Only need cataract surgery in one eye. What to do?
Posted , 12 users are following.
I am 53 years old and have a severe cataract in my left eye as a result of surgery to fix a macular hole. The cataract formed very quickly as I am only 7 weeks post op. I have no usable vision in that eye from the cataract (can't even see the first line of the eye chart) and my retina specialist tells me I need cataract surgery within the next couple of months as he can't see back into my retina and of course I would like my vision back.
My right eye is perfectly fine (thank goodness) with better than 20/20 vision corrected. I've worn glasses for myopia since grade 4. I have primarily used multifocal contact lenses in recent years with good success. My glasses prescription before surgery was:
Left eye: -7.00 (dominant)
Right eye: -5.75
with 2.25 ADD both sides and no astigmatism
My retina surgeon says once I get my cataract fixed I will need the other lens replaced soon thereafter as the prescriptions between the two eyes will be too different (assuming they correct to plano). The other option would be a contact lens for the right eye. My right eye is healthy with no cataract at all.
My choices as I see it are:
Get both eyes done: Pros - less reliance on glasses (type of lens choice is another discussion but thinking of Vivity). Cons - risking surgery on my good eye by exchanging a perfectly good lens.
Get my left eye done to plano and leaving the right eye alone: Pros - no surgery on the good eye or delay surgery to some other point. Cons - stuck with using a contact on my uncorrected eye. Not sure if glasses are an option when prescriptions will be so different (plano in one eye and -5.75 in the other). Does anyone know?
Get my left eye done to a similar prescription as my natural state (or similar to my right eye such as -5.00) with a monofocal IOL. This puts me kind of like how I was before surgery. Pros: no surgery on the good eye. Cons: continue to wear glasses/contacts like I'm doing now, but missing an opportunity to have my vision corrected.
It's a tough decision, and I have to remember any option is probably better than what I am dealing with now. I'm curious if anyone reading this has had any similar experience?
Thanks for spending time to read this.
0 likes, 20 replies
Night-Hawk dale65885
Posted
Yep if your eyes Rx is different by more than about 2.0D then glasses wouldn't be a good option - could cause headaches and other issues due to the image size between the two eyes being too different. A contact lens is much closer to the eye so it doesn't change the image size as much, so thats why thats the only option besides getting an IOL in both eyes.
You could start with just the one eye cataract surgery and try a contact in the other eye for the couple months it takes for the eye to heal completely after surgery. If you get used to that you can stay like that, if not then you could consider the other eye surgery.
dale65885 Night-Hawk
Posted
Thanks! Interesting about not tolerating glasses when the prescriptions are so different. I'll likely try contacts for the non-operated eye for a while and see how it is tolerated and go from there. I am a long time contact lens wearer so I'm used to them but it's always nice to have the glasses option at the end of the day when the eyes are tired. Still wondering whether getting a prescription for my IOL that's not plano at close to my good eye prescription is a reasonable option.
Pascal111 Night-Hawk
Posted
I have Vivity in both eyes, in one eye for 2 years. The result was excellent and was discussed at congresses worldwide. Look at these two articles, one of them is about my case.
Vivity 1st eye for plano. 2nd eye only if necessary. Then you still have all options. I wish you success!
Items Search:
Google these words
"non-diffractive extended range-of-vision IOL Khoramnia"
soks dale65885
Posted
nothing compares to the natural eye however much the myopic correction.
dale65885 soks
Posted
Yes I hate to have an operation on a good eye in case it gets screwed up. But stuck with a contact lens and no glasses option doesn't seem very appealing either!
RonAKA dale65885
Posted
That is a bit of a dilemma, and I think you have the options with pros and cons well identified. I went about 15 months with one eye done and not the other. However my eye differential was in the 2.0 D range, not 6.0 D. I used both prescription progressive eyeglasses and as an alternative a contact in my non operated eye. The contact in the non operated eye was a preference other than the inconvenience of using contacts.
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Option #1 is probably going to give you the best vision, but has the downside of better lenses coming along in future that will require an exchange to take advantage of. I think my thoughts would be to go with one IOL and a contact in the other eye until you get tired of it. Perhaps a procrastination option #4! Then go with an IOL in the second eye.
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You may want to look at this thread which talks about a special IOL for macular issues.
