Cataract surgery visual outcomes with severe myopic vision

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I am 38. I have a cataract in my left eye, that I am scheduled to have surgery for. And I have pretty severe myopia. My contact lens prescription was -12 in my left eye, before the cataract, and its -9 in my right eye. I see well in my right eye at all distances with a contact lens in, but apparently there is the very beginning signs of a cataract in that eye as well. I guess I have some astigmatism in my left cataract eye also, but I wasn't told any actual number value for it. I don't correct for any astigmatism with my contact lenses.

I am having some trouble in my research finding out how having very severe myopia effects my options and what expectations I should have for vision post surgery. All the reading I have done is basically on people with about -5 D or better. I'm like twice that. There are toric lenses, multi-focals, EFOV, mono-focals but with mini-monovision, ect. Lots of people seem to be achieving glasses free most of the time and are happy.

My doctor seemed to be much more pessimistic about my vision when I met with him. He made it seem like I would most likely need glasses most of the time no matter what, and there are no guarantees of getting any outcome all that close to the chosen target. Plus he believed that I would have awful distortion between my two eyes and there wouldn't be really any option to help it, except getting the surgery on my good eye as well. That seems awful to me, because I may have years left before that eye gets presbyopia or a cataract bad enough to cloud my vision. And he couldn't really explain the why to what he was saying. So I can't really weigh out, does he just want to under sell and over deliver, or is he just a lazy surgeon that doesn't want to be precise enough with my new lens and thinks its fine just to adjust it all with glasses later, or is it just me having such poor vision to start with, that it really hurts my chances for a particular outcome? I left not really knowing what to do and I am meeting with him again next week to discuss my lens choices further, after I have done more research.

I really need some help from anyone else with fairly severe nearsightedness that has gone through getting a cataract surgery. How close was your vision to what you were going for? How is your range of vision without glasses now? Is it impossible to see with one eye fixed for distance and the other wearing a contact lens?

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26 Replies

  • Posted

    I am 71 and just had one eye done with an IOL. It was about -2.5 D or so with astigmatism before the surgery. When I was your age my eyes were worse, and in about the -4.5 D range. So, I can't really offer you any help based on experience with high myopia. I do only have one eye corrected, and can comment on that. When I first had the eye done I tried using a pair of prescription glasses with the lens removed in the IOL eye. That certainly did cause me some issues. I think the basic problem is that each eye can get the focus sharp, but the image size is different for each eye, based on where the correction lens is located. This is exaggerated when an eyeglass lens is used to correct a lot of spherical error, because it is located so far in front of the eye. However, I have found that correcting the non IOL eye with a contact to be very good. I do not get the dizzy effect when I use a contact. I believe the reason is that the contact is right on your eye, instead of in front of it. My thoughts would be to try the one IOL plus the contact on the other eye, before going ahead with the IOL for the second eye. I am not sure why the surgeon is dismissing that approach. She/He may be thinking of the one lens eyeglass approach and that does not seem to work.


    On the lens selection be aware that almost all lenses are 6 mm in diameter. As you are younger the chances increase that you will have a larger pupil and may have issues with light going outside the diameter of the lens. In higher correction powers the Tecnis IOLs reduce down to 5.2 mm which makes this issue worse. The other choice is the Alcon lens which retain the full 6mm diameter in all power ranges. This is something you should discuss with the surgeon while considering the power you actually need. Alcon is now making their lenses in a newer improved material called Clareon, and that may be a choice too.


    On astigmatism keep in mind that eyeglass astigmatism is the sum of the astigmatism in the lens (which can be impacted by the cataract) plus the astigmatism in the cornea. The two amounts can be offsetting or additive. When the lens is removed in cataract surgery that astigmatism is gone, and only the cornea astigmatism remains. You should ask what the cornea astigmatism measures at. If it is 1.0 D or more it is probably worth considering a toric IOL instead of the standard one.


    Hope that helps some.

  • Edited

    Hi Jennifer...

    I was -13.75 in both eyes until last week, with cataracts. I used glasses and contacts. Then I got PanOptix in both eyes, and now I’m 20/40 for close and far, and still healing. No glasses for anything. Hoping to improve further in the next month. Contacts vs surgery comes down to personal preference. But for me, not using contacts is an amazing freedom. My suggestion is to do both eyes since both are highly myopic and both have cataracts, even tho the right cataract is less developed.

