Posted , 16 users are following.
Hi All - i have high myopia ( minus ten point five ) i have been diagnosed with cataracts i am a sixty five year old female - i have been offered National Health Service ( free) cataract op here in the United Kingdom - any advice on plus factors of early surgery or should i wait ?
thank you for any advice here ?
0 likes, 31 replies
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Guest AFlower
Posted
Hi
If your eye doctor says your eyes are suited for the cataract surgery, there really is no reason to wait.
It all depends on how affected your vision is, it really is a matter of doing what feels right for you.
But it is a difficult choice, we all know the feeling, personally I only regret I waited so long, I am really happy with my new vision.
There are different types of lenses on the marked, there are also what is known as premium lenses, that can offer more independence from glasses, but premium lenses are very expensive and they do have more side effects as well, so they are not for everyone.
The surgery in itself is the least part of it all, it is really quick and painless, I think it is worse to go to a regular check at the dentist.
You will be instructed to use a lot of eye drops some weeks after surgery, I stopped with the drops 4 weeks after surgery.
And there will be some things you will need to get used to with the new lenses, but being highly myopic I am sure for you the surgery will be one of the biggest thrills in your life, you will be able to do a lot of things without glasses after surgery 😃
Sue.An AFlower
Posted
Hi Aflower - Danish has provided good info so won't repeat. As I have lots of family in UK and was actually over there this summer I am somewhat familiar with National Health.
If having the cataract surgery done by NH you will not be given a choice of lens (IOLs) as they use monofocal lenses. That means you will see perfectly at one distance and need glasses for other two distances.
Distance vision = driving, watching TV etc
Intermediate = computer distance
Near = reading
Most surgeons like to correct for best distance but you can request differently. Some near sighted folks like to remain so after cataract surgery and continue to wear glasses for distance. Hopefully at your consultation your surgeon will discuss this with you. If you have astigmatism there is a toric lens that can correct that. In my opinion worth paying the extra for those or you would need glasses for all distances anyways after surgery.
You can decide to get more range of focus with monofocal IOLs but having one eye targeted for slightly nearer. This would cover 2 distances and you would only need glasses for near or distance depending on your preference. This is called mini monovision. Eyes would be about .50 to 1.0 diopters apart. If you vision isn't too bad now you can simulate that with contact lenses to see if your eyes adapt well to that setup.
Premium lenses if you want to look into those you would need done privately and the total cost would be yours. These provide the greatest range of vision and often times you do not need glasses at all after surgery. Drawback to premium lenses you do have more glare and halos at night with them due to their design. Some people are more bothered by those than others.
Good luck to you. Welcome to cataract forums. We are here for you if you've questions pr just needing support.. None of is are professionals or doctors that I am aware of (wish some would join if they were faced with cataract surgery). But we are at various stages of this journey. I had my surgeries 2 years ago.
Guest AFlower
Posted
There is a negative to waiting, the longer you wait the more dense the cataract becomes. It is easier for them to remove it earlier than later.Everything else I would have told has been said so I wont repeat! Good Luck!
mak73 Guest
Posted
To elaborate it a bit. The more dense/cloudy the cataract become, the more difficult not only to measure your eyes but even check the state of your eyes. It doesn't let the light through in both directions so it is difficult to see what is going on behind the cataract.
cazms53 AFlower
Edited
I also have high myopia. At the time of my cataract surgery on my right eye, I was -13. I had surgery on my left eye five weeks later and it was -10. Because of my extreme myopia, my biggest fear going into the surgery was the increased risk of retinal detachment. I was so relieved and grateful that my surgery was successful with no complications. I had to see a retinal specialist prior to surgery and he advised me to not go with a multifocal lens so I choose a toric monofocal for both eyes. I did have to pay out-of-pocket for the toric option which was $1,000 per eye (seems to be a bargain compared to what others have said they paid). I also chose to go with mini-monovision with my left, dominate eye corrected for distance and my right eye for mid-range. This allows me to be glasses free for most of my daily activities but I do need readers for close vision. After years of not being able to see clearly beyond 6" from my face, I am amazed by my new vision. Good luck with whatever you decide!
Sue.An cazms53
Edited
A great outcome - perhaps best strategy to investigate AFlower.
