High Myopia and IOL

[sophia35]

Dear Doctor,

I've contacted you before ( female, 35 ,history high myopia -22 -17 with  
retinal holes/ tears treated with gas bubble in left eye and laser in both,
cataract recently detected in right eye, astigmatism in both eyes, as well as  
floaters, use RGP contacts and get along fine with them )

I greatly appreciate your opinion, so please answer whatever possible of the  
following questions and please pardon  me if some  are silly.

To begin with, maybe I've just been unlucky with the doctors I've been to in
Portugal, but I have been considering England for a consult and eventually  
surgical procedures I will need in the future.Can you reccommend a doctor or    
clinic?

Rest of question in next post!  

[John C Hagan III, MD, FACS]

Hello Sophia,  are you looking for a cataract surgeon, a retinal surgeon, considering a scleral reinforcement procedure?  Please try and be quite specific and I will ask the retinal surgeons in our group if they can recommend anyone in England. I personally do not know anyone.

Probably the most well known eye center in England is Moorfields Eye Hospital. This is their website:   http://www.moorfields.nhs.uk/Home

JCH MD Eye Physician & Surgeon

[sophia35]

Based on your advice I will definitely only get IOL implants when the cataract
or cataracts really impair my vision ( no doctor here ever explained how much
the risk of retinal detachment increased...)

Based on reccommended research,I have no intention of getting multifocal
implants    (so for me  that eliminates  Rezoom, Restor and Crystalens,
right?).

Since I would really like to avoid glasses and assuming that toric IOLs are not  
indicated ( ? ) do you agree that this is my best option:
When it is absolutely necessary I should have monofocal lenses implanted and be
left slightly nearsighted and able to see up close ( to put on contacts for  
example!).I can then use bifocal contact   lenses (RGP?) to see far
away(astigmatism...)

Assuming this is correct could I use the contacts all the time or would I have  
to take them off in certain situations?

Is it possiblefor a cataracct to not impair vision but be  so "ripe" it  
requires surgery?

Is it possible that before I ever get IOLs, presbyopia will force be to abandon
contact lenses and use glasses again?

I thank tou beforehand for your attention!
Wishing you the best, Sophia

[John C Hagan]

Based on your advice I will definitely only get IOL implants when the cataract
or cataracts really impair my vision ( no doctor here ever explained how much
the risk of retinal detachment increased...)

Based on reccommended research,I have no intention of getting multifocal
implants (so for me that eliminates Rezoom, Restor and Crystalens,
right?).

ANSWER: At present those are the most commonly used multifocal IOLs in the USA. Things change quickly in medicine and ophthalmology and in a few years there may be other types and the "success" may improve. Also bear in mind that some people are happy with these multifocal IOLs.  Remember that the companies say "success" is wearing glasses 20% of the time and that night vision is impaired with this type IOL.

Since I would really like to avoid glasses and assuming that toric IOLs are not
indicated ( ? ) do you agree that this is my best option:
When it is absolutely necessary I should have monofocal lenses implanted and be left slightly nearsighted and able to see up close ( to put on contacts for example!).I can then use bifocal contact lenses (RGP?) to see far
away(astigmatism...)

Assuming this is correct could I use the contacts all the time or would I have
to take them off in certain situations?

ANSWER: There is no reason you couldn't wear a contact lens on your corneas after cataract/implant surgery. Bear in mind that as people age their corneas become dryer, more sensitive and prone to irritation. So the older you get (even if you did not have cataracts or retinal surgery) the likelihood of wearing contact lens successsfully diminishes.

Is it possiblefor a cataracct to not impair vision but be so "ripe" it
requires surgery?

ANSWER:  A "ripe" cataract will severely impair vision to the level of "count fingers" or "light perception only" levels. A ripe cataract is like a tense bag of milk with a rock hard marble in the center.


Is it possible that before I ever get IOLs, presbyopia will force be to abandon
contact lenses and use glasses again?

I thank tou beforehand for your attention!
Wishing you the best, Sophia

    

[John C Hagan]

Sorry I hit "post" before I was finished with my answer.


Is it possiblefor a cataracct to not impair vision but be so "ripe" it
requires surgery?

ANSWER: A "ripe" cataract will severely impair vision to the level of "count fingers" or "light perception only" levels. A ripe cataract is like a tense bag of milk with a rock hard marble in the center. Ripe catarcts rarely occure in developed countries but are a big problem in third world countries where ophthalmological surgery is not available.

In dealing with some of our older and less observant patients they may not notice how bad their vision is getting. We (ophthalmic surgeons) sometimes have to say:  

1. Have cataract surgery or stop driving.
2. Your cataract is getting "hard" and surgery in a year will be more difficult in a year than right now. You may want to consider going ahead with surgery in the next several months.  Such cataracts are brown "brunescent" or red-brown-black. They do occur but again usually in patients in their 70-90's.


Is it possible that before I ever get IOLs, presbyopia will force be to abandon
contact lenses and use glasses again?

ANSWER:  At some point presbyopia will cause you to do one of several possible options:  1. undercorrect one eye to allow your read with it (monovision)  2. switch to bifocal contacts lens  3. wear reading glasses over your contact lens.

I thank tou beforehand for your attention!
Wishing you the best, Sophia

ANSWER:  You are welcome,     JCH MD FACS Ophthalmologist

[sophia35]

Dear Doctor,

Thank you once again for your attentive answer.

I really don´t know what sort of specialist to consult, I just want
to find a doctor I can trust and who will observe me and advise on the
best course of action to guarantee as much as possible the "well being" of
my eyesight.

In the short run I think I should see a retinal specialist but, although there are
certainly many good doctors if you could give me the names of specialists in  
the three areas you mentioned I'd appreciate it. I will definitely eventually need
a cataract surgeon ! As for prophylactic scleral reinforcement, I really don't
know...I guess I would at least like to be observed by a specialist in the area...
( I don't think the axial length of my eyes has ever been measured...)

Thank you for the name of the clinic.Since I feel dissappointed here in Portugal
I thought of England rather than Spain as an option which I intend to pursue
as soon as it is  possible.

Sorry to insist, but before I really need IOLs and assuming my corneas allow  
me to use bifocal contacts, what  puzzles me is if I will be able to see up
close in order to see enough to grab the contacts and put them on! If it's
necessary  I wouldn't even mind having glasses just for the purpose of putting
on the lenses! I'm sure you're aware now how much I really hate glasses...

Thank you once again for your support,
Affectionately wishing you and everyone the best,
Sophia

[John C Hagan]

This is so far down the line that things might change but if an implant is put in your eye such that the post operative "refraction" is -2.00 you should be able to read in good light, put on your make-up, put in contact lens all without glasses. On the second eye you might opt towards better distance vision (maybe a goal of -0.50) in the other eye.

JCH MD Eye physician & Surgeon

[sophia35]

Dear Doctor,
Thank you again for patience. Sometimes I have so many  doubts
I don't express myself clearly. My worry in the short term is that because of
presbyopia I may not be able to put on my contact lenses!

Wishing you the very best,
Sophia

[John C Hagan]

Middle age men and women have been doing it for over a century and you should also. Some of the solutions. 1. Magnifying mirrors 2. inexpensive half frame reading glasses 3. There is a speciality lens just for this purpose that uses a frame with a single magnifiying lens that pivots from one eye to the other. (there is only one lens).  The magnifying lens is used to put in one contact then its flipped over for the other eye.

Half glass magnifiers or full fame magnifiers work nicely for almost everyone.

JCH MD

[sophia35]

Thank you!

You've been of great help.

Affectionately,
Sophia