    Perhaps your doctor is thinking, “Let’s just correct her vision now rather than taking half-measures that will inevitably fall short in a few years.” And of course, if you feel uncomfortable with your current doc, get a second opinion.

    Also remember, if you get an IOL monofocal, you WILL need glasses for near vision, unless you intentionally request an over-correct and essentially give yourself myopia again. One doctor told me about a jeweler he did this for, IOL monofocals with close vision that started at 10 inches. Remarkable.

    In any case, needing reading glasses for near vision in one eye while correcting for high myopia in the other may produce an unsatisfactory result. Perhaps you should do both eyes.

    • Edited

      Hello fellow high myope. We are the zebras in this forum. Do you mind if I ask how different your visual experience is with multifocals vs your natural lenses corrected with contacts? I've been a CL user my whole life, and I am nervous about the change. I had a vitrectomy which damaged my lens so I only need one eye done as well. Can you report if you wore a contact lens in between surgeries and if it was tolerable? As a high myope do you have large pupils, and has this negatively affected your IOL vision at all? I have had starbursts my whole life due to high myopia/pupils so I am used to them, but not sure if they would be even more amplified with a multifocal.

      Mind if i ask how your near vision was with -13.75? At -10.50 I am using +1.50 readers.


    • Edited

      I was wondering the same thing you asked author11.

    • Posted

      me too. i have same contact lens questions asked to author11

    • Edited

      Hi Lunabug...

      I had cataracts in both eyes starting about 10 years ago, so it’s hard for me to precisely remember and compare my vision now vs before cataracts when my natural lenses were clear and I was using contacts. From what I do remember, my vision now seems about comparable to then, but probably and realistically it’s slightly worse. Then again, maybe not. Here's why... Right now I’m 20/40 and still healing, hopefully vision gets better. I’m pretty sure that I was corrected to 20/20 with glasses in the good ole days. As I recall, contacts seemed less precise.

      I did both eyes with PanOptix at the same time, so my contacts became obsolete in one day. Starbursts and halos happen, but they're not a bother. They’re less noticeable compared to halos and starbursts with cataracts. I never used readers with contacts, tho I often used a strong light for reading in the last couple of years. And I don’t need readers with the IOLs. Clear vision begins at about 14 inches and extends to infinity. I’m one of those patients where everything went well, at least so far. It’s only a week into recovery, so the eggs have hatched, but I’m not yet counting chickens.

  • Edited

    I am in the same boat. -10.5 in both eyes with one eye possibly needing surgery. I'm a little older at 45 but have all the same concerns as you. I would get a second opinion, you have the right to fully understand the process and why a surgeon reccomends one option vs another. If you are located near a major city, I would seek out a cataract surgeon there.

  • Edited

    “My doctor seemed to be much more pessimistic about my vision when I met with him. He made it seem like I would most likely need glasses most of the time no matter what, and there are no guarantees of getting any outcome all that close to the chosen target.”

    What were the specific concerns he gave that he came to this conclusion

    I was nearsighted and wore contacts for decades, but not as myopic as you are. I always say don’t get a diffractive IOL if you have any other eye conditions other than cataracts or mild astigmatism. I do not know if server myopia is also a problem. Is there an issue with IOL size or IOL placement when dealing with severe myopic patients?

    My best guess and it is only a guess, if there are no other eye issues they should be able to hit your refractive mark. Now if you go around not using your contacts a lot and then hit hyperopia with the other eye that might be a shock to you.

    You might look at a doctor that uses the ORA refractive analysis machine to better hit your refractive mark or choose the Light Adjustable Lens.

    But my first thought is either get this doctor to explain in details exactly what your conditions are that will make it difficult to hit your refractive mark or find another doctor who will.

    “Plus he believed that I would have awful distortion between my two eyes and there wouldn't be really any option to help it,”

    Hmmm, I have 20/20 in one eye and not even 20/200 in the other eye and I am able to live with it.

    I can see where it might be an issue, but don’t agree 100% with the statement. Yes studies show people binocular implanted are happier, but that is a bit misleading IMHO and not really surprising. In general you will be happier if the 2 IOLs project the same or similar picture to the brain. But normally those studies are done when getting the same IOL in both eyes, so yes if you have a severe cataract in one eye and a mild cataract in the other and you get a PanOptic IOL in just one eye, it is not a shocker you will have better vision if both eyes had a PanOptics IOL (assuming you don’t have negative issues with that IOL).

