measure the eyes of highly nearsighted people. They have made progress in the last couple of years, so its useflt to be sure any surgeon you use is up on the latest approaches and tries multiple formulas, e.g. google: "High to Extreme Axial Myopia - IOL Power Calculations. Axial length correction for high to extreme axial myopia." for Dr. Hill's page discussing one approach.

    If the lens power is off, that just means you'd need vision correction afterwards, either glasses/contacts or a laser enhancement (and even if you weren't a candidate for LASIK/PRK with your high presciption in the past, e.g. due to corneal thickness issues, you might be for the much smaller correction this would be). Though any correction you need would be much thinner than what you have now.

    In my case I was highly myopic, but not nearly as high as yours, and the one eye that was -9.5D or so before the cataract , wound up being very slightly farsighted, +0.5D, while fortunately the other that was -6D preop wound up on target at 0D (though the last check at 2 years postop put it at -0.25D, though since they round to the nearest 0.25D notch it may not be much different).

    Most  IOLs remove the ability for your eye to accomodate to different focal points (if you have any left, I don't know how old you are), so you'd need to wear correction anyway for some distances unless you consider things like a premium IOL or monovision. I don't know if those are issues you are already familiar with or are asking about. 

     

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  • Posted

    Please know that I am not trying to scare you, but I am going to share part of my experience to help. I was -21 in both eyes. Because of that degree of myopia, I have had retinal detachments in both eyes. Also, probably due to that myopia I had zonular weakness. In my first cataract surgery, the lens capsule collapsed due to zonular weakness, and the surgeon implanted a phakic lens (in the front part of the eye, rather than the back). The second surgery (right eye) went just fine. 

    If you are severely myopic, make sure the doctor has a plan for zonular weakness. 

    The other thing I wish I had known before surgery was how long it would take to get a working prescription for glasses so that I could resume work. If you are still working (I'm only 43), make sure to plan for the problem that your distance vision may be functional, but your reading vision may not be suitable for work. They are still trying to get my prescription right (5 months post surgery), and only in the last month have I felt was vision allowed me to see well enough to truly do my job. 

    I know this seems doom and gloom, and I seem to the the .01% of problems, but had I just known what it would be like, I would have been better prepared to go on the journey. I still would have had cataract surgery, I just would have planned my post-op care much differently, and I would have had a different expectation of my prognosis. 

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    • Posted

      Although its true that -13 is extremely high, I'm not sure that its anywhere near the same league of potential problems as a -21 myope, but your point regarding zonular issues is still a useful precaution to check on.

      I'm guessing since you don't mention otherwise that your 2nd IOL was a monofocal? (I'm assuming the phakic lens was, I don't know if they make anything other than a monofocal).

      Its unfortunate that you had to deal with cataract surgery at an age where you likely hadn't had to deal with loss of near from presbyopia (or not much if you did have some) to at least be used to the idea of dealing  with losing near vision.

      Are you just using progressive glasses (called varifocals some places)? I don't know if you've tried options like multifocal contacts,  some people aren't aware of them, which is what I liked   before I had cataracts (and got a premium IOL to provide more near, the Symfony), since they provide good vision over a range of distances without the need to look in different directions.  Unfortunately I think they aren't quite as good for higher adds of the sort you'd likely need with an IOL, I didn't yet need a high add when I had them.

       

      They also have corneal inlays like the Raindrop and Kamra which are implanted just under the surface of the cornea to provide a larger range of vision, usually just in one eye. They were created for people with presbyopia, but they have been studied for use with people with IOLs as well. Since they are implanted near the surface the procedure isn't as much of a risk and the implants can be removed if needed. There are also some laser methods for providing a multifocal correction on the cornea, though I'm unsure how they compare (or if they are available in the US, I don't know which country you are in, this site seems to be a mix of US and UK and others).

      I'm guessing the original poster's choice to use "Grandpa" in his username suggests he is likely old enough to have experienced at least some amount of presbyopia to be aware of the problems of losing near vision (though technically someone can be a grandpa before they are old enough for presbyopia). The average age for cataract surgery is in the mid 70s, though I'm guessing those atypically young for a cataract are more likely both to be online and to be checking for sites to help with their unusual experience. (I was 49 when diagnosed so atypically young but  I had some experience with presbyopia beforehand at least to be aware of the concerns over near, and  52 when treated since my 2nd eye remained 20/20 correctible so I postponed surgery in hopes of new and better IOLs coming out). 

       

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    • Posted

      I responded to Grandpa for just the infromation, not to scare. Very few people have as bad of eyes as I, but had I more information pre-surgery, it would have made post-surgery much more palatable. 

      I actually had LASIK when I was 20. There might be enough material on the cornea to do another LASIK fix, but we want to wait because I have an epiretinal membrane growing on my right eye now. 

      Both IOLs are monofocal, and I have bifocal glasses. I actually am now satisfied with my distance vision without glasses. I am perfectly capable of driving and doing most tasks without my glasses, but I am an ENglish teacher, so the reading part of my job necessitates having a visual solution that does not involve putting on and taking off reading glasses every 15 seconds as I work with a class. (I tried that for a week, disaster!)

      I've looked into the Raindrop solution, but it can't be done with a phakic IOL and there are some concerns related to the other problems I have had with my eyes. 

