Cataract surgery one eye only
Posted , 6 users are following.
My left eye, which is dominant, has a rapidly developing cataract. My right eye has no indication of a cataract forming. I currently wear progressive lenses eyeglasses, and have for 40 years for distance. I prefer to read without my glasses, although the current prescription has near vision correction. I'm typing this without glasses, as the left eye still assists with near vision, although it is best at about 9-10" away and I lose clarity beyond that.
I have astigmatism in my left eye and my doctor leaned heavily toward implant with a toric lens and correcting the left for distance. I asked various questions, especially about having near vision lens replacement and correcting the astigmatism with glasses, as in the past. It must have been a perplexing question and probably not one heard before. He did say that a few patients select near vision and that is an option for me, but it didn't address the stigmatism. Even while talking with the scheduling nurse, she kept reminding my of payment options for the toric lens (it isn't covered by Medicare or my supplemental). I didn't think I would need the $1800 lens for near vision and told her so. Maybe it was a normal discourse for her. I will probably setup a consultation prior to actual surgery.
Since I will have to continue to wear glasses for my right eye, I am close to deciding on near vision lens for the cataract, hopefully to be able to correct distance with glasses. Does this sound logical and I would like to hear from others that may have chosen near lens over distant.
0 likes, 14 replies
robert20416 steve09278
Posted
steve09278 robert20416
Posted
My script from one year ago is:
OD Sph -1.25 Cyl +0.75 Axis 170 Add +2.50
OS Sph -2.00 Cyl +0.75 Axis 130 Add +2.50
I didn't get full report, but was told my left eye is 20/50 with cataract rated as a 7.
sunny68454 steve09278
Posted
Based on my experience I’d say wait for as long as you can until with both your eyes open and prescription glasses worn you are just not satisfied with what you see. Regardless of what lens and where you set focus with it, after surgery life is a compromise. First assess how bad is your current situation versus what it could be - loss of near vision, glare, halos or any other surgical complications etc.
steve09278 sunny68454
Posted
Sunny - I'm 65 coming up on 66 in May. My depth perception is suffering and driving at night is difficult, especially in rain, oncoming traffic and dim lighting. I'm not sure I can wait 2+ years or more.
at201 steve09278
Posted
1. If you read best with the right eye at about 9-10 inches away, you probably have a distance prescription of about -4.0D (assuming that your astigmatism is relatively small in the right eye). It will be good if you can share your current prescription, but for the following comments, I am going to make that assumption for your right eye.
2. If the right eye does not have any cataract and you plan to have a cataract surgery only in the left eye, DO NOT HAVE THE LEFT EYE SET FOR BEST FOCUS AT DISTANCE. When they try to fit you with the glasses, they will be trying to give you a prescription (which you will need) with too large a difference of power between the two eyes. No one' brain can handle a difference of about 4D between the 2 eyes with glasses. The difference in the image sizes seen by the 2 eyes due to the different power of the 2 lenses will result in possibly double vision, which you definitely won't want.
3. Thus, the best choice for you will be to go for the best focus at about 16 - 17 inches (corresponding to about -2.25D or -2.50 D) for the left eye. Then the 2 eyes will be working together well for as long as you don't develop a cataract in the right.
4. Regarding whether you should get toric lense for the left eye depends on the astigmatism prescription; i.e. the amount of astigmatism. If it is less than about 1.0D, then I would not. If it is more than 2.0D. I would.
steve09278 at201
Posted
AT - With the cataract, my only clear vision in the right eye is no greater than 9-10 inches. Distance with current script is nonexistent. Glare, halos, the blur and it is as if the eye has a film over it are causing minor issues (night driving in low lighting with oncoming traffic & depth perception). My current script is:
OD Sph -1.25 Cyl +0.75 Axis 170 Add +2.50
OS Sph -2.00 Cyl +0.75 Axis 130 Add +2.50
Doctor and I talked about distance in one eye and eventually near in the right, but he warned that many patients have difficulty with depth perception. Already experiencing issues with that, I told him that wasn't an option. I don't know if it makes any difference, but my astigmatism is vertical (up/down) and not normal as described as football on the ground. I suppose mine is more like a football on a kicking tee.
