Deferring second catarct surgery

My original plan for my cataract surgery was to go for monovision, which I'd done previously with contacts.  My right eye, which had the bad cataract, is the dominant eye.  The surgery was done this past Monday, targeting distance, with the left eye scheduled for mid January.  The left eye has a small cataract that hasn't caused any problems yet.  My ophthalmologist said that my insurance will pay for the second eye as well, due to the anisometropia, and I'll admit that part of my motivation for doing it now is to avoid having to pay a second deductible when my insurance plan year clicks over in March.

Currently I'm seeing quite well, using a bifocal contact in the left eye (Proclear Multifocal, -3.50/+150 N).  This is from a couple of years ago, before the cataract made contacts untenable, so it may not be a perfect prescription, but it's certainly better than I've seen in a long time.  The downside is that I can only wear the contact about 10-12 hours, plus it tends to lose clarity over time, forcing frequent enzyme usage.  

So now I'm tempted to change my mind.  I like being able to read in bed at night without glasses, and I doubt an ideal monovision IOL in the left eye will let me continue to do that.  Plus, since there are no guarantees, I might still need to wear either glasses or contacts at work to get the range of vision I need (computer plus paperwork).  

My question is how much time should I spend with the current situation before deciding whether to go ahead or defer the second surgery?  I'm assuming that I'll get my contact lens prescription updated sometime in the next week or two, and maybe even find one that's more comfortable.  Alternatively, I may ask for single-vision contacts, so that I can test out the target monovision before the surgery.  Either way, the question of how much time to give it remains.

Many thanks.

[John C Hagan III, MD, FACS, FAAO]

Two cardinal rules that have served me and our practice well over the years: 1. Don't do the second eye till the patient is happy or content with the first eye 2. Unless its a special circumstance don't operate on a happy patient [there are some exceptions like people whose vision is not good enough to drive and who wish to drive or who have cataracts that are getting too hard or in whom the back of the eye is inot visible.

You see happy with the first eye result. You seem okay with the situation re contact on your second eye. I think only you can answer the question.

JCH MD

[GaryFx]

I should add that another advantage, to me, of deferring the second surgery is the possibility of multifocal IOL technology advancing, along with my financial situation.  Even something as simple as my ophthalmologist choosing to do the Crystalens would be a change.  (As far as I know, she doesn't currently do them at all, though she does do the Tecnis and Restor multifocals, and I didn't think it worth shopping around for an ophthalmologist who did.)

[John C Hagan III, MD, FACS, FAAO]

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