Cataract surgery on one or both eyes?

Sorry to hear about your horrible experience, sj82317. Decades ago, my mother had a similar experience too. There was bleeding and they could not complete the surgery. It took a few months for her eye to recover, and the second surgery was a success. At that time, I think they were only removing the cataract, her prescription glasses stayed, maybe with minor adjustments. My brother, on the other hand, had both eyes done, just a few years ago. Mind you, he had cataracts on both eyes, so he had to go for it, and luckily it went fine.

Yeah, maybe that old saying "don't fix it, if it ain't broke" isn't  there without a reason. I wish you a speedy recovery, and thank you for replying.

Yes there are so many variables in cataract surgery and the healing process - they can't predict how the incision will end up healing in each eye so it can end up with adding some residual astigmatism for example also the IOLs come in 0.5D steps so they can't get the power exactly right, so perfect vision is not guaranteed possible even in the best circumstances. So expect to need at least weak eyeglasses at least at sometimes, and if you get better than that its a gift!

Sorry for the late reply, Night-Hawk, and thank you for your input. That's what I'm thinking of doing, just my bad (right) eye, and leave the left eye the way it is. If I get an IOL of -2.0 D, that would bring my right eye to -2.0 D, and the left would stay at -3.25 D. What do I do after that is still a bit of an enigma. Most likely another pair of progressive lens glasses. If it turns out that I can read and use a computer without glasses (not very likely, I'd say), then just a pair of glasses for distance.

The idea of dumping glasses altogether, while inviting, would require me to get surgery on the left eye as well, and even then there's no guarantee I wouldn't need glasses. Doing the eye with cataract only, sounds like a logical choice.

Hi P93570,

I strongly agree with the suggestion to try a contact lens in your left eye before making your choice on the right eye surgery. There are more possibilities than you seem to be centering on so far. The best decisions can be made with the best information available.Everyone is different but here's my experience so far. 

I had cataract surgery with a standard monofocal IOL set for -0.5 in my DOMINANT left eye in mid-June. I've been wearing a very high (-9.0) contact lens with a "+2.0 add" (for near) in my right eye for the past 4 months with no problem as far as image size. As the cataract in my right eye is getting worse, I am starting to have some problems.

I am about to have a Symfony Toric IOL put in my right eye next week (mid-October), set for slightly more myopia, -0.9. After much research and help from those on this forum, I chose this plan as the best chance to get pretty good distance vision in my dominant left eye without the night vision halos & concentric circles from the Symfony lens.

I chose this because I've had severe myopia for many years and didn't want to lose my near vision at all. If I have to wear glasses for night driving, that's fine with me. I was already doing that on top of my contacts anyway. I haven't needed glasses for daytime driving so far, unless in an unfamiliar area.

After some confusing measurements from my first surgeon's inexperienced staff, I went to my optometrist  a few weeks ago. He said the end result was -0.75 in my left eye, with about 1.25 of uncorrected astigmatism remaining. I knew the standard IOL wouldn't correct astigmatism, but the cataract had apparently increased astigmatism in the 2 years preceding surgery, so I'm happy to know the astigmatism is greatly reduced.

Because my first surgeon was uncomfortable with my plan, and because of my discomfort with his staff, I decided to go back to the first surgeon I had consulted for the Symfony Toric IOL in my right eye. At his office last week, when they measured my left eye (with the newer type of eye chart which shows the letters on a well lit screen), I tested 20/20 in  the left eye. The refractive test (with all those "better #1 or #2?" questions) still came out at -0.5, exactly what I had hoped for. The hand-held near vision test came out better than 20/20. 

Al this with only a standard IOL!!! So- the moral so far, is that you may get much BETTER results than others, don't know. Hope for the best!:-)

My (2nd) surgeon explained that some of my exceptional near vision is a result of the remaining astigmatism in my left eye. I expect that when the right eye receives the Symfony Toric, I will have roughly equivalent distance vision as my left eye because the astigmatism will be gone, and perhaps a little better near vision. 

Someone else on this forum wrote that he tried this combo of standard IOL in one eye and Symfony in the other and he was happy with it. So I'm grateful to him, (tho unfortunately I don't remember his name.:-)

Hi seeherenow49806,

Thank you so much for your input. I guess you are suggesting that I should consider the possibility of going with -4.0 D IOL (instead of -2.0 D), and try using contact lenses in my good left eye (-3.25 D), until the time when that eye will need a cataract surgery as well (could be years away, but it's impossible to predict).

The first question that comes to my mind is: if I try contact lenses now, before I go to surgery on my right eye, how can I be sure that contacts in my left eye will be okay after my right eye surgery? My point is that right now, with my left eye at -3.25 D and my right eye at -4.0 D, there shouldn't be too many issues with wearing contacts, provided I can get used to them. However, things may be completely different after the right eye cataract surgery, if I bring it to zero, by implanting -4.0 D IOL in it. So, if I am to be okay with contacts now, how can I be sure it'll be the same after the surgery (because the difference between the eyes would be 3.25 D, versus only 0.75 D, where it is now)? Would I really be proving anything by trying contacts before the surgery, or am I missing something here?

Also, I'm not sure what would happen to my near vision (reading and computer), if I go with -4.0 D IOL in the right eye, and use -3.25 D contacts in my left. In that case, I'm guessing that my right eye would be perfect for distance, and so would be my corrected left eye (with contacts in, and provided I don't experience anisometropia). Where would that leave me for reading and computer distance?

