Cataracts: Is it worth waiting?

I am 28yo with the beginnings of a cataract in one eye.  I am not excited by the prospect of needing reading glasses, but I don't want the reduced clarity or problems of current multifocal iols.  My eye length is about 29mm, and I am very myopic with about 19.0D of correction before spherical rgp contacts with about 2.0-3.0D of astigmatism.   I spend most of my day working at a computer.  Currently neither glasses or contacts are providing a very good solution right now.

My doctor is recommending monofocals, possibly a toric.  He says he can do the multifocals and accommodative, but they lack same clarity of a monofocal, aren't great for reading all day long, and are more of an excuse to charge more.

My question is, is it worth waiting for something like Visiogen's Synchrony Dual-Optic or Kellan's TetraFlex?  Has anyone had any experience with these, or the new Crystalens 5-0?  Do they sacrifice some clarity compared with monofocals?

Or am I overreacting to life with reading glasses?  I can't really do a trial run of monovision before surgery so any experiences with that could be helpful too...

[John C Hagan]

Hello myope-xl.  Cataracts are not like climbing mountains ("you do it because they're there"). Cataracts should not be removed until they are causing significant visual disability. Any form of cataract surgery is going to increase the risk of a detached retina by a factor of 10, not 10% but 10 time. The medical literature clearly documents an increased risk of RD in young myopes with long eyes and males more than females. This is consistent with my surgical experience.

In my opinion you are over-reacting to life with reading glasses. You're use to glasses and contact lens. Only time will tell if these new implants will help with the problems of multifocal implants including poor night vision and frequent need to wear glasses for many tasks after surgery.

JCH  MD FACS FAAO  Eye MD

[myope_xl]

Thanks for your comments.  I appreciate the increased risk of retinal detachment.  Currently I see about 20/50 at best in the cataract eye.  Generally, I need to focus, squint, and adjust to see things decently.  I have to find the sweet spot in my lenses.  At my computer I am constantly having to use the screen zoom to read things throughout the day.  Not to mention the eye discomfort and flares from my contacts.  So I think using reading glasses would be an improvement to my current situation, despite my reluctance.

What is the approximate risk for a young high myope male?  Is the increased risk lessened with age?  My thinking was it would be better to take care of the issue while I was younger and healthier.  My father had a retinal detachment as did my aunt, they are both high myopes.  I always figured it would be my turn eventually.  I did see a retinal specialist and he said my retina's were healthy, and the only consideration for surgery would be the myopia.

[John C Hagan]

With your long eye and your really bad family history the risk of retinal detachment after cataract surgery might be as high as 1-4%, if there was a complication such as vitreous loss the risk could go to as high as 10%. I don't know why the risk is so high in the young myopic male. Maybe you should ask your retinal specialist.

If you need cataract surgery we've discussed the drill I use: 1. see a retinal surgeon for evaluation prior to cataract surgeon, treat any weak areas with laser, cry if indicated.  2. See the retinal surgeon one week after surgery for a repeat exam  3. See the retina surgeon about 6-8 weeks after surgery for a final exam.

JCH MD