    I suggestion procrastinating. If you can correct your distance vision to 20/40 (driving requirement) then I would procrastinate as new IOL and Lens materials are in the making. As Ron pointed out Alcon has the new Clareon. And if you wait long enough they might finally approve an actual accommodating IOL with a modular base. The modular base IMHO is actually more exciting as it keeps the capsular bag open, bye bye PCO and turns lens exchange into minor surgery.

    Worse case get 1 eye done, try various correction methods as needed, give some time to adjust and if vision produced from the 2 eyes cannot work in combination then you can always get the 2nd surgery.

    • Posted

      rwbil what does that mean " if there are no other eye issues they should be able to hit your refractive mark. Now if you go around not using your contacts a lot and then hit hyperopia with the other eye that might be a shock to you"?

    • Edited

      Worded quickly and not the best possible.

      Her doctor and the article Ron provided stated it might be more difficult to hit her refractive mark, in other words if they shoot for plano they could over estimate axial length and risk end up Hyperopic. And another article I read from Healio stated:

      "In addition to the typical cataract evaluation, care must be taken to accurately assess the retinal status and measure the axial length of the eye. Highly myopic eyes often have a posterior staphyloma, which can generate an erroneously long axial length when measured with the standard A-scan ultrasound. This would cause an error in lens calculations and residual postop hyperopia, resulting in an unhappy patient. "

      Also from that ariticle:

      "Myopic patients often use their natural nearsightedness, and if they are corrected for plano they need to understand that their ability to see a few inches away from their face will be lost. "

      So might be best to instead of shooting for Plano might be best to shoot for a more mypoic goal to avoid hyperopia.

  • Edited

    Jennifer, my situation was similar to yours, but my myopia wasn't as bad as yours. I was between -6 and -7 in both eyes (I don't have the exact numbers at hand). I had slight astigmatism. My right eye had a rapidly growing cataract; my left eye had a small cataract that wasn't ready for surgery.

    My doctor mentioned getting surgery on the eye with the small cataract that wasn't ready and I originally told him "No". He then told me that he wouldn't be able to do a full vision correction on one eye only. He said that there would be too much of an imbalance between the eyes, and the brain will never get used to it. He would give me somewhat better version (say -3 instead of -6) in that eye. I would still have to wear prescription glasses all of the time.

    My surgery last year was delayed due to Covid and the more I thought about it, I was not comfortable with the idea of only having a partial correction done. I called him up and told him I wanted to have cataract surgery on both eyes. (They were done one month apart). My lenses are plain, non-toric lenses by Johnson and Johnson. I am very happy with the outcome. I have 20/20 vision in one eye, 20/40 vision in the other eye, and 20/20 vision with both eyes. I no longer have to wear prescription eye glasses all of the time. (I've worn glasses since I was eight years old). I don't need to wear glasses to drive or to use my lap top. I use readers for my phone, reading books, etc.

    Medicare paid for the surgery in my left eye with the small cataract because once my first eye was corrected, I had an imbalance as the doctor said. But I had told him that I would pay for it myself if Medicare didn't cover it.

    I am 72 years old. I already had presbyopia, so that did not factor into my decision. Your doctor is right about the imbalance between your eyes, if you don't have surgery on the other eye. After I had the surgery on my first eye, I had nausea and headache because of the imbalance between my eyes. That happened right after I had my surgery (the same day). I had to wear a patch on the eye that wasn't operated on for a month until I had the surgery on that eye, so that I wouldn't get the headache and nausea.

    My recommendation to you is to get both eyes done, rather than to wait for the small cataract to get bigger. But also, I think you should go to another doctor and see what another doctor says.

    • Posted

      hello, i am having the sane issue where one eye is operated on and now have a hard time balancing. My surgery was 13 days ago. I am high myopic about -11 ij both eyes. Now wearing a contact lens in the unoperated eye, my eyes are imbalanced. i occasionally will have nauseated feeling. My question is: does the second surgery really will balance out my eyes? I an really frustrated as I am 49 and still need to work!

