Only need catarct surgery in one eye
Posted , 6 users are following.
This is a 2 part question
I recently went to the opthomologist and was told that my right eye's cataract is severe enough so that Medicare will cover the cost of a standard IOC lens.
It will be several years before my left eye's cataract will require surgery.
For right now I get along fine with glasses ( I realize most of my vision is through my left eye, as the right sight is cloudy)
The opthomologist is recommending toric for my right eye because of an astigmatism.
My prescription for my right eye is: SPH: -0.25; CYL +0.50; Axis x085
I did not think my astigmatism is all that bad where I need a special lens for it.
So my first question is: Should I wait until my left eye's cataract worsens before I have cataract surgery ?
My second question is: If I have surgery just on my right eye and have a toric lens installed will I be asking for trouble with vision ? (I am thinking double vision as my left eye will be corrected with glasses)
0 likes, 24 replies
Guest dennis27175
Edited
What is your best corrected distance vision in each eye? If you can still correct with glasses I would wait on both eyes.
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O.5D probably doesn't call for a Toric. I think that's probably too little to worry about.
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Also there is no way to know when your other eye will be bad enough. It could be months. It could be a decade. Cataracts progress differently for everyone.
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Bottom line though, if you can still get good vision with glasses and you are not being impeded in any significant way for work, driving, or hobbies, I'd wait. Personally.
RonAKA dennis27175
Posted
Your correction in your right eye is pretty minor. I also am a bit surprised that it would need a toric lens. Have they done the detailed eye measurements with an IOLMaster or Lenstar instrument, and the Pentacam? They can't predict the residual astigmatism until they take those measurements. If they have you should ask to see the numbers. Normally a toric is not considered unless the predicted residual cylinder is 0.75 D or greater. And with some IOLs the minimum is 1.0 D before correction is used. The reason is that this is the minimum correction IOLs can do. But, it is possible you have astigmatism in your cornea which is being corrected by the opposite angle astigmatism in the lens. I think that is fairly rare, but it can happen. When it does instead of astigmatism going down with cataract surgery it can go up.
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The other thing to think about is whether or not you plan to wear glasses after surgery. If you plan to wear glasses then it is probably not worth the extra cost to get a toric. The astigmatism can be easily corrected and more accurately with an eyeglass lens. And, the surgery itself can cause some astigmatism, so the eyeglass lens corrects for that as well. But, if your long term plan is to be eyeglasses free and astigmatism is greater than 0.75 D then it is worthwhile to get a toric.
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My thoughts are that it is not worth putting up with bad vision and it would be better to go ahead with cataract surgery if your vision is significantly impacted in the cataract eye. You may want to think ahead as to what your final solution for vision is. If you plan to do mini-monovision for example you may want to think about which eye you want as your distance eye. In other words have a plan for both eyes even though you are only going to do one now.
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One being able to cope with one eye having an IOL and the other eye needing eyeglass correction it will depend on how much correction you need for the other eye. If it is large then there can be issues. If it is very minor like your right eye then you should have no issues at all. What is your left eye prescription now?
dennis27175 RonAKA
Posted
My left eye is:sph: +1.25; cyl: +1.25; Axis : 035
RonAKA dennis27175
Posted
In normal optometrist format with negative cylinder this converts to:
Sphere +2.50 D, Cylinder -1.25, Axis 125 deg
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This is more than your right eye, and this eye would seem more likely to need a toric. But, on a spherical equivalent basis it would be about +1.90 D, so not real strong. Just a guess but I suspect there would not be much issue due to the differential between the eyes. It is not dissimilar to what I had for 18 months between eyes. I did however resort to using a contact in my non operated eye.
dennis27175 RonAKA
Posted
How did you convert my script numbers to optometrist format?
RonAKA dennis27175
Posted
The easiest way is to use an online calculator. Google this and you should find one:
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Eyeglass Prescription Positive Cylinder Conversion
dennis27175 RonAKA
Posted
How different is a mini-monovision from the standard mono IOL that medicare pays for (in vision)?
RonAKA dennis27175
Posted
Standard mini-monovision just needs standard monofocal lenses. The basic method is to correct for full distance in your dominant eye (target -0.25 D), and then target mild myopia (-1.50 D) in the non-dominant eye. It is recommended to try it first using contacts. But, that can be difficult if the cataract is advanced. So one plan would be to correct the bad eye for distance with an IOL, and then use a contact in the other eye to simulate mini-monovision. If that works ok then you target the second eye when the time comes to -1.50 D. These are all spherical equivalent numbers which correct for some astigmatism (Sphere plus 50% of the cylinder).
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in vision is not a name I recognise. There is a Bausch & Lomb enVista monofocal lens that is very good. The more common ones are J&J Tecnis 1, and Alcon Clareon or AcrySof IQ. I am in Canada so not sure what medicare pays for. Depending on the province in Canada they will pay for one or more basic monofocals.
dennis27175 RonAKA
Posted
Before the cataract my right eye was better at near vision and my left eye was better at distance vision. Should I stay with how the eyes worked before aging?
RonAKA dennis27175
Posted
The convention is to use the dominant eye for distance. Point at something across the room, then close or cover your left eye. If you are still pointing at it, then your right eye is dominant. But at the end of the day I am not sure it makes much difference which eye you select for distance. My mini-monovision is crossed which means my close eye is my dominant eye, and it works.
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If you are considering mini-monovision it would be helpful to tell the surgeon up front and get their advice as to which one to do for distance. Logistically it makes some sense to do the distance eye first, and if for some reason the surgeon misses, then you have the second eye to do for distance as a back up plan.
dennis27175 RonAKA
Posted
Could I gain any insight if I delayed getting the cataract surgery and tried contact lenses rather than glasses ?
RonAKA dennis27175
Posted
Sorry for the delay in responding. Yes, you can gain a lot of insight if you do a contact lens simulation before you commit to your surgery. The only issue can be vision quality to evaluate it if the cataract is very advanced.
dennis27175 RonAKA
Posted
First of all I would like to express my gratitude for all the feedback!
I contacted my opthamologist and asked about predicted residual astigmatism for the eye that has the cataract. He says they cannot say until they run an ASCAN before the cataract surgery. Is this typical?
RonAKA dennis27175
Posted
Yes, and no. A-Scan is an ultrasonic measurement method that is not used much any more. It is the less accurate method of measuring your eye. If you have any choice in the matter I would have the eye measured by an optical instrument like the IOLMaster 700 or Lenstar 900. Also I don't think the A-Scan measures astigmatism. The Pentacam does that measurement, and the IOLMaster does as well.
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But, yes, they cannot predict astigmatism until after they have done the proper measurements.
dennis27175 RonAKA
Posted
What is the best way to find out what type of equipment an opthamologist uses?
RebDovid dennis27175
Posted
In advance, just ask. I would be suspicious of any ophthalmologist unwilling to answer. When measurements are being taken, you should be able to tell by looking at the equipment or, again, just by asking.
RonAKA dennis27175
Posted
It is best to call the office and ask what they use before you book with them. It is a bit late to check it out after you get to the consult appointment. In some jurisdictions the healthcare system will only fully pay for the ultrasonic A-Scan method but usually they offer the optical IOLMaster or Lenstar for a small extra cost. If you google this you can find a cataract surgery information pamphlet from Queen's University. It is quite dated and the prices are not current I suspect. But on page 6 you will find the measurement methods listed. The corneal topography instrument is typically the Pentacam.
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Queen's University Cataract Brochure PDF