      I'm pretty much in the place of waiting for either a brillant new lens/surgery solution or a decrease in my currently functional vision before I sign up for any more work on my eyes.  (I'm in the USA -- Colorado btw)

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    • Posted

      If you haven't tried disposable contacts I'd suggest trying them for either multifocals or monovision, some folks try contacts when young and haven't tried the modern improved ones that are quite a bit better (i'd worn contacts all my life and always had issues with the older soft lenses during allergy seasons, the new ones made a big difference). Though admittedly as I said I don't know if they work as well for the high adds you'd need. I'm guessing the bifocals work better than progressives would for you, partly also due to the high add?

       

      The Raindrop and Kamra tend to go in only one eye usually, unless you mean the monofocal IOL eye would have problems with it for other reasons. Unfortunately though I'm not sure whether doctors in the US are technically supposed to implant them in people with IOLs now since the FDA approval was only for presbyopia, or if they'd be willing to do it "off label" since its being done outside the US. Unfortunately in the US there are fewer options available, outside the US there are other brands of inlay in the works and various multifocal laser approaches. 

      Odd coincidence given Colorado is a small state,  I'm in Boulder, Colorado (though I traveled to Europe to get the Symfony implants before they were approved here, and partly out of curiosity I keep up with whats going on elsewhere still, someday perhaps they'll have an IOL that'll provide the vision of an 18 year old that'll be worth getting a lens exhange for). Its party odd since the last person sending me a personal message on this site turned out to be from Fort Collins, a few weeks ago, he   is considering clear lens exchange or inlays for presbyopia.

       

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  • Posted

    I just had surgery on both eyes, were - 11 and -12 before and have 20/20 vision now, just completed surgery mar 6 th , and can even read small print? 
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    • Posted

      So good to hear that. I've always thought that these forums might be dominated by people who have had problems. Those people who are very happy with outcomes have less need for sites like this. 

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    • Posted

      I was much less myopic as I noted, -6D and -9.5D, but having been a somewhat high myope  I'll add that in my case I have at least 20/15 distance vision now (they didn't have a line below that to check and that line was easy). I have Symfony IOLs, and have 20/20 plus a bit at 80cm intermediate, and at best near 20/25. At 40 cm they measured 20/30, but they didn't have a 20/25 line on that chart and since I saw the 20/20 line a bit I suspect its 20/25.

      The sites do tend to be dominated by people with problems, but some like me used such sites for research before surgery, and decide to "give back" afterwards regardless of results, especially in my case to sometimes provide a counter balance to some of the atypical horror stories to remind people they aren't typical. Obviously your case is atypical, but overall there are 20 million+ cataract surgeries worldwide and the vast majority do great, so even a minuscule fraction with problems can lead to a disturbing number of posts that can scare some people who don't keep things in perspective. 

      That said, I suppose I should acknowledge I did have one extremely rare issue postop, like out one  of tens of thousands perhaps at least (don't have a good estimate, even high volume surgeons hadn't seen it), related to having been a high myope, which is another reason I came back to such sites at first postop.  Its unlikely to impact others so I didn't mention it at first and rarely mention it, though it was related to being a high myope. I get flickering light when trying to read close up, due to iridodonesis which is the iris jiggling when the eye moves quickly trying to read. It usually never causes visual artificacts, but in some rare  people with light colored eyes who have darker striations in betwen the light ones the movement of the iris is like a spinning fan in front of the light causing it to flicker (though even in most of those it doesn't cause issues, they don't seem to know why it does in some) .  The iridodonesis (which again is usually an innocuous thing when it does happen, no one looking at me would ever notice the subtle jiggling) is due to having been myopic enough that when the larger natural lens is replaced by a smaller artificial lens, the iris loses support and can move a bit. The brain over time learns to tune it out, though not entirely yet.

       

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  • Posted

    I'm 74. Worn glasses since early childhood. Done virtually no research. Hence my post.

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  • Posted

    I found it interesting to reread this. I’m having my first eye done in a few hours. Fingers crossed.
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  • Posted

    Time to update.

    Glaucoma in both eyes and high myopia. Told that it increased risk of complications from 1% to 3%.

    First eye. Posterior capsule rupture followed by emergency treatment next day for loss of vision and extreme nausea - due to very high eye pressure. By end of day starting to see and aware of retained lens fragments and vitreous. Next day saw my surgeon. Decided to arrange vitrectomy. That was done 12 days after my original surgery. It ended a very traumatic experience. The vitrectomy was painless during and after, completely cleared the debris and my vision was simply wonderful at +0.25. My first experience of quality sight in 74 years.

    11 weeks later, second eye done by the same surgeon. Was very apprehensive. Went perfectly. No pain during and after. Next morning vision was as good as in my first eye.

    I endured 11 weeks of having to use one good eye. Wearing glasses with one lens was useless.

    Imagine my joy when journeying through the New Forest this weekend seeing colours I have never been able to appreciate before. No new TVs needed - it was my eyes not the age of the televisions!

    Of course I need reading glasses - I accepted our UK NHS monofocals set for distance. No problem for someone used to needing glasses. My reading and computer work is so much easier with my temporary off the shelf specs set for +2.5

    Its been a roller coaster.

    It was worth the prize.

    And I was brilliantly served by the NHS.

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