catract grade 3

Hi,

Thank for the reply. I'm not sure how to read the prescription note.  It says Adjusted Left SPH -175 CYL -50 AXIS 140 VA 6/6 ADD +175.

Adjusted Right SPH  -025 CYL 075 AXIS 100 VA 6/6 ADD +175.

I'm not wearing glasses now as strangely my left and right eye seem to compensate each other. With both eyes open I can see near and far without glasses.

The 6/6 is the visual acuity I guess is in meters equivalent to the american 20/20.

The catract is the bad news. I told it looks yellow which means its Grade 3.

Made a mistake the left and right should swap and the CYL stated as 075 should be -075.

I was told my astig was 50 in one eye and 75 in the other. the 175 seems overpowered for short sight since I have my 30 year old glasses from collage at 100 and when I put them on my short sight is corrected well.

A catact can definitely change how myopic or astigmatic your eyes are. Some people see almost no change, in my case my problem eye went from -0.75D of astigmatism to -4D, then the astigmatism faded and instead the myopia went from -9D to -19D before surgery (which I postponed since my other eye remained 20/20 correctible and my brain just tuned out the bad eye). Even that initial astigmatism may have been the cataract, or merely abnormally high lenticular astigmatism, since postop I wound up with 0D of astigmatism in that eye without anything done to correct it.

 

Your eyes essentially have the equivalent of a bit of monovision due to the astigmatism. Astigmatism means that your eye has different lens powers at different angles, and since you have 0 sphere in both eyes, that means at least one part of the eye in each case is focused well at distance, but the astigmatism in your left eye is enough to blur things at all distances a bit. The other angles of your eye focus in further, in the left eye's case part of it focuses in as far as -1.75D which is the equivalent of +1.75D readers, though its average focal point (half way between the two) is less. Your left eye has a spherical equivalent of -0.88D (sphere + cylinder/2) which is like having +0.88 readers.

What matters is its impact on vision, not its grade which is based on its appearance. it seems its impact can vary quite a bit depending on its location and the person.

In my case I had a puzzling situation in the opposite sense. My best corrected visual acuity in one eye dropped from 20/25 to 20/60 in only about 3.5 months,  but my optometrist didn't  see enough of a problem with the lens to think the issue was a catarat  and referred me to an ophthalmologist to diagnose the issue. On the referral she merely referred to it as "trace nuclear sclerotic changes", and the ophthalmogist diagnosed it as a cataract (which eventually became more noticeably obvious to the optometrist before surgery).

Usually most government and private health plans don't cover surgery until visual acuity is worse than 20/40 or whatever the driving standard is. Some places I gather are starting to become more flexible and will cover surgery if the cataract is in some other way interfering with visual function in a major way. For instance even some people with good visual acuity with a cataract during the day have nighttime visual symptoms like reduced contrast sensitivity or visual artifacts from headlights that impede their ability to drive. 

 

Cataracts usually develop very slowly, mine was very atypically rapid, in addition to causing trouble at the atypically young age of 49. So there is no way to predict how long it will be before your vision degrades to where you'll wish to get surgery.

One advantage you have over many patients is still having good visual acuity so you might consider doing some research now to decide what to do when your eyes bad enough that you are ready for cataract surgery. After you have surgery, most IOLs don't accomodate at all, your eye loses the ability to change focus. The default lens covered by health plans is a monofocal lens, which when set for distance is like the level of presbyopia of someone elderly. Results vary, but I've seen doctors often suggest you should be prepared for vision to start to get blurry around 6 feet inward, though some tiny minority can do a bit of reading held out far, while others have posted about having vision start to get blurry around 10-12 feet. To balance that issue, some people get the IOLs implanted to provide monovision, one eye focused nearer in. The level of monovision people adapt to differs, but larger amounts of monovision are harder to adapt to since the brain has trouble merging the images and depth perception is reduced since its mostly using one eye for each distance. 

 

Other people get premium IOLs they pay for out of pocket which provide better vision at a range of distances, e.g. multifocal, extended depth of focus or accommodating lenses. 

Since you have good visual acuity now, you could consider doing a contact lens trial to test what level of monovision might work for you, or try multifocal contacts to see if that sort of correction might work for you. Even if you normally don't like contacts, it might be worth trying them temporarily to decide what sort of permanent correction you'd like after cataract surgery. (and if you haven't tried contact lenses recently, they are more comforable than they were a decade or two ago). They aren't perfectly accurate tests since the optics of multifocal IOLs is a bit different and better so you might like them even if you don't like multifocal contacts, but it might give some clue what its like. I liked multifocal contacts better than monovision since I noticed the improved depth perception, but many people don't. 