Thanks again to you and anybody else who took the time to read this thread and reply, and please keep your opinions and experiences coming. I am getting more and more confused, the more I think about different options. The safest bet (at least I think it is) is, as I said in my last post, to just go -2.0 D IOL in my right eye, and do not touch the dominant left eye. The difference of 1.25 D between the two eyes should not be a problem (I hope). It's probably the safest option, but is it the best in the long run? Yup, I am confused.

Cheers!

Hi again

Oh, boy, I'm sorry I definitely added to your confusion, probably by adding too much detail regarding my own situation. But my main point is that your surgeon's idea that you only have 2 options is definitely not accurate!

I'm NOT suggesting you "go with -4.0D IOL". That's not how it works. The IOL's aren't measured in the same way as glasses or contact lens prescriptions. (More complex.)

When I say that I aimed for -0.5 in my left eye, I mean that the end result would be as if I needed a very weak pair of glasses, at a prescription of -0.5D, giving me a little more near vision than most people would expect with a standard IOL aimed at "zero" (as you called it,) or perfect distance vision. Personally, I wouldn't choose to end up needing a glasses or contact lens prescription of -2.0, not good enough distance vision, when you easily aim for much better distance..

I must have confused part of another thread with yours. The suggestion was to try soft contacts with your current prescription in both eyes to see if you can tolerate them. Most people can. Then if you're comfortable, just continue to wear the contact in your left eye after your right eye surgery. There would not be much likelihood of the imbalance in visual images that way.

The important question then would become whether you most value near & intermediate vision, or intermediate & distance vision, and aim for your preference. Many "old-school" cataract surgeons are in the habit of assuming that all their patients prefer perfect distance vision, so they aim for that and tell their patients they will have to wear reading glasses for the rest of their lives. But the "mini-mono- vision" technique of aiming for slightly different end results in each eye can greatly improve overall vision. (That's what i was describing in my own case.) You can look that up on other threads here.

If you are able to wear a contact  lensin your left eye and have you right eye set for your preference, then you could definitely be glasses free at least until you need the surgery in the left eye. Are you certain that your left eye is dominant? (Most people are not.) This can also be a factor in choosing the aim.

Best of luck in choosing - take your time! But I wouldn't wait for the left eye to get worse. And don't be in a hurry to do the left eye if it's not really necessary yet. The IOL options are continually improving. If your left eye is still good for years, it's possible there could be another IOL option by then that would give you even better results.

Thanks again seeherenow49806,

What I meant by -4.0 D IOL in my right eye is an implant that would bring that eye to "zero", with no additional glasses, or contacts needed (at least not for distance). And if I decide to go that way (not very likely, the way I'm thinking now), the difference between the two eyes would be 3.25 D, which is too much, almost certain to cause anisometropia. That's why my surgeon told me to either go with:

Option 1 -bring the right eye to "zero", followed by another surgery on the left eye, in a few weeks, bringing that eye to "zero" too, or

Option 2 - bring the right eye to -2.0 D, and leave the left eye the way it is now (-3.25 D). The way I see it, I'd need glasses either way after the surgery (reading and computer).

Now, should I go with option 1, contact lens in my left eye may, or may not help and eliminate anisometropia. I don't think it's easy to predict that. So, my point was that, even if I try contacts in both eyes now, and find out that I can tolerate them, how will I know that with the difference of 3.25 D, after the surgery, the contact lens in my left eye will do the trick and prevent anisometropia.

To make a long story short, the whole point here is - can I be sure that a contact lens in my left eye will prevent vision imbalance, if I go with option 1? On top of that, shouldn't I still need glasses, even in that case? My right eye, after the surgery, would be perfect (kinda) for distance, and so would be my left eye (with contacts). But how about reading and computer distance? Glasses?

Btw, when I called my left eye "dominant", I really meant good (cataract free) eye.

Thanks!

HI again:)

I'm afraid you haven't understood my post and I'm at a loss to explain it further. If your difference in refraction has been correctable with glasses, then it seems it would be easily corrected with contacts. perhaps I'm mistaken.

I suggest researching the posts on this forum about mini-monovision.

Generally, the "dominant eye" refers to whichever eye was naturally dominant in the act of seeing (before cataracts), tho it can temporarily vary and some people are more flexible. This is also something you can research.

Wishing you the best!:)

"If your difference in refraction has been correctable with glasses, then it seems it would be easily corrected with contacts. "

I'm sorry if I am misunderstanding something again, but the difference between the eyes now, with glasses, is only 0.75 D (-3.25 versus -4.0). If I do the right eye, and correct it perfectly for distance (bring it to "zero"), then obviously that difference would be 3.25 D. Would contacts in my left eye be able to correct it then?

I will definitely read more about mini-monovision.

Thanks again!

Yes. That is what I have been doing for 4 months with no problem, wearing a contact lens in the unoperated eye.

P93570, prior to surgery on my right eye, my contacts were -6.50D on my right eye And -4.00D on my left with monovision. After surgery on my right my vision is 20/20 with a toric lens. My vision seems excellent back to about arm's length. Wearing the same left contact lens, my near vision for reading works just like it did before and there is some correction in that lens for distance as well. Without lenses I'm very nearsighted. I'll probably have the left eye done just like my contact lens. But I've been told that not everyone can tolerate that big of a difference. I also had glasses with that correction. Now, with the right lens removed, there is too much of a size difference between the eye with the IOL. I often wear the glasses for reading but take them off otherwise.

I would suggest waiting to make a decision until after your surgery on your distance eye. I didn't expect such a good correction at different distances with a toric monofocus lens. The only thing I can't see is closer than about arm's length. Maybe I'm just lucky.