steve09278
Posted
Correction. only clear vision in the left eye is no greater than 9-10 inches, even better at 6".
steve09278
Posted
AT - I probably should start over! Left eye near vision is from 6" - 10". Beyond that it is a blur, with or without glasses. My right eye, without glasses is best at arms length and I'm fine reading newsprint, computer screens. With glasses my right eye is corrected to 20/20.
at201 steve09278
Posted
Somehow I had gotten the wrong impression that you were reading at about 10 inches with the right eye, which does not have a cataract. So, please ignore the suggestions / recommendations in my earlier post, except for item 4 about astigmatism and the toric lens.
Any way, looking at your 1 year old prescriptions and assuming that the change in the vision in the left eye recently is mostly due to the cataract development in that eye:
1. As you state, your vision in the right at the 20 - 30 inches range is reasonably good. Therefore, aiming to have the left eye for distance is a good choice. You will then be able to do most of the things well without glasses, needing them only for reading fine print or when you want just a little better distance vision for driving at night.
2. You did not have much astigmatism in your left eye a year back and you probably won't see much change in that amount of astigmatism after the cataract surgery. The toric lenses will be of very limited value in your case and can in some cases may make the situation even worse due to the lens rotation. So, just go for a regular monofocal lens and save yourself some money.
steve09278 at201
Posted
AT - Thank you for your input. My only concern with setting the left eye for distance is possible issues with depth perception, and that might be unfounded. Also setting the left for distance, would my only option when the right eye needs correction is for distance? I really don't want to lose my near vision and have to wear readers. I'm comfortable having to wear glasses and rather have them than trying to keep up with reading glasses.
at201 steve09278
Posted
1. I don't think that you need to worry about depth perception because of having the left eye set for distance (or for close reading) , while the right eye is set naturally right now at the best focus at intermediate distance. Neither I nor any one I know personally (including my wife and many other relatives and friends) have had a depth perception issue because of the resulting monovision or mini-monovision.
2. Whether you get the left eye set for far distance or for near distance is strictly your choice depending on your preference. Both of those should work equally well. The only difference is that in the former case, you will need glasses when reading fine material while in the later case, you will need glasses to see well while driving etc. You just have to make your choice based on what you feel more comfortable in doing. What an average person may decide should not affect your choice.
steve09278
Posted
Had surgery Wednesday and post op visit today. Seeing 20/25 with the new lens. Doc followed my request for near vision and gave me a 18.5 diopter. Light and colors are bright and although my right eye doesn't have a severe cataract, comparing the two is literally night and day. Doc wanted to operate on the right eye next week and I declined. He had a nice sales pitch "only have to worry about 5 weeks of drops, instead of 4 weeks now and dealing with 4 weeks later. You depth perception will be uncomfortable until you have your other eye corrected". Will go in for new prescription for my left eye to correct distance in 3 weeks. Until then I'll use my current glasses to drive.
Vision is still a bit blurry in the operative eye, but I'm typing this without glasses with my right eye closed. As expected, I don't have clear vision beyond 6 to 8 feet in my left eye. I hoped to have a bit better intermediate vision and that may improve with healing.
indygeo steve09278
Posted
Just picked up on this thread today and noticed you have been in a somewhat similar situation as I. My left eye is my bad eye and my right my (relatively) good eye tends to have a range of 10-18 inches or so unaided reading. My surgeon has recommended a distance mono-focal lens in my left eye, contrary to what you've chosen. I guess I'm inclined to prefer reading glasses over distance glasses. You seem to have had a good result for what you were aiming for. Your intermediate vision may very well improve in the operated eye in the coming days. Best wishes.
G
steve09278 indygeo
Posted
Long and hard thoughts on remaining near sighted or opting for distance, prior to surgery. I'll have the expense of prescription glasses, but would have had to get a new script for left eye, regardless of near or far choice. I'll hold off on right eye until it can no longer be corrected with prescription, estimated at a year+ according to the surgeon.
Only drawback today is that I've lost fine print vision, which my left eye provided, prior to surgery. Would/will need glasses regardless.