I don't know your age, but you  likely have a larger degree of accommodation left in your eyes than you will with a monofocal IOL so even the monovision test isn't completely accurate, but it'd give you some sense of things (better than your imperfect  monovision you have now without correction).

 

Your prescription explains why you are able to see well at distance as well as be able to read. Essentially you have develped monovision naturally where you are seeing well at distance with your left eye (the one with the -0.25 spherical correction) and at reading distance with your right eye (the one with the -1.75 spherical correction). The brain automatically picks the better of the 2 images in the 2 eyes. I used contact lenses for many years to achieve such monovision and now have the IOLs after cataract surgery to achieve the same effect. 

Thus, unless you have some other vision issues due to the cataract, I would suggest that you not have a cataract surgery. People would be happy to end up with your eye prescription after having cataract surgery.

Also, if you feel that you need to get prescription glasses to get somewhat better vision, I would strongly suggest not getting those with the prescription as written. With the significant difference in the prescription of the left eye and the right eye, there is a good chance that you may have slight double vision because of the resulting difference in image sizes between the 2 eyes. In your situation, if I were to want better vision with glasses, I would opt for correcting for astigmatism only and not have any spherical correction. Alternately, I would opt for getting the best prescription for reading with right eye and the best prescription for distance correction with the left eye (this will also give you essentially the same results).

Thank for the reply. It cleared up  things for me. Note that the optometrist I went to was at the eye glass shop not a medical clinic.

I'm 59 years old BTW.

I'm not using glasses at all currently. I have no issues at at functioning even at night. Do you think not using glasseswould be detrimental in any way to the short sighted eye since I do a lot of computer work? The astig is totally imperceptable to me as long as both eyes are open.

What worried me was the optometrist saying after the split lamp exam that the catracts were yellow. Does that mean that eventually I'ii see all things yellow? Currently I look at a white sheet of paper and it looks white.

Whould you know why my catracts are at Grade 3 and I see things clearly. ( Not complining just curious. )

 

If you don't have any vision issues and your eyes don't get tired or feel strained after reading or computer work without glasses, then you don't have to use any glasses. You can't do any harm to your eyes by not using glasses in that case.

Also, if you are seeing white as white right now, then there is nothing to worry about. It is possible that your perception of different colors is slightly different from what a normal person may see, but unless that color perception is critical  (as it may be for a painter or an interior decorator), it is not worth worrying about.

Regarding your improved ability to see close after develping a cataract, think of the cataract as a somewhat unclear prescription glass. If one puts on a pair of prescription glasses with a random prescription (as will happen if one puts on someone else's glasses), most of the time the vision will be worse. However it is possible that someone else's glasses will be just right. The same with the cataract effect! Thus, just consider yourself lucky!

By the way, you are not the only one with a positive effect of a cataract. My father also stopped having to wear reading glasses when he develped a cataract in one of his eyes when he was in his 70's.

thanks for the quick response.

Just curious - how long did the "good effect" of the catract for your father last. I hope very long.

I'm into 6 months of this effect which is why i got myself tested.

I'm going to start some supplement known to delay catract growth. I wont list the supplements in case the post gets stopped. Hopefully they work.

I was more concerned about the catract grading. I thought that if cartacts are at grade 1 or 2 then theres no issue. After Grade 3 you're in surgery territory and its just a matter of time. Is this wrong?

 

To answer your questions:

 In my father's case, the good effect lasted a few years. However, the period of good effect obviusly depends on how fast the cataract develops. Also, if the effect continues to be increasing nearsightedness, your capability to read at even closer distances may even improve a little, while that at intermediate distances, it may worsen. But why worry about it? When the time comes when you have to have cataract surgery, then go for it.

By the way, it seems that you have been able to adapt to monovision easily. So, try to achieve that (with the right IOL power) when you have the cataract surgery.

Cataract grading is not an exact science. Usualy a grade 3 cataract means that the majority of the pupil is covered by a cataract, which results in significant visual issues. But you don't have any significant visual issue! You should definitely see another eye doctor to get his/her opinion, but should hold off having any surgery until you feel a clear need for it. You can't do any harm to your eyes by waiting as long as you want to.

 

Hi

Thanks for the detailed informative post.

Would you be able to shed light on the following test. I was given a pinhole shade on each eye. When wearing the pinhole shade I could read the distant eyechart perfectally. Even the smallest last line. With either eye - both the lonsighted one and the shortsighted one.