  • Edited

    I did a little more research into IOLs for high myopia. It seems the biggest issue is measuring the eye accurately and getting the normal formulas used for calculating power adjusted to get an accurate result. There seems to be a few different adjustment methods used with varying degrees of accuracy. It may be worthwhile trying to find a surgeon that specializes in doing cataract surgery in those with high myopia. This is perhaps why the surgeon you went to is guarded on accuracy and need to wear glasses after surgery. On the power issue I mentioned before it seems that a high myopia eye requires a low power lens, and sometimes even negative. One of the issues is selecting a lens that can go as low as you need. Here is an article to google to get a more in depth explanation.


    EyeWiki High Myopia and Cataract Surgery

  • Edited

    I am 53 and having both eyes done in the next 4 weeks, 2.5 weeks apart. Before cataracts my prescription was in the -6D range, which has rapidly progressed to -12D over the past 9 months. I have spent weeks reading journal articles and clinical studies and everything else to make my lens decisions. Here are some pointers:

    • The myopia is a secondary effect. The primary cause you care about is your "axial length" (AL). That can be hard to measure when it gets abnormally long (mine is about 28mm). Ultrasound is less accurate than laser. If you can, find someone who uses a Lenstar or IOLMaster. Ideally get a doctor to do your eye measurements first, and then use those as the basis for future decisions. Your current prescription (both sphere and cylinder) is really irrelevant - after all you're going to have that lens removed. What you care about is what's left - your basic eye geometry and your cornea shape. Don't worry about toric lenses until you know what your corneal astigmatism is.
    • There are a wide variety of formulas that are used to convert eye measurements to IOL power. All of them do well with "normal" eyes, but most go haywire with very long or very short eyes. Make sure your surgeon is using the Barrett Universal Formula II (or, maybe, a combination of Barrett and SRK/T if they know what they're doing). Barrett works well for extreme myopes, usually getting the power right to within about 0.1D. SRK/T does only slightly worse, erring up to maybe 0.2-0.3D in the direction of hyperopia.
    • The more "unusual" conditions you have (extreme myopia, extreme astigmatism, glaucoma, retinal detachment, etc. etc.) the more you should go for the simple lens. A friend is the head of ophthalmology at a major university (but not local so not my surgeon), and I called him up to ask his advice. As soon as I told him my AL he said to not even think about a fancy lens like Vivity, that I was guaranteed to be unhappy with the results. Of course this won't be universally true, as the guy in this thread with the PanOptix showed.
    • I'm about to suffer the problem with one uncorrected eye for 2.5 weeks, with a 12D difference between eyes. From what I've read elsewhere, apparently I should basically plan on throwing up the whole time. I'm planning to always use a patch over one eye or the other, but we'll see how it goes in reality.
    • I don't blame you for not wanting to do the "good" eye until forced. If you can tolerate a little downtime, I might get the bad eye done, then try a contact in the good eye and see how well you tolerate it. If you can't stand it after a few weeks, schedule the second surgery.

    Regarding this particular surgeon, get a second opinion. There is nothing worse than having a surgeon you don't have confidence in. If you can afford it, and can find one that uses the latest technology (including ORA), you will have a better result. Also find one who really cares about getting it right. I know people who had their eyes measured 5 times because the results just weren't consistent enough for the surgeon.

    Good luck!

    • Edited

      Excellent post. You are obviously well prepared for your surgery. I would not discount using a contact in the non operated eye as an interim measure. The contact is located very close to where the correction is needed, especially if the error is in the cornea, and should produce similar results as the IOL does. I will go a long time between eyes and wear a contact or a pair of progressive glasses which fully corrects both eyes. I prefer the contact even though it only partially corrects and leaves me with some astigmatism.

    • Posted

      Excellent Post

      " I know people who had their eyes measured 5 times because the results just weren't consistent enough for the surgeon."

      That's me (not surgeon) and make sure you do it before your cataracts are too bad if you are going to wait and double make sure you keep a copy for your records.

    • Posted

      Thanks guys 😃

      I had my third biometry last night. I asked for it because I didn't like how much the first two differed in one eye. I finally have two that agree to within tiny precision (but still taken 3-4 weeks apart) so my confidence has greatly increased (and my stress decreased!). I just can't emphasize enough how important it is to feel like you understand what's going on and that you trust your surgeon to be doing the right thing. You're the one who's going to have to live with it for the rest of your life, after all.

