Thinking of getting just one eye done, which means locking in -6 myopia
Posted , 8 users are following.
I'm reluctant to move forward with cataract surgery on both eyes. I have 20/25 and J1 best corrected vision, don't mind the halos on lights (they're pretty, actually -- rainbows) and have good contrast sensitivity. The risk/benefit balance just doesn't seem to favor moving ahead. My main complaint is presbyopia and a right eye with so much astigmatism (8.25 cyl) that many labs can't make my glasses, The right lens ends up very thick even with the highest-index material, and right-eye vision is useless without glasses.
I find my left eye vision without glasses to be very useful, even though it is -5 sph, -2.25 cyl. I love that I can see tiny detail at 6 to 8 inches. I don't notice the astigmatism at all in the left. I just wish I could do close work with both eyes contributing. The right eye image is so smeared-up and messy, I generally close the right eye when I take my glasses off. The uncorrected right-eye vision is really a joke. I'm amazed glasses can fix it.
If it did just the right eye, I would have to leave it almost as myopic as the left eye, in order to comfortably wear glasses. One can tolerate up 1 diopter of difference in glasses prescription, or a little more, but not a lot more. The image size would be too different, they tell me. So, if I did just one eye I'd be locking in -5 or -6 myopia for the rest of my life (I'm 73 and healthy). That doesn't sound bad to me. I have no dreams of being glasses free. I find my high myopia vision in the left very useful for close work.
The cataract density is rated 2+, with no discernible change over the past 12 months. My sister absolutely had to have surgery by my current age, while my brother is six years older and has no plans for cataract surgery. So, genetics is no guide as to how long I might go without surgery if I chose to wait.
What do you think? Any drawbacks to doing just one eye that I haven't thought of?
I have lined up a top surgeon in Canada who has a Zeiss monofocal toric aspheric aberration-free IOL with high enough cyl to fully correct my astigmatism. My doctor here in the US would do the follow up care. You can't get more than 6 cyl in the US and I need about 10 cyl.
1 like, 18 replies
RonAKA jimluck
Edited
My thoughts are that we only get one chance (short of doing a post cataract surgery explant) to fix our vision for the rest of our life to what we really want. When you put it in that perspective, I think that short term issues with differences between our eyes become less important than the overall objective. You are in a very unusual and difficult situation. If I were in that position I would bite the bullet and correct both eyes to what you really want them to be without any consideration of interim issues. I would never ever lock in -6.0 myopia. And in fact having spend the most of my life since age 10 or so at about -4.0 or so, I really do not consider that a good solution either. Yes, it is convenient to take off the glasses to get some "super-vision" but really how important is that? You can do the same by putting on some high power readers. Yes, I miss the convenience occasionally but for 95+% of the time I enjoy my eyeglass free mini-monovision.
.
Short story. Do both eyes to what you want them to be.
pershoot jimluck
Edited
I had a similar personal decision to make, recently. I opted to near-match the power of my left (problematic eye) to the right's (uncorrected). This is approximately half (give or take) of what is needed for this particular eye. I am in my mid 40s. While I may have complicated matters for my left, down the line (~2-3 decades ideally), I was reluctant to 'break the seal', as it were, on a body part (right; pristine), if I can help it, with further surgery.
While wearing glasses may be challenging due to the large diopter difference and image perception issues, you may be able to adapt to wearing a contact lens (which would still have some perception issues, but significantly less so) while the other eye is fully corrected via an IOL. Depending on how you can get a long in life / your life's activities in this configuration, then it may suey you in a more pointed / definitive direction with regards to your decision, in having surgery on the other eye.
RonAKA pershoot
Posted
Age certainly plays a role in making this decision, and if you can manage the impact of significant anisometropia then it makes sense to delay surgery on the good eye. I did that for 18 months before I got tired of the contact regime and went ahead with surgery on my second eye, which was still pretty good. But, it was much easier for me as I am 73 and at the prime age for cataracts, and one was starting in my second eye. I have had no regrets doing it.
jimluck
Edited
Thanks Ron and Pershoot for your thoughts.
I would not hope to tolerate a big difference between eyes. Adjustment to that seems like a longshot. And if I couldn't tolerate it, then I'd have to do the other eye pronto.
I would not willingly choose any solution that makes me dependent on reading glasses. When I need to see close I need it now and can't stand the idea of hunting for reading glasses umpteen times a day. I use my left eye glasses-free many many times a day.
I would not willingly choose any solution that makes me dependent on contact lenses. Too much bother, with the solutions and the cleaning and the putting them in and taking them out. I would have to wear a scleral contact and they are a bit more difficult to manage than others. I've got them. I don't use them. And the ones I've got narrow my depth of field significantly. You can't nap with them. You can't swim with them. You probably can't go 18 consecutive hours of awake time with them.
I'm fine with being very myopic. Peoples' tastes differ. Glasses-free distance vision is not an important goal for me. I marvel that it seems so important to most others. And I marvel that others can tolerate being near-blind (as in, can't see near) unless and until they find their reading glasses.
Thanks for the discussion. It helps me think this through even if I reject most advice.
Bookwoman jimluck
Edited
My thoughts exactly, but that's not how most people are wired. Those of us who have been myopic since childhood have never had good distance vision, so it's not something we need. Seeing close up is, however, non-negotiable!
You need to do what works for your life, no matter how strange it might seem to others. What you might consider, though, is doing a -3 lens rather than -5 or 6. You will still get plenty of closeup vision, and the difference then might be manageable with glasses.
billy111 jimluck
Posted
This is purely a judgment call. Go with your gut instinct.
trilemma billy111
Posted
I would prefer analyzing, and discussing the pros and cons, as jimluck is doing.
laurie30147 jimluck
Posted
First off, let me say that I have mini-monovision with two Vivity lenses and I am mostly glasses -free, though I like to wear driving glasses or prescription sunglasses (distance only) at times.