Why is this do you think? And what does this test prove ?

As a side note, I discoverd there are eye drops in the market for pets like dogs and cats that clear their catracts rapidly. For some reason there don't seem to be any research on humans except statements like human trials would take years. In fact the eyedrops for pets that are sold are doped with a substance to prevent humans from using them.

 

Thank you for replying. I feel better discussing with someone about these things. All the best to you and your father.

Am glad that I may have been of some help.

Regarding your question on being able to see well with a pinhole shade, it shows that your retina and visual processing is fine: it does not say much about the eye lens focussing capability.

Without going through the details of the related physics, the smaller the area through which one sees, the greater the depth of focus; i.e. the greater the range of good effective focus aroung the point of best focus.That is true of even any camera. Taken at a small aperture, a picture will show the whole background and foreground around a person (point of focus) in a scene fine. If the same picture is taken at a very large aperture, the person will be in focus and everything else may be blurry.

A pinhole test is one indicator of your potential best corrected visual acuity, which meshes with your 6/6 vision which indicates the cataract isn't influencing your visual acuity yet. If you do a search for the "pinhole effect" you'll see more detailed explanations of how a pinhole works. There is actually one IOL, the IC-8, which provides a larger range of focus than a monofocal lens using the pinhole effect. The same company makes the Kamra corneal inlay which uses the pinhole effect to provide more near vision for people with presbyopia (or a monofocal IOL), which is implanted just under the surface of the eye (and can be removed if it doesn't work well).

I haven't seen any good head to head comparison between the IC-8 and the Symfony IOL which provides a larger depth of focus using different optical methods. Unfortunately   since the myriad pinholes in the IC-8 only let a subset of the light through they only implant it in one eye usually and I suspect it reduces contrast sensitivity. 

On the issue of why it is grade 3 but you still have good vision, consider the fact that outdoors with sunglasses you still have good vision, and a very light tint indoors like they put on some computer glasses doesn't tend to reduce visual acuity. So the mere fact that a cataract is visibly impacting lots of the lens doesn't mean it will necessarily influence the visual acuity, it may or may not, depending on how dense and irregular it is, how much it scatters the light, or merely changes the strength of the lens to make the eye more or less myopic. The cataract can change the refractive index of the lens, changing how much it focuses (like eye glass lenses with different materials with different refractive indexes are different thicknesses for the same power).

I think the eye drops for pets are usually ones known to not be very effective,but there tend to be less stringent regulations on marketing things that don't have a proven effect for animals compared to marketing such things for humans. There have been reports of early tests of some substances that have helped cataracts in some animal tests, but as you note it will take time befoe they are available for humans since they are very careful to be sure they are safe, that there aren't side effects that they just hadn't noticed in small trials. Anything biologically active enough to have a positive impact for some, may potentially risk having a negative impact as well. I tend to suspect they have had limited benefit or they would have found places with less stringent restrictions on human trials and then been touting the results and selling the drops via the net in a black market, or selling them for pets and touting the human evidence even before they are officially approved. I'd wait until there are actual decent human trials showing an impact before risking anyting. 

Its likely that the drops that show some impact  on animals are merely a starting point since they'll use that to hunt for similar substances that might work even better, and they'll need to figure out the appropriate dosage, etc.

Oh, and in terms of how it will impact your color vision, its like wearing blue blocking eyeglasses that some places sell for use with computers, which have a yellow tint when you look at them. There is debate over their utility, I don't think its worth bothering with based on what I've seen. A cataract does cause you to see less blue light than a healthy natural lens, though as you age the level of blue light you see is also reduced by the aging lens (the age related changes are now being referred to as "dysfunctional lens syndrome" if you wanted to look that up). The change happens gradually so most people don't notice colors being impacted, aside from people like artists who are particularly atuned to color perception. However after surgery the sudden change to a clear lens does lead some people to notice colors have shifted a bit due to getting more blue light.  Some IOLs actually let through some in the UV spectrum that even a young healthy natural lens blocks, so some people are able to actually see a bit into the UV spectrum beyond what is usually labeled "visible light".

There are blue blocking IOLs that block the UV and some blue light, but most surgeons seem to consider that an unnecessary marketing gimmick, though a minority do see some benefit. Based on my reading I wasn't concerned about it so I didn't bother with a blue blocking IOL.

Thanks for the advice. I guess I will see an eye doctor.

I'm not sure about grading catracts as well but at201 above has given a good reply to that.

Hope you're ok now. Stay well.