Wasn't aware multifocals not advisable for those with high myopia. Learn something everyday!
cazms53 Sue.An
Posted
I don't know if a multifocal is not recommended for all high myopics or if there was an issue with my eyes that made me a poor candidate. I do have a retinal membrane. Maybe that plays into it?
Sue.An cazms53
Posted
Could very well be. Did read that calculating the power is more difficult for patients with high myopia so might be one reason to be careful of IOL selection. Often they have had refraction surgery already so it is important to get those pre-surgery results/mapping of the eye if possible for cataract surgeon to review.
mak73 cazms53
Edited
I also have high myopia (-15 and -10) and the first thing that I heard is that I'm not a good candidate for multifical IOLs because of this. When I asked "Why?" the answer was "because of higher risk of retina detachment". But then I asked "how come that the type of the lens impacts the risk of retina detachment?". No, really... the sizes and material of both types of the lenses are basically the same (well, they can be different, of course, but it is not a problem to find monofocal and multifocals of the same material and size). The procedure is also basically the same (correct me if I'm wrong). Why on earth it should have different physical impact on the retina? Then they have to admit that there is no difference. However, as far as I understand, multifical lenses gives less predictable results and high myopic eyes are also less predictable. It includes more difficulties with measurements and calculations. So the idea is that if you go with monofocals you can expect less surprises.
On the other hand, there are also surgeons who think that while the low and moderate myopic eyes are not good candidates for multificals, the severe myopic eyes are good candidates (although there should not be other problems with the eyes, including retina degeneration). The reasoning for this is - the advantages of new vision will be so huge comparing with high myopic vision, that they will outbid all (most of?) disadvantages.
So... After running in loops for few weeks trying to chose the lenses I decided to go with multificals after all. When we discussed the lenses with my surgeon first time he was also suggesting monofocals. But on the next appointment he agreed that multificals are probably not so bad for me. Let's see how it will work out. My operation is in 4 days.
Sue.An mak73
Edited
Best wishes for your upcoming surgery mak73. Look forward to your updates.
Guest mak73
Edited
Well Mak, you struck my nerdy side here, so sorry, but now I am going into nerd mode for moment 😃
Thing is, you are absolutely right.
I spend several hours each day for a couple of month reading about lenses, outcomes and everything I could find, I was kind of obsessed.
When you get to site 100+ in google search result, there comes up sites that nobody ever see, except me I guess.
I have seen slideshows from eye doctors congresses, where manufacturers explain to eye doctors, how they select patients for premium lenses.
And it has in fact little to do with eye conditions (in most cases) and a lot to do with protecting their brand.
There is a lot of money in these premium lenses, and the manufacturers will go a long way to protect their brands.
If I wanted to sell Rolls Royce cars, I would have to live up to whatever Rolls Royce demands, and at the same time as a seller, I would probably want to keep their good name for making the most money.
And you do this by selecting costumers you now will be happy with the product, don´t sell a Rolls Royce to a costumer that you know on forehand will not be satisfied, you would rather not sell that one car and protect the brand from unsatisfied costumers and bad publicity.
These lenses are the same, eye doctors are instructed to only sell them to people that will have good results, and to people that are not too demanding.
I have seen text that says, if you know on forehand that the costumer is hard to satisfy, only offer the costumer a monofocal.
Or if you are unsure of a near perfect result, offer the costumer a monofocal.
Added from my own opinion - regardless if the costumer might would be satisfied with less than a perfect result, it is not about the costumer, it is about their brand.
It is not only in the state of Denmark. that something is rotten, to almost quote Shakespeare 😃
So you are absolutely right, whether you go for monofocals or premium lenses, measurements are the same, it is equally difficult to hit target, lens are physically the same, risk for complications are the same, surgery are the same, it does not matter to the surgeon what lens he/she is installing.
That said, there are somewhat bigger contrast loss in the multifocals, and if your vision is really bad beside the cataracts, multifocals will probably not bee good idea.