I was myopic all my life from an early age, around the -2D or -3D level. I always appreciated the ability to read without glasses. Before getting my cataracts taken care of last year, I never wore my progressive glasses at home for most purposes, even if things got blurry across the room. I did use glasses for working on the computer.
While it's fun now to be able to see distance without glasses, I don't value that as much as reading without glasses. Not even close. The thought of dealing with reading glasses makes me cringe.
That said, you might consider staying myopic without going to the extreme of -5D. But everyone is different and you are ahead of the game by doing research and making an informed decision.
trilemma jimluck
Edited
I would feel uneasy to even comment on most of your post.
I would point out that it is sure nice to have good vision without glasses when glasses fog up or get raindrops on them.
Bookwoman trilemma
Posted
But how often does this happen? If they fog up, you wipe them off and are good to go. I've worn glasses off and on for much of my life (I wore contacts for many years) and this has never been an issue.
trilemma Bookwoman
Posted
It happens when you are out in cold weather and step indoors.
It can even happen when you are in AC in Florida, and step outside in the summer.
But I agree that that is not that big of a problem. I only bright that up as an additional advantage of having good enough no-glasses sight to climb down a stairs. It is good to be able to walk to the bathroom safely without glasses. Jimluck has thought thru a lot of potential advantages and disadvantages, but I thought maybe that might be able to tilt the choice a tiny bit.
He already knew that heavy glasses tend to slide down your nose more, and a bunch more downsides.
Bookwoman trilemma
Posted
One reason I never visit FL in the summer. 😃
jimluck
Edited
Bookwoman, Thanks for your comment.
Can't do -3. I'm worried about Aniseikonia.
"Aniseikonia is the difference in image size perceived between the eyes from unequal magnification... Symptoms of aniseikonia include diplopia, headache, dizziness, disorientation, and excessive eye strain."
It usually takes more than 2 diopters difference in spherical equivalent between spectacle lenses (right vs left) to produce symptoms.
If doing both, I'd probably tell them to aim for -2.5. But if only doing one, I don't want the eye with the IOL to be targeted more than 1 diopter different than the eye with a natural lens lest it end up more than 2 diopters different, giving me headaches and double vision with glasses.
The left is -6 spherical equivalent. So, I have to end up in the -4 to -8 range on the right to be safe from symptoms from aniseikonia. Targeting -4 leaves no margin for error on a hyperopic miss. So I think the least myopic I should target is -5 if doing on the right eye at this tiime.
I thought about getting the IOL for the right and PRK for the left, but I just read they don't do PRK or LASIK if you have a cataract until you get it removed.
Right now, the right is -7 spherical equivalent, so I'm living with 1 diopter of difference in my right vs my left glasses lenses. Ideally, I would not exceed 1, I fee.
trilemma jimluck
Posted
#1: I have thought further. I would have the right eye IOL selected to to as close to plano as the surgeon can get without danger of going farsighted.
Your existing left eye will work with new right eye. You will have pure monovision, and I suspect you will adapt to that.
#2 If I were confident I would very much miss strong nearsightedness (which I would not), I would get the right eye selected for about -5D sph zero cyl. This is is not what I would do, but to approach your thinking, that is where I would go.
#3: (or 1A), have the right eye set close to plano, and the left eye get a new IOL targeted at 1 to 1.5 D more nearsighted than the right eye turned out. Get some reading glasses, and get an Optivisor for close close work.
This is not to say that your plan is bad, but I fear that you would regret it. I don't reject your thought that your strong nearsightedness has some advantages that you would miss. But I think you would come to love the new capabilities on balance a lot more.
jimluck trilemma
Edited
Bear in mind, Trilemma, that I don't even choose plano with eyeglasses. I have plano-prescription eyeglasses, but half the time I don't even know where they are because I use them so infrequently. 99.9% of my waking life I choose to wear glasses with 0.75 under correction. Weirdly, this is the best for me for intermediate (28 inches) and is sharp enough to read road signs and house numbers when driving, and good enough for using my phone or reading a book. When I need super near, I use the left eye without glasses.
I hate wearing the plano spectacles. They are shockingly un-versatile.
I gave up on progressives. For me, there is no intermediate zone on progressives, and I don't often need the near zone they provide at +2.25. I had my progressive re-made at +1 to see if that would be useful. I can't even tell they are progressives. Useless.
trilemma jimluck
Edited
On your progressives, I think there is a wide difference in technology. It is more than the corridor width. If you get the best lenses, the fitting gets more important to take advantage. The calculation should take into account the center of rotation of your eyeball. You won't get that at Costco or most optical places. Typical add for progressives is 2.5 to 2.75D I had gone for +3.
So if considering minimonovison or monovision, it sounds like -0.75 would be the target nearsightedness for your far eye. That centers the best focus at 4.3 ft.
.
I propose an experiment. If you produce a pinpoint of light, such as putting a tiny hole in aluminum foil covering a light source, what do you see in dim ambient? The period on a lighted keyboard would be an alternate target. If your eye has pure sph and cyl, you would expect to see a fuzzy elipse. If you see a shape made of a series of dots, that would imply a higher order aberation, such as flats in the cornea. That is like your own EDOF. To be clear, I am not proposing a pinhole near your eye, but at the light source.
RonAKA jimluck
Posted
"99.9% of my waking life I choose to wear glasses with 0.75 under correction"
.
Perhaps that is the key then. Get IOLs that will bring you to -0.75 D with minimal to no astigmatism. Also when your eyes are corrected to that level, progressives are likely to work much better as there will be limited range of correction over the height of the lens.