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Asinometropia/cataract in one eye.
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Asinometropia/cataract in one eye.

I have a cataract in one eye and a tiny one in the other, which is causing no problems. Ideally I only want the bad eye operated on but am at a loss as to what to do, as the surgeon has suggested bringing the eye to minus 3. Pre cataract I was minus 6 and the vision the other eye is minus 5.5. I am worried that my sight will be worse due to the difference causing my eyes not to work together.The NHS surgeon kindly agreed to see me twice but I now feel that I may have to go private.
How much of a problem would the visual difference between the two eyes be? Also is there any reason for not keeping my myopia the same? I wear varifocals and am happy to continue to wear glasses after surgery.
9 Comments Post a Comment
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233488_tn?1310696703
You should use the search feature and archives and read articles about mini-monovision  using monofocals IOLs.  If you end up -3 and -5.5 there is a good chance your eyes will not work well together, glasses might be uncomfortable and you might have to wear contacts AND glasses.

you need to stop and think about if you havd a choice what would you like without glasses. some myopes dream of having good distance vision without glasses, some want to be still able to read without glasses and mainly use glasses for distance. some want to reduce glasses use to a minimum then a mini-monovision with either distance bias (0.00 one eye and -1.50 other eye or near bias -2.5 one eye (read) and -1.00 in the other.


-3.00 is closer than many people like to hold their near focus.

You can tell there is no best option and lots of choices.  In my most recent case like this the patient had a cataract in the dominant eye. We set the IOL power to 0.00 then the other eye that had only a tiny tiny cataract has lasik and we moved the power to -1.5   the patient was delighted. The 0.00 eye had 20/20 at distance and the -1.5 eye worked for shopping and computer and in good light could read well without glasses. For their best vision they had a pair of no line biocals  the Rx in operated eye was 0.00 and a reading add of +3.00  the non-cataract LASIK eye was -1.50 and an add of +200 for reading.

You will need to do a lot of homework to understand where you want to go.

JCH MD
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1932338_tn?1349223998
If at all possible, do a trial of contact lenses before you make your decision!
That is the best way to know what you personally will tolerate.

  The trial lenses should be free, but make sure you go contact lens free for at least a month (ask your Dr.) before you actually have the IOL surgery because you want the surface of your eye not to be affected by the contact lens wear.
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Avatar_n_tn
Thanks for all of the advice. Initially I was going to ahead with this surgery, but I'm glad now that I trusted my doubts and asked for thinking time. Years ago I wore contacts but no longer find them comfortable.so they wouldn't be an option, I did mention this at the hospital. I suspect that my eyes are quite dry, which would also make Lasik a bad idea.
At a loss really as to what to do. It does look, from the internet, as though I could get a surgeon to maintain my bad eye at minus 5.5/6. I suppose its revisit the surgeon and insist on the eyes matching, ask for a second opinion or go private. Very frustrating as I only want a fixed distance lense which is available on the NHS.
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233488_tn?1310696703
I have never lft a person -5.5 to -6.0 in over 12,000 cataracts and also managing post op another 6000.  I have seen a few people left that myopic and to a person they are sorry they chose that option and which they went for somewhere between 0.00 and -2.50.

That's all I have to say. Best of luck
JCH MD
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Avatar_m_tn
I agree with the doctor 100%...I had cataracts in both eyes but the dominant eye was pretty bad and the other eye wasn't bad at all...but since i was quite nearsighted in both, i knew it was best to have both eyes done to put them "in synch" as it it were...such a large difference would drive you crazy to be sure (lol)....

Initially, he did monovision with 20/20 in dominant eye and set the non dominant for about -2.25 diopters but i found it was too much for me, even though i could read quite close up, i felt by distance and mid vision was being compromised too much, so i eventually ended up having the
non-dominant eye moved up to -1.50 diopters (mini monovision as the doctor here mentioned) and had it done with a Lasik Touchup...
and am much happier now with that...

My distance and mid range is pretty good and i can still do light reading as well...i do have to hold things a bit further away but still have useful reading vision and i put on very light readers when i need to do a lot of extended reading...So, i am glasses-free like at least 90% of the time...

I also had astigmatism...so i got the monofocal toric lenses which are excellent...

I'd recommend what the doctor said...monofocals with mini monovision...only go 20/20 in both eyes if you don't mind constantly needing readers for ANYTHING close to you...
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1932338_tn?1349223998
Love that you are taking "thinking time"...as regrets are the worse when they become permanent mistakes.

Keep in mind that there are no "perfect" solutions though, so at some point you will want to move forward.  If you have insurance that covers additional opinions, I would suggest going to as many Cataract specialists as you can.  I went to 6 before I made the decision to have the surgery and I can tell you that I learned something different and valuable from each appointment.  

I agree with Dr Hagan, ending up with a -5 is not a desirable outcome.  I get that you don't want to remove your lens from your good eye until absolutely necessary, but the trade off by trying to get a close diopter post Cataract surgery in your bad eye is not worth it (in my opinion).  Think about it practically, a -2.5 gives you close reading distance vision...any more than that in the "-" direction (nearsighted) wouldn't be useful.

My previous suggestion to do a contact lens trial to test this out would only have to be for several days if your eyes are too dry to tolerate the lenses.  It would be up to you and you could even remove the lens after a shorter time if you needed too.  Free contact lenses, so what do you have to lose ?

Keep reading and researching this, the "right decision" will come to you and you will feel a big sigh of relief when it does.
Also, take Flaxoil and Fishoil or Codliver oil for dry eye, it helps. ;-)
    
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Avatar_n_tn
Thanks for all of the advice. I've been following your thread Craig and so glad you had a successful outcome. I think mini monovision may be the way to go.I already have a natural 0.5 difference between the two eyes plusadapted to varifocals quickly. A contact lense trial could be difficult, as , due to the cataract, I have little sight in my left, most myopic eye.
The NHS surgeon started the initial meeting by saying I would only need reading glasses if both eyes were done, he didn't explain how this would be achieved.NHS ppointments are , I suppose rightly, for basic care. I'm thinking a private consultation,which I woud pay for, followed if possible with NHS surgery.
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Avatar_n_tn
Ran out of space and talking to myself. Since the cataract was diagnosed( it seemed to apperar overnight), Ihad a general blood test, to rule out diabetes in particular.I am young to have an advanced actaract, 52, and know that high blood sugar can be a factor. I've had borderline thyroid and diabetes results in the past, the first 20 years ago, felt very ill. Gradually improved without medication.My TSH now is high so I am taking Levothyroxine. I only know my tsh level 7.7 plus cholesterol 7.1 high levels of good cholestrol. The most likely reason for this is Hashimotos, which can cause bout of overactive thyroid. Plu wondering if thi could have affected my eyes. I know that TSH i not that bad I'm assuming that I'm on the Levodueth the highcholestrol
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