Cataracts at 32 after chemotherapy and decisions on surgery

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3 years ago I finished treatments for cancer and two weeks ago I was told I have "spiral-shaped" cataracts in both eyes and the doctor suspects they are from chemotherapy. I have high degree myopia that never really has stabilised (it is -7.25 diopters each eye) and can be corrected to 20/30. I have worn prismatic lenses for the last two years to be able to read or do any near work at the computer and such.

I've always associated cataracts with aging and so many co-workers and family members have been through the surgeries without complaint that I assumed I'd simply be able to have a new lens implanted in each eye and that was that. Done!

I don't see much of anything at night (except for bright lights) now not even with glasses or my contact lenses in and have had to stop driving. The glare from the sun at particular angles around dawn and dusk is overwhelming and I cannot keep my eyes open and there is also quite a lot of a halo effect around streetlamps. He said this is due to where the cataracts are forming which is on the periphery of each lens though one side it affects the periphery and a slight amount of the center.

I cannot understand why he feels I am not a good candidate for this surgery. Not that my insurance would even begin to cover any of the cost yet anyway. Apparently they only will cover removal of much larger cataracts only regardless of how thr affect your vision. I was told that I only could have artificial lenses that would be set to correct my distance vision and that as a result my near and intermediate sight would be significantly affected and likely not correctable with any sort of lenses.

This surgeon is my second opinion and the first doctor told me nearly the same as this one. But I have read many many stories of people with much greater levels of myopia than myself who have had good results. I don't know anyone who has lost near and intermediate sight that cannot be fixed with simple reading glasses.

He tells that should I decide against surgery I'll become legally blind which I'd much rather not have happen! Yet if I have surgery I may lose all ability to do near work (with my job being heavily computer-dependent, this is not an option I'd rather choose either!). He said the sort of cataracts affecting me would cause legal blindness but not affect close work any more than it is already affected. And I asked him so what do I do? I have a bit of time to decide, a year or two, but I thought why not, and came here to ask of others' experiences. Do you have any ideas on what I have been told?

ETA: By second opinion I mean as in surgeons. My regular doctor I see for yearly eye exams made the initial discovery of cataracts and I did not like what he said, nor what the first surgeon said. So, when I heard it yet again from this surgeon, I thought perhaps it's not the doctor who's wrong here!

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  • Posted

    Not sure where you live or your personal financial situation but based on your info unless it is a financial decision there are options for premium lenses that give you far and near vision. Symfony lenses. I am 46 and had both eyes done and am reading and writing this on my mobile galaxy. Also distance is good.
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  • Posted

    Ask them about the possibility of having lens that are under-prescribed, or having just one lens under-prescribed for your close work and the other lens for distance

    CarolĀ 

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    Unfortunately insurers do differ in their coverage of cataract surgery. It used to be standard that they only cover it once vision can't be corrected to 20/40 since that is the level required for driving.  Recently some have begun to cover it if there are visual impacts like night driving problems due to the cataracts (since of course that increases the risk of accidents), but that isn't yet standard.

     You are right that after surgery (unless there is something really unusual about your case that I can't imagine) you should be able to correct intermediate and near with glasses (or contacts). If you have good vision at distance, then a lens can adjust that focal point to other distances. Or you could opt for a premium lens or monovision to give you better near vision during surgery.

    The level of myopia has nothing to do with the surgical results after cataract surgery since the artifical lenses they implant come in a wide range of powers.  I was more myopic than you in one eye, a bit less in the other, and after having Symfony lenses implanted I have almost 20/15 vision at distance and 20/25 at near, and reading glasses work fine if I need to thread a needle or something really near. 

    I'd suggest attempting to get them to email an explanation as to why they claim you wouldn't be able to get your intermediate&near vision corrected after surgery with lenses, if they claim there is some other eye health issue perhaps that you hadn't mentioned. Sometimes in a stressful doctors appointment people can naturally become distracted thinking and miss a few words.

    re: "the sort of cataracts affecting me would cause legal blindness but not affect close work any more than it is already affected. "

    Hopefully he merely didn't explain that well, since that seems questionable. I'm assuming that like other kinds of cataracts, that these will eventually cloud the entire lens, even if they are proceeding from the edge inward. How long it takes for cataracts to develop varies greatly, it can take decades... or months or even weeks.  It may be that it will merely affect your peripheral vision at first and allow a narrow window of good vision in the center that you can use for reading, but eventually they'll reduce that vision. 

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    Your degree of myopia (-7.25) is what I'd consider moderate, not high.  Why were you only able to be corrected to 20/30 before?  Are there are eye issues, perhaps astigamtism?  That can be corrected with glasses or contacts as well, so I'm puzzled.

    To echo what others have said, unless there are other eye problem (aside from your inherent myopia and now cataracts), you should be able to get standard replacement lenses and use glasses or contacts to provide good reading and intermediate, or have standard replacement lenses with monovision (one eye corrected for distance and the other for near) and have decent vision at most distances, or choose premium replacement lenses that can provide good visian at multiple distances.  There are three main types of premium lenses, which cost a few thousand dollars extra per eye: multi-focus, where the lenses have two or three zones providing near, distance (and if three, intermediate) focus; pseudo-accomodating, where the lens is hinged and moves to provide some ability to read; eand xtended range of focus, an option that's been available for some time in Europe but is newly approved in the U.S.

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