And in worst case scenario, if you get a really bad retina detachment, that can not be sorted with laser as most can, then in few cases it may be necessary to remove the iol to fix the retina, and then you can loose the expensive iol, but I assume that would be the least concern at that point.
mak73 Guest
Edited
Damn! I knew it! This is a pure commerce after all. Thank you for confirming it. I'm also nerdy a bit but not as much as you, obviously 😃
As for the difficulties with measuring and calculating of high myopic eyes I'm still puzzled. I found it in few articles that looked pretty trustworthy (they didn't try to sell me anything at least). However I'm still not sure why the size of the eye should make a difference. I'm not on the level to understand their explanations yet 😃 I asked my surgeon about this and he said that this is not completely true. Yes, there are some difficulties but they know very well how to handle them and do precise calculations. Well... I can only hope that they really know how to do it.
soks cazms53
Edited
hi cazms, have you had PVD (posterior vitreous detachment) or the YAG? that combination can sometimes cause the epiretinal membrane.
i think the multifocal is not recommended for high myopes because the calculations for multifocal would be off if they suffered from a retina detachment for which they are at a high risk at.
at 65 at least the OP has lower risk of RD as the vitreous is naturally drained.
cazms53 soks
Posted
Hi soks...I have not had PVD or the YAG. I was 66 when I had my surgery.
mak73 cazms53
Posted
cazms53 may I ask you what you did with your left eye between the surgeries? A contact lens? How difficult is it to handle such huge difference between the eyes?
Hudsongrl mak73
Edited
my right eye is corrected to -.50 after cataract surgery
my left eye is -4.75
glasses are not an option as you will get double vision
i wear a toric contact in my left eye and no problems with eyes working together but i still merd readers
mak73 Hudsongrl
Posted
Thank you Hudsongrl,
yeah, I was told by one optician that glasses will give me a double vision. A contact lens is obviously an option. I just wonder how bad is it to be with one eye near to 100% and another <50% or even <20%?
cazms53 mak73
Edited
I was originally scheduled to have my second surgery one week after the first, because of the large discrepancy in vision between my eyes. However, that felt too rushed for me so I postponed it and was rescheduled for five weeks later. I thought I would be able to wear my glasses by popping out the right lens but quickly realized that would not work. I had worn hard/gas permeable contacts for 50 years so I had to go without them for a few months prior to surgery until my eye measurements stabilized. After my first operation, I did not want to risk changing my measurements by wearing my contact on the other eye so I just lived with that vision discrepancy for those five weeks. It wasn't as bad as I had anticipated...I could still function well with my daily activities and I could still drive...but after about the first three weeks, I was so over it and could not wait until my second surgery. It
mak73 cazms53
Posted
Got it. Thank you.
seeherenow49806 mak73
Posted
HI mak:)
Glad you followed your intuition!
I was also highly myopic > -10D by surgery date. I saw retina specialist before each surgery (which I scheduled 4 months apart) and was approved easily by him.
I believe it's true that surgeons prefer patients who will be most easily satisfied with the multi or EDOF lenses.
I chose a monofocal for near perfect distance in my dominant eye and a Toric Symfony (EDOF) in my non-dominant eye set for slightly nearer. Very happy with the results, now more than a year later.
Wishing you the best possible outcome!
mak73 seeherenow49806
Posted
Thank you seeherenow.
Zeiss AT Lara was implanted yesterday evening. Even though my vision with the operated eye is far from being perfect right now, my level of confidence that it will improve is pretty high.
Sue.An mak73
Posted
Looking forward to your updates on atLARA. Hoping all goes well with th healing. Has the pupil returned to normal size?
mak73 Sue.An
Posted
I've just shared my experience in "Why was EDOF invented if Trifocal is better?" thread (by mistake).
The last time I checked the pupil (few hours ago) it was almost the same as in another eye. I believe it should be the same by now.
JSue mak73
Posted
how did it work out for you? x
mak73 JSue
Edited
Wow. Long time... Hello everybody.
Well, everything worked out not perfect but pretty good for me. Both eyes were treated and have very good long distance and acceptable short distance sight. Now a bit more details.
