Cataract surgery now or later?

[seetoscrap]

I went to an opthomalogist to inquire about a Phakic IOL (I'm not a candidate for Lasik) and he discovered I have cataracts developing in both eyes and I'm only 42. The cataracts do not interfere with my vision yet, except for maybe nighttime driving. I'm happy with my corrected vision, just not with contacts. One surgeon suggested a Verisyse lense now and cataract surgery when I need it. Another (I sought a second opinion) suggested going ahead with cataract surgery now instead of a Phakic IOL, perhaps because insurance will cover part of the cataract surgery.

After reading about multifocal lenses, I'm wondering if it would be worth waiting until multifocal lenses improve and wear contacts until I need cataract surgery.

1) will multifocal lenses improve enough to make it worth waiting? what are the pros and cons of having surgery early?
2) can monofocal lenses be removed easily with minimal risk if I later want a mutlifocal lense (when they improve) or I choose monovision and I can't adapt?
3) What are the cons of monovision?

Thank you for the information in this very confusing decision.

[John C Hagan III, MD, FACS]

1. all IOL technology will improve with time. None will ever be perfect. If you've made your peace with wearing glasses I would not recommend multifocal implants.  I have literally thousands of patients in my practice that have had their cataracts for 10-15 years and still don't need surgery. You don't want to have cataract surgery until the cataracts are a moderate to big problem in your life.
2. Any IOL removal/exchange is generally more complicated and risky than the initial cataract removal/IOL insertion. I would never tell a patient that they should try monovision and if they didn't like it I would take the IOL out and exchange it.  
3. Monovision: you don't see as well because you use only one eye for distance and the other for near, your depth perception is shot, you still can't see at middle distance, many to most mono-vision patients where glasses for some cases.

Have your ophthalmologist give you a trial of monovision with soft contact lens. You can get a quick appreciation of whether you like it or not.

JCH III MD

[seetoscrap]

Thank you for your insights. I have not made peace with wearing contacts, and wanted to have my vision surgically corrected. What are the pros and cons of using a Phakic IOL (Verisyse) versus having cataract surgery now?

Laura

[seetoscrap]

Let me clarify that. I can either have a Verisyse implant now and cataract surgery when I need it later, or go ahead and remove my cataracts now. Would having two surgeries (Verisye and then cataract) increase the risk of retinal detachment (I am -8 in both eyes)? I need to weigh the pros and cons of both approaches.

Thank you for your insights. The problem with second opinions is that it leaves me confused!

Laura

[John C Hagan III, MD, FACS]

Hello Laura,  Two operations will double the risk of infection, bleeding, inflammation. It will not double the risk of cataract surgery BUT ONE CATARACT OPERATION INCREASES THE RISK OF RETINAL DETACHMENT BY TEN TIMES NOT TEN PERCENT.

Your risk of retinal detachment given you degree of myopia is in the order of 1 in 1000 to 1 in 2000. After cataract surgery  the risk will increase to about one in a hundred to one in five hundred.

The Veriseye implant will not increase the risk of retinal detachment that much but may make your cataract grow faster.

JohnHaganMD