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
jeff36973 dale65885
Posted
Just curious to know what your final decision was. My concerns are almost identical to yours, at 56 having worn multifocal contacts for a long time and faced with a single cataract replacement following retinal surgery. My good eye is a little better thean yours at -4.00. I have thought about the same options 1,2,3 and am still on the fence. What did you end up with and how is it going?
greg59 jeff36973
Posted
If you can still tolerate contacts, I'd keep using one in the -4 eye until it causes problems (dry eye, inflammation, etc.) That will give you the best possible vision since your eye will accommodate to some extent while the IOL will not. Practically, this means you'll see better in lower light at a variety of distances with your contact lens than with any IOL. You can always decide to get an IOL if it doesn't work out....but once you're in an IOL, you can't go back.
I was in a similar situation with one posterior subcapsular cataract that I couldn't see out of at all My other eye was -5.5D, had a good start on a typical old-age cataract, but was still correctable to 20/20. I probably had another 5 years or so of good vision left in that eye. Unfortunately, I had to give up contacts several years ago because I couldn't get more than about 8 hours of wearing time in per day and they were causing inflammation around my cornea.
I was concerned about the loss of contrast sensitivity and other issues with the multifocals and Vivity. Like you, I'm young enough to need a couple of decades or more of use from an IOL but myopic enough to be at higher risk of eye diseases that could further reduce contrast sensitivity. I didn't want an IOL that just gave me a minimally acceptable level of contrast sensitivity today with no room to decline further with future eye problems.
I ended up with an Eyhance but strongly considered a standard monofocal. I targeted -1D and -1.3D and am pleased with the result so far (17 days since my 2nd surgery). A mediocre 20/20 at distance in most environments, can easily drive without glasses, excellent night vision, can read just about anything in bright daylight but struggle more with dim indoor light that with my natural good eye. That's why you should keep your natural eye for as long as you can wear contacts.
When I had just one IOL, I didn't have problems that some have trying to fuse images of different sizes in the brain that many people have. One eye saw clearly from about 15-25cm and the IOL saw from about 35cm to infinity so my brain didn't need to fuse the images. When not wearing the contact, you might not have problems fusing the images with just one IOL either.
Indianageo dale65885
Edited
Hi Dale,
Interesting dilemma. My advice would be to implant an EDOF like the Rayner EMV lens set to plano in the dominant eye and, for now, use a contact lens in the other eye if your doctor determines you're suitable. With the Raynor EMV lens you will get great distance and intermediate and possibly even some near vision. With the contact lens you could do a mini-monovision set up. I would not go with your Option 3 as I think you'd be blowing an opportunity to be potentially glasses free.
My thinking is that, sure, you have one "good" right (near) eye, but in my opinion it's not all that good if you're at -5.75D and can't see distance with it. Most people I think would choose to use glasses for reading over distance vision. So if you can get your dominant left eye successfully set at plano (or virtually so) then you're low hanging fruit when/if you decide to get the right "good" eye implanted. The Rayner EMV lens is a very forgiving lens, if you set "in" at just -0.75D you'd likely gain good reading vision. I'm only going on about the Rayner lens because I've got it and I'm quite happy with it. I have a monofocal set for distance in one eye (from 4 years ago) and the Rayner set "in" -0.75D which I got recently. I have my life back.
IndyG
Pascal111 dale65885
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"
jimluck dale65885
Edited
I would not do surgery on the good eye and not put myself in the position of a contact lens always being required. That means choosing to remain very myopic in the bad eye after surgery and I would be fine with that. That way you have the option of glasses or contacts for both eyes. I am very myopic and don't find it a burden.