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https://patient.info/forums/discuss/implant-of-special-maculopathy-lens-during-cataract-surgery-786260
dale65885 RonAKA
Posted
I like the procrastination option as I tend to be a procrastinator at heart! The fact of the matter is I have to get the bad eye done whether I like it or not and I will have time to think further about my options with the good eye. There will always be better lenses developed and maybe it's to my advantage to wait. In the next few weeks I'll have to decide on the best lens for my situation. From what I have read it might be best to go with a monofocal and avoid diffractive lenses such as Panoptix when there is macular pathology although from what I understand my macular problem is not that severe. Vivity might be a good compromise. I am not accustomed to reading glasses as I've used multifocal contact lenses in recent years. My job relies heavily on computers and my phone.
Thanks for the link!
vasily48550 dale65885
Edited
I also had cataract in the left eye only having highly myopic right eye (-7.5D contact lens, -0.75 cyl.) Now I have Eyehance IOL in the left eye set for intermediate vision. I am very happy. I prefer wearing glasses when driving and going out, but I can do fine without them.
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One of the ophthalmologists I talked to before the surgery also said that I'll have a problem with the second eye because of the large difference in the prescription (anisometropia.) Two others said that I'll do fine with a contact lens. Well, I do fine.
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However, it may be true that if you want Vivity than it's better to have it in both eyes, according to what I read on this forum.
dale65885 vasily48550
Posted
Thanks for replying. Your situation sounds similar to mine. So your surgeon set your IOL so you are moderately myopic (set for intermediate vision) and you've left your right eye alone? I'm also considering Eyhance and am glad you have found it to be a good lens. It's interesting that you can do fine without glasses some of the time with your right eye at -7.5 uncorrected and your Eyhance. Do you know approximately your current prescription difference between your 2 eyes?
Sounds like glasses are a no go if the prescriptions are quite different but you have found it to be OK sounds like. Are you still wearing contacts some of the time?
I have not yet had my appointment with the cataract surgeon so I'm sure he will have an opinion but I want to go into the appointment informed,
Appreciate your help!
vasily48550 dale65885
Edited
Hi, I am sorry for the late reply. I almost always wear a contact lens on my unoperated eye. Without it my right eye is virtually useless. I can’t use glasses for the unoperated eye because the lens has to be very powerful, which makes the image in one eye substantially smaller than in another. Sometimes I also wear glasses. Thus I have optional glasses for the left eye, and the must-have contacts for the right eye. This might sound like a hassle, but I don’t think I suffer any inconvenience.
Guest dale65885
Posted
One IOL + Contact. If it doesn't work out you can still get the second surgery but I would be in no rush to operate on a perfectly healthy eye.
dale65885 Guest
Posted
Yes I'll start there. I already wear contacts so won't be hard to do. However not sure I like not being able to wear glasses with the Rx difference. Anyway I have time to decide and we will see what the surgeon thinks when I see him.
Sue.An2 dale65885
Edited
i had cataracts that needed surgery at 53 so no option for me except 2 IOLs.
If it were me I would opt for 1 Iol and use a contact for the other eye. i'd go for a Monofocal lens for best corrected distance. Some people get surprisingly better than norm intermediate vision with a mono focal and you may be in that category. If you don't get enough close vision when you need to do the other eye you could opt for another monofocal targeting intermediate vision or look at another IOL that has a eider range of vision. The monofocal would mitigate the halos and glare of that new lens. Waiting allows time for newer and better IOLs to come to market - another benefit of waiting for 2nd eye that doesn't need surgery now.
Good luck to you.
dale65885 Sue.An2
Posted
Thanks! I appreciate the advice. I think my goal is to aim for the best possible distance vision with my bad eye and a monofocal will be likely be the best way. I'm still not 100% sure what is going on with my retina (as I can't see because of the cataract) and I fear if I go with a refractive IOL or EDOF and I'm not happy I won't know if it is my retina problem or the IOL.
I can't imagine doing surgery on my good eye but my hand might be forced if I can't tolerate the contact all the time. I agree newer IOLs would be worth waiting for.
I appreciate you taking the time to write.
Guest dale65885
Edited
I would just point out too that any retinal pathology would probably rule out a multifocal anyway although Eyhance would be ok and maybe also Vivity (your surgeon is the best person to answer that)