Right eye. It is my leading eye and it was -15. The cataract was replaced with EDOF lens - Zeiss LARA. It happened in October 2019. The surgery and recovery went as expected. After few days (3-5) I was able to see all the lines. I could even read small texts at short distance with this eye but it was not easy, I must admit. The picture was very vivid and I would be absolutely happy but unfortunately it didn't work out very good with the side effects. In the dark I saw (and still see) not very wide but quite dense halos around sources of light (LED mainly). But I was/am able to drive a car. Since the main reason to go with LARA was the expectation to get less or no side effects it turned out that this decision wasn't fully successful. So I was very puzzled (again) about what to do with the left eye. My initial idea was to go with LARA + LISA. But LISA in theory gives more side effects then LARA so it was really tough and scary. This decision took me some time. By the way, after the surgery I used a contact lens for my left eye (it was -10). It was OK but every day I felt more and more that the left eye sucks big time comparing with the right one so I wanted to fix it more and more. Anyway, 8 months later...
Left eye. In June 2020 the cataract was replaced with 3-focal Zeiss LISA. The surgery also went good, but recovery took few days longer than after the first one. Nothing extra ordinary though. The sight was also excellent. Perhaps not as good as with LARA but it was definitely more than 1. It was also a slightly less vivid than LARA but it was really marginal difference. Short distance reading was much easier, of course. But what is most important - LISA gave me much less side effects. There are also some halos but they are much smaller and not so dense. It was a big relief and at the same time a bit of disappointment about LARA. Yeah... you never know how it will work out. My doctor was also surprised by the result but not much we can do about it now. Basically I've got more or less the same result as Danish Viking did. It's interesting that we live in the same area of Denmark (never met in person though) 😃
Last year I've got a secondary cataract on my right eye. It was treated with a laser. The sight we restored as before. I still can see all lines. The halos stayed the same after the treatment. I hoped that it may improve a little bit but it didn't happen apparently. However, it is hard to say since I already get used to it and do not pay much attention to it.
Last week my left eye secondary cataract was also fixed with a laser and you know what - I think it become even better than before. It is probably equal to the red eye in sense of sharpness and vividness of the picture. However now I've got some star-burst effect that I didn't have before (as far as I remember). Now I hope that it can be fixed by adjusting a bit the hole that the laser made. My control check is in November so we will see what the doctor will say.
Overall, I'm quite happy with the result. After -15 and -10 it is completely another world. Short distance is a bit a problem but I can read without reading glasses although I prefer to do it with glasses (+0.5 - +1.0 is enough). Yes, I expected a more from LARA but it is still very good lens. I get used to the side effects. It could be better but not a big deal. Would I pick LARA again if I had another chance? No. Two LISAs would be a better choice. However, who knows how would LISA behave in my right eye?...
Oh yes... The big discussion about multifocal lenses for high myopic eyes. I do not have any problems because of multifocal. Not yet, at least. (knok-knok-knok). Many doctors checked my eyes last year and they didn't notice anything suspicious. I fixed retina with a laser in both eyes before I proceeded with cataract replacement surgeries.
Ooh... It was long response. Hope it will be helpful.
Cheers.
JSue mak73
Posted
hello thanks for your reply
overall it sounds very successful at such high minus who would imagine such good results
Im glad
still not able to decide myself
prob must write separate post as im basically monocular
cheers
kind regards
j
RonAKA JSue
Edited
Yes, it would make sense to start your own thread and outline the situation. As I understand it from your previous responses in other threads you essentially only have sight in one eye and the other eye is highly myopic. And, your concern is that if you get corrected for distance you will lose your near vision.
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My first thought is that with only sight in one eye you should stick to the low risk options which is most likely a monofocal lens. Then you only have to decide on whether to go for; distance, intermediate, or close. They all have their pros and cons, and all will require glasses for at least part of the time.
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If you go for distance the biggest issue will be getting an accurate IOL power calculation. I would seek out a surgeon that has experience and is using one of the formulas most suitable for high myopia. If the surgeon can hit the target for good distance vision you might get away with being eyeglasses free except for close up, and then you may only need readers. Progressives would likely be better though.
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If you choose intermediate with say perhaps a -1.0 target, best vision will be at 1 meter. Distance will not be sharp, and you may need reading glasses for smaller print or in poorer light. I think you would likely end up needing progressives.
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If you go for close vision with say the standard -2.5 that is used for the add in eyeglasses, you will not need glasses for close activities like reading. However, you will need glasses for distance, and progressives would make the most sense.
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I don't think there is any wrong decision. They all have their pros and cons.
JSue RonAKA
Posted
thank you
this is so helpful