Cataract surgery lens selection for legally blind with high myopia

[Joe4]

I'm 57 with retina problems from birth that gives me 20/200 corrected vision in both eyes. My glasses are -17D in both eyes (2D of astigmatism). I remove my glasses to read. It’s like using +17D reading glasses. My focus distance is 2 inches, but I need to get this close to see the type (because of my retina), so that works very well. I'm very used to lifting up my glasses to my forehead to see close.

I now have cataracts in both eyes that are getting bad and I need to have surgery.

I need to choose what correction to get implanted (if any). If I had no retina problems, and had normal corrected vision, the answer would obviously be to fully correct my vision so I wouldn't need glasses for distance, and I could use regular reading glasses of, say, 2D. But in my case, if I chose the full correction, I'd need to have 17D reading glasses for reading.

Fully correcting my distance vision would involve a big lifestyle/habit adjustment. I'd no longer have instant +17D reading ability by removing my glasses. Instead, I'd have to carry the +17D reading glasses around my neck and pop them on as needed. On the other hand, my distance vision wouldn't need glasses and might be slightly better because I won't be using thick glasses. It's hard for me to guess how this change will affect me. It's scary to feel like I won't be able to read or see close without glasses. I feel pretty attached to being able to do that.

Correcting my vision to match what my eyes do now would be comfortable, but I'd still have to wear these thick glasses for distance.

I’d like to know of anyone's experiences adjusting from very high myopia to a complete distance correction after cataract surgery - if their corrected vision is as bad as mine (20/200). How long did it take to adjust? Do they/you feel better off, worse off, or the same, as before the change and adjustment period. Any other thoughts?

Also, if I can get by without an IOL after surgery, is there any advantage to that?

[Sandra M Brown, MD]

You probably wouldn't need +17 glasses to read.  If your corrected distance vision is 20/200, you should be able to read with a more modest degree of magnification.  This would allow you to hold reading material further away and see more than one word at a time.  This would be a big lifestyle adjustment for you, but optically it should work.

I think you ought to "win one race", meaning have surgery to end up with minimal distance correction.  If you aim for intermediate undercorrection to reduce the magnification needed to read, you need glasses near and far.  Usual disclaimers.

You should be in the hands of the most skilled anterior segment (cataract) surgeon in your region.  Don't be surprised if they have to order your lens implants custom made.

[Sandra M Brown, MD]

Also I should add that your distance vision is likely to be better than 20/200 because you will gain a lot of magnification by NOT using those -17 glasses.