      I'll report back after my surgery next week.

    • Edited

      OK here's my interim report. I had surgery just under two weeks ago on the right eye (left eye is coming up next week). My implant was the AcrySof IQ monofocal 1.5 D toric at 11.0 D. Target was -0.33 D with no astigmatism. It took a few days for things to settle down, but by day 4 or so I was seeing 20/20 at 20 feet, 20/15 at 15 feet, 20/40 at 3 feet, and 20/100 at 18 inches. It hasn't changed much since then. My autorefraction at one week was 0.00 SPH + 0.25 CYL. I'd say we pretty much nailed it. I certainly can't complain about the distant vision. Stars are perfect points with no distortion and I can see the various parts of airliners flying far overhead. There were dysphotopsias for the first day or two but they went away; now there's just a little bit of glare if the incoming light is at just the right angle.

      Having only one eye done, the other eye (with a -11 D prescription) is essentially useless. I haven't even tried to remove one lens from a pair of glasses. Instead I either don't wear anything, or just wear a patch over the "natural" eye for distant vision. My brain mostly ignores the completely blurry image although it does get a little distracting over time. For computer or reading, I wear cheap readers I bought off Amazon with a piece of paper taped over the "natural" eye. I'm really glad I'm going to get the other eye done soon. Only having one working eye gets old really fast.

      The other thing that's really hard to get used to is being farsighted. It's great being able to walk around without glasses on, but then you realize you can't read the buttons on the microwave or the labels on a pill bottle without finding your reading glasses. I can at least read the car dashboard without glasses, though.

      The left eye is targeted about -0.60 D, so just slightly more nearsighted. Experimenting with glasses I don't think that will significantly hurt distant vision, while it should give me just a bit closer reading without glasses. I'll let you know how it goes in a couple of weeks.

    • Posted

      It sounds like you got an excellent outcome. Have you considered using a contact in your non operated eye? A place like Costco may give you some samples to try for free. Probably no point in buying some for such a short period of time.

    • Edited

      Unfortunately I can't wear contacts. I've tried many times in my life - hard, soft, disposable, extended wear, every technology they invent. I have some sort of allergic reaction, and my eye coats the contact with opaque protein in just a few hours, and then I have conjunctivitis for a few weeks. It's really annoying.

    • Posted

      That is unfortunate. They are the best solution to a high differential between the eyes for necessary correction. But in the larger picture it is only a temporary problem until the second eye is done.

    • Edited

      Left eye done Tuesday. One-day follow up auto refraction shows 0.00 SPH, 0.50 CYL. Now three days post and no longer dilated, and I can see 20/15 in both eyes at 20 feet. I expect the astigmatism to recede over time as the inflammation goes down, as happened in the right eye (currently 0.00 SPH, 0.25 CYL). I had targeted -0.58 in the left eye, so 0.00 is pretty far off, but with the right eye I was initially about +0.50 farsighted and that went away after a couple of weeks, so I'm hoping the same will happen with the left and I'll end up with -0.50. Near vision is lousy. I can't use the computer or look at my phone without readers. I don't understand how some people end up with perfect far AND near vision. It doesn't seem like the physics should work out that way. But it certainly didn't happen for me! I miss my near vision, but I'll get used to having readers in every room and every vehicle.

      Back to Jennifer, it is quite possible to have great results even when extremely myopic to start. Just choose the right doctor and stay deeply involved in the selection of lens and power.

    • Edited

      I didn't get an accurate refraction on my IOL eye until the 6 week mark, so I can't comment on how my vision changed in the weeks after the surgery. I see 20/20 plus a few letters on the 20/15 line, so distance is fine. The last refraction I had was 0.0 D sph, -075 D cyl. I can start to read a computer screen at about 18-20", but that is too far away with my monitor size to be comfortable. I can also just start to read my iPhone 8+ at full arms length, but again not comfortable. I think I get some of this reading ability from the -0.75 D astigmatism. I initially was interested in getting LRI to correct the astigmatism, but have now decided that I don't mind it.


      I still plan to target about -1.25 to -1.50 D myopia in the second eye. My contact simulated -1.25 D myopia is working very well for me. I would think -0.6 D would give you some closer vision, and possibly enough for a larger computer screen, but may be pressed to read normal size text on paper.

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