Cataract surgery for highly myopic persons like me

[Art0512]

My optometrist has informed me that my cataracts have worsened. I am also highly  myopic, -18.25 in the right eye and -12.50 in the left eye.  I am 62 years old. He told me that cataract surgery would cure my cataract problem  and  referred me to a cataract surgeon .

The surgeon said I was a candidate for the Crystalens IOL implants and that my chances of a good outcome were 99%.  He wants me to see my regular ophthalmologist who is a retinal specialist before proceeding with the surgery. That opthalmologist has had concerns over my risk for retinal tears or detachment because of my high myopia.  I also have myopic related macular degeneration . My ophthalmologist has opposed cataract surgery  because of my risk for retinal tears and detachment.  I will see him in a few weeks .

I've read that the multifocal IOL's which is what the eye surgeon  recommends can result in problems with halos, glare and poor night vision. There appear to be fewer of these kinds of problems with the standard IOLs. There is a huge cost difference between the multifocal IOL's and the standard IOL's: $6700 plus surgical, hospital and anesthesia costs which would bring up the total out of pocket costs to over $8,000 versus  $1,000 total cost for the standard IOLs.  

According to my optometrist and the eye surgeon the cataracts will  worsen and it will be more difficult to perform cataract surgery the longer I wait.  I can afford the $8,000  but  am  concerned about  the risk of retinal tears or detachment.  I am also concerned about the cataracts worsening. While my vision is not ideal, with eyeglasses I can read, watch television and movies, drive although night driving has become more difficult, and have not  been limited in my normal activities.  It is only my right eye where I notice the effects of the cataract significantly. There is  more cloudiness in that eye.

I  need your perspective on my situation. I am scheduled for the cataract surgery in early March.

[JodieJ]

I developed a cataract in one eye only in my early 50's (three years ago) following retinal surgery.  I had been about -7 in both eyes with astigmatism.  I had aspheric monofocal IOLs implanted in both eyes and limbal relaxing incisions for astigmatism, and my Blue Cross paid for the whole thing.  My outcome truly exceeded my expectations--I never had any kind of problem post-surgery.  My uncorrected distance vision is 20/20 but I need glasses for the computer and reading.  If you've never had a problem with monovision (I did), you might consider a mini-monovision correction for a wider range of focus.

The Crystalens has improved a lot in the past few years.  I didn't even consider the Crystalens because my retinal specialist was opposed to silicone IOLs for his patients.  (I suspect that many retinal specialists today have changed their position about silicone IOLs.)  My impression is that it usually takes a surgeon who is very experienced with this IOL to get a good outcome (defined as excellent distance and intermediate vision and some near vision).  I'm suspicious of a surgeon who claims a 99% success rate.

I'd suggest that you follow the recommendations of your retinal specialist regarding the timing of cataract surgery.

[Sandy Feldman, MD, MS]

Dear Art0512,

Cataract surgery is usually performed when the vision is interfering with your lifestyle. If you are not impacted much, I would wait further for surgery.  In a highly nearsighted person, the risk of retinal detachment is significant.  Seek the care of the retinal specialist to determine the risk of this complication for you.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[JodieJ]

In your place, I'd want input from my retinal specialist before I made a decision about cataract surgery.  If I did decide to proceed at this time, I'd ask my retinal specialist for a referral to a different cataract surgeon for a second opinion about choice of IOLs.  Frankly, I'd be apprehensive about having cataract surgery with a doctor who promises a 99% chance of a good outcome with the Crystalens and does not discuss other alternatives.  (It's not even clear that the Crystalens is available in a power which will correct your right eye.)  And (at the risk of offending some people) I'd probably place more trust in a referral made by an ophthalmologist than one made by an optometrist.

[Art0512]

Dear Dr. Feldman
Thanks so much for your advice and perspective. The more I read about IOL implants and  especially regarding highly myopics such as me, the more hesitant I become about going ahead with cataract surgery. I am very disappointed that the eye surgeon with whom I consulted did not go into the possible complications which could occur--remote as their possibility might be. I am consulting with my regular ophthalmologist who is also a retinal specialist at the end of January and will give a lot of weight to his view. What I am "hearing" loud and clear from this blog is unless one is experiencing significant normal activity limitations--wait and do plenty of research. Do you have an opinion regarding the pros and cons of monofocal, multifocal and crystalens implants?
Art0512

[Art0512]

Thanks for the info. Have you had cataract surgery and IOL implants? If so I would appreciate learning about your experience The vast majority of comments on this blog re crystalens implants are very scary to me. Since none of my normal life activities are being affected yet by the cataracts I am going very slow on doing IOL implants.