Should I Have Both Eyes Done?

Aloha Lucy

I recently had both eyes done the same day through my Kaiser insurance. Kaiser nationally is one of the few groups in North America that do simultaneous bi-lateral cataract surgery, although it is fairly common in Europe. My experience has been excellent, with both eyes achieving identical (and excellent results). Full disclosure, I am in my mid 50s and my eye and overall health are very good. This is what I see as the pros and cons of having both eyes done at the same time.

Pros:

Both eyes adopt at the same time, meaning you don't have to go through this process twice

You only go through the surgery process once. Which to my mind is huge, especially as we get older.

Cost is potentially lower

You don't fall Into the practice of comparing the "good eye" to the "bad eye". Which I feel may impede adaption.

You only have to heal once.

You can get on with your life sooner rather than later.

Cons:

If your surgeon is not comfortable with doing both eyes on the same day you may get an unexpected result.

If you're vision doesn't improve quickly after surgery, you may start to worry/panic (my vision began to improve in the post-op recovery room so I never had this problem)

If you and your surgeon choose a different Implant and/or strategy for each eye you may have some descrepincy between the two (although if he/she is comfortable with the strategy, it is likely they have employed it before. You should ask about that.)

All in all, you should feel comfortable with your surgeon and the IOL/strategy you AGREE on. If you have any doubts do not hesitate to get a second and third opinion. Either way you should end up with essentially the same outcome. So really, it is your choice and you should not let anyone persuade you to do something you are not comfortable with

I hope this helps. Please feel free to ask more questions.

I want to clarify that my doctor would not be doing the surgery on both eyes on the same day. They would be done one or two weeks apart. My question is should I have the left eye done now when it doesn't need it now and may not need it for years. On the other hand, it may need it in 1 or 2 years. There is no way to tell how fast the cataract in that eye will develop. The only way I can have 20/20 vision is if I both eyes done now (by now, I mean a couple of weeks apart for each eye).If I only have the eye that needs it done now, he will improve the vision somewhat, but not totally. I will still need to wear glasses. Then if the other eye needs to be done in a couple of years, I am stuck with this eye only being partially improved and I will still need to wear glasses.

You are at the beginning of a interesting and challenging research project. Let me start by stating that I had cataracts in both my eyes with IOL replacement nearly a year ago. The surgery was laser assisted and performed two days apart with Panoptic trifocal IOLs. An expensive procedure not covered by any health plan. I just had my annual checkup and my vision is 20/20 and do not need glasses, but this is not to suggest that I have perfect vision.

Besides trying to decide on getting the second eye operated on you also need to think about your expected outcome. You will not get perfect vision, may be great but not perfect. Here is a short rundown of the options:

• basic lens (normally covered by health plan) provides adequate vision but glasses will be required for either reading or distance
• premium lens (usually not covered) provides good vision but glasses will also be required
• monovision with premium lens (usually not covered) where one eye is adjusted for distance and the other for reading. The brain adapts over time to this configuration, and reading glasses may still be required for fine print.
• multifocal lens (usually not covered, and more expensive than premium lens) provides multiple focal lengths, and often eliminates the need for glasses.

If it were my decision, I would have both eyes operated done, but this may be a financial consideration for you. If you choose to go the monovision route then it makes sense have them done 3-4 weeks apart so that any final adjustments can be made to the strength of the lens for the second eye based on the outcome of the first. With all other configurations there is no good reason for them not to be done on the same day or a couple of days apart as this aligns all your recovery time, and followup visits.

For most people I would recommend premium lens with both eyes adjusted for distance vision, along with reading glasses. A variation of this option, for the best vision, would be progressive glasses, worn all the times, that also adjusts for any astigmatism. This is more expensive that just reading glasses.

Hope this has helped rather than confused you.

Thank you for the reply. If I get both eyes done, they would be corrected for long distance vision and I would need readers. If I don't get both eyes done and in a few years I need to have the cataract in my other eye removed, I would need to wear prescription glasses all of the time.

I just called my doctor's office and they are going to have the doctor call me. She did say that unless I can get a Medicare exception, the cost for surgery on my other eye would be around $5000 that I would have to pay.

I am basically in the same situation as you, but I am in Canada and that changes some things with respect to cost and ability to get the surgery done. Essentially unless I go to the US, I cannot just ask for and pay for a IOL that is not medically necessary. Well actually I may, but even if I could, I would be the very lowest on the priority list and it would be a year or more wait to get the non medically necessary lens. At least that is the way I understand it.

.

On the eye that needs to be done due to a pretty bad cataract I am only going to get a monofocal aspherical lens for distance. I have a small amount of astigmatism that is not enough to be corrected with the least powerful toric IOL. If I did need a toric lens I believe it would cost me $1200 or so. The monofocal aspherical lens is covered by our health care. If I went for the Panoptix trifocal it would probably be in the order of $2000 to 2500 extra, that is not covered. I thought about the Panoptix option and did not discount it due to cost. I was just not prepared to accept the risk of optical side effects like halos around lights at night. Good night vision for driving is a priority for me.

.

My decision has been to go for the monofocal distance option for my first eye. I will get new progressive glasses with my standard correction in the non IOL eye, and progressive reading in the IOL eye. I have had others here say that there is a problem adapting to having full distance correction in one eye and continuing to need eyeglass correction in the other eye. I asked my surgeon about it and he said it was not a problem at all to do that. This said, I need about a -3.0 correction with some astigmatism correction as well. Perhaps if you are in the much higher (-6 to -10) range things could be different. But, I don't really see why the eye/brain should care whether the vision is corrected in the lens or with eyeglasses.

.

In any case my plan is to get full distance in the IOL, and continue with eyeglass correction in the other. In addition my plan is to get a contact lens for my non IOL eye that under corrects by about -1.25 to simulate monovision. If the contact lens trial goes well, then my final plan is to get the second IOL, when it is necessary, with a similar under correction of -1.25, or whatever works for me with the test contact lenses.

.

At the end of the day, I expect I will still have glasses to correct for very fine print reading, and also to correct any residual astigmatism. But with monovision I expect I will be quite functional with no glasses at all.

.

It may have been mentioned already, but I don't believe it is a good assumption that the actual correction you get with an IOL will be exactly what you (or the surgeon) wants. You get what you get. And due to that possibility, it may influence the decision as to what you do with the second eye. Even if I was able to get both eyes done at the same time or close together, I would wait 4-6 weeks between eyes to be sure of exactly what I have in the first IOL eye.

.

Hope that helps some. I cannot speak from experience, just from being faced with a similar situation as you have.

RonAKA, my prescription says -7.50 in one eye, and -6.00 in the other eye. Is that what you are referring to?

My doctor said that he cannot fully correct just one eye because the imbalance would be too great and my brain would not adjust to it. I cannot wear contacts because I have dry eye syndrome.

I just talked to my doctor. I have decided to have both eyes done. My right eye will be corrected for distance vision. About three weeks later, my left eye will be corrected for distance. After the first eye is done, there will be an imbalance which will be the reason for Medicare to cover the cost of the surgery on the left eye. I would have had the left eye done even if Medicare didn't cover the cost. I just think I will have a better outcome with both eyes corrected, rather than a partial vision correction. I will need readers.

Thank you to everyone who replied.

I was reading your post, and I am a little confused. Are you saying that if you only do the eye that needs surgery now, and wait to do the other eye, the doctor says the other eye will not be able to be fully corrected because you waited to do the second surgery?