Cataract surgery with high nearsightedness

I am very near sighted and had my first eye done one week ago.  I am thankful that my doctor is conservative, and it appears he helped prevent possibly serious complications.  He recommended that I go to a retinal specialist to be examined before the surgery and it was discovered that I have retinal thinning in the eye that does not have an advanced cataract.  For that reason the surgery in that eye is delayed.  In addition, in that eye, the vitreous gel has not separated, and it is recommended that I wait until it has separated to do the surgery.  As my doctor put it, we are just going to hope it separates before the cataract in that eye is so bad that it interferes with my vision. Also, in my surgery eye I will see the retinal specialists four weeks after my surgery to assess the health of my retina.  I  also learned that as the gel separates, it can tug on the retina which can then tear it. So now I  know that the non-surgical eye is at risk and to get to the doctor quickly if I have symptoms.  

 The problem with only doing one eye when you are severely myopic is that the eyes have trouble working together.  The solution for me is to wear a contact in the non-surgery eye to make it match the surgery eye. I have found that mono-vision is also somewhat satisfactory, so I feel that I have several workable options for correction.  Because of the lack of accommodation after cataract sugery, I would delay surgery as long as reasonable. Finally, I really struggled with whether to correct for near or far.  So many people correct for far, but I love my near vision and use my smart phone a lot.  My doctor recommended that correct for near.  It does require that I wear glasses, but I have many options for how to correct my eyes and don't mind glasses at all.  I am thrilled with my bright, clear near vision. I also went from -10 to -3 in my cataract eye, so ironically I'm pretty pleased with my new vision in that eye, even though I am still near sighted. I also learned that when both eyes are done, my glasses will only be one third as thick as the old ones which I feel is a major improvement.  I fretted about all this a lot, but feel that I ended up in the right place for good vision going forward.

 

PS.  I started my cataract journey with a doctor who never did a great job answering my questions, didn't recommend a retinal specialist despite my high myopia, and made me very concerned.  It was upsetting, but I canceled the scheduled surgeries and changed doctors. I am so thankful that I did, and I would not worry about inconveniencing your doctor. You are making a pretty big decision for your future and if you aren't ready, then wait. I agree with everyone else....don't have the surgery until the cataract is preventing you from having satisfactory vision.

No surgery is without risks, including laser surgery, however the vast majority of patients have great results with cataract surgery, or "refractive lens exchange"/"Clear lens exchange" as its called when done for people without cataracts. What you need to remember is that even if only a minuscule fraction of patients have trouble, they are likely the ones that will be reading an online forum and posting and so you will get a skewed impression of the results. They are a reminder to take the risks seriously, but if you have cataracts then you will need surgery anyway at some point. You said at first you don't have much vision impairment from them, but another posts says the doctor indicates you qualifiy for surgery which suggests your vision may be more degraded than you realize compared to how it could be, and it may not be too long before you'd want to get surgery anyway. I think those with bad eyesight often don't notice when their vision gets a little worse at times. 

 So there is a tiny risk you'll have a problem you'll live with a few more years than you would otherwise, and greater odds you'll have good results that you'll have more years to enjoy. That said, you do need to be prepared for the risk of a problem. 

The evidence is actually not conclusive regarding how much of a risk factor high myopia is for retinal detachment after catatact surgery. If I include a link the message will get sent to the moderator, but if you google for this article: "'Cataract surgery not apparent risk factor for retinal detachment in highly myopic eyes, study finds "  you'll see that they noticed a problem with prior studies. Studies for retinal detachment after cataract surgery showed that people with high myopia had a greater risk of retinal detachment. However people with high myopia have a higher risk of detinal detachment even if they don't get cataract surgery. Their look at the data suggests cataract surgery may not change the risk of retinal detachment much. Unfortunately many surgeons don't keep up with the latest papers, and the issue is still being researched so I wouldn't rule out some added risk.

 It  partly depends on issues like whether losing accommodation, the ability to see near, is a big deal to you. You don't give an idea of what your age is, the question being whether you are already dealing with presbyopia, losing the ability to see near.  If you are, have you tried contact lenses with monovision to see if you can adapt to it before you try it with IOLs? The cataracts may be impairing your vision too much to give them a good test, otherwise it would be useful to see whether you like monovision. Alternatively if you have presbyopia already you could try multifocal contacts to decide if you like them to see if you'd consider risking a multifocal IOL (which most people have great results with, but has a risk of halos at night). Unfortunately premium lenses  like multifocals or the accommodating Crystalens are more expensive than monofocals, but since you say you are "not a candidate for lasik" I'm guessing you were considering spending money on that so they might be an option in your case. I also don't know what country you are in (this is an international site), there are newer IOLs available outside the US that are better in various ways, like trifocals and extended depth of focus lenses. I had my cataract surgery done at age 52 a year ago and since I figured I'd be living with the results for decades longer than the typical cataract patient, I   went to Europe to get the new Symfony lens (not approved in the US yet, they are waiting on FDA approval now), which studies show has a risk of side effects comparable to a monofocal but gives good intermediate and more near vision. (I'm almost 20/15 at distance, and 20/25 at my best near distance). 

The major risk for highly myopic people is that they have a harder time selecting the right lens power.  There isn't an exact formula for what lens power someone will need, they use formulas based on your eye measurements that are essentially an educated guess based on statistics on prior patients. For various reasons there seems to be a higher risk of errors for more myopic patients, partly I'd guess because there aren't as many high myopes so there is less data, though its partly they suspect some errors in the measurements they take for high myopes. 

Usually if they don't get the power exactly right, it isn't too far off so either you won't need to wear correction since its close enough, or it'll be minor correction, or you might be able to get a laser enhancement. Even if you aren't a candidate for lasik for high myopia, if the error is only -1 Diopter or something instead of -14 diopters then you might be, most people can get laser tweaks afterwards (or they can, with added risk, swap lenses or add a piggy back lens).

 I do have a rare side effect from surgery (flickering light when reading close up, likely due to my iris moving) that hasn't yet gone away, though its slowly improving and my vision is great otherwise, but its perhaps one out of tens of thousands or more surgeries or rarer (they don't have statistics on it, thats a guess based on doctor reactions)  so I keep it in perspective that I'm very atypical and most people get great results.