How big of a problem is being corrected beyond plano(farsighted)for a highly nearsighted person during cataract surgery

[Capes55]

I'm the 53 year old high myope (-9 contact prescription)  I'm trying to make the right decision concerning my probable upcoming cataract surgery.

I have a posterior subcapsular cataract in my right eye that's causing me significant difficulty.  I've also recently noticed something small in my left eye, but it's not causing me any trouble yet.

My optometrist told me about 10 years ago..."I'll bet by the time your 60, you'll have cataracts in both eyes"  Well, I'm 7 years ahead of schedule.

I'm really concerned about my situation.  I own several businesses and need my eyesight.  I'm also in a higher risk category for RD (male high myope) I don't see where I have a choice but to go ahead with surgery.

I know quite a few people who have had cataract surgery, all successful, and they all say there was nothing to it.

My mother, who is 74, is having cataract surgery on both eyes, 2 weeks apart, in August.  She's not as nearsighted as me. probably a -5 or so.

So here I am, needing to take care of this, and thankful I found this forum with very experienced MDs and others who are very knowledgeable and generous and helpful.  In my opinion, you are all good Samaritans.

I was within a week of having cataract surgery 1 year ago and decided to cancel.  The surgeon was very good and very conservative.  He was going to implant a +7 power IOL with a target of correcting me to a -1.5.  I also have some astigmatism.  He said I have thin corneas and that he couldn't do anything about that.

His head technician said they didn't want to take any chances on correcting me to beyond plano.  She said it would be disastrous if I became farsighted and that I would hate them.

When I cancelled surgery last year, they recommended I see a renowned Surgeon in Houston TX, which I did last August.  I have another appointment with him on Jul. 28  Last year he said he didn't think I needed surgery yet, but that "these things develop quickly" and that I should see him every 6 months (I had to cancel my follow up appointment in March)

Am I making too big of a deal about this?

I've seen 2 other local MDs recently....

MD#1 does surgery 2 days a week...is that a good or bad thing?..he operates on Mondays and Thursdays...I'm tentively  scheduled with him for Thursday Aug. 7  Is Thursday a good day of the week to have this done?  I see where most Doctors operate on Tuesdays and Wednesdays. This MD is very positive and confident, very experienced, in his Late 50s.  I don't think he's board certified..I'm not sure what that means.
He plans to use a +7 power Alcon 1 piece aspheric monofocal which they said would make me a -1.5

MD#2 is younger, around 40, a solo practitioner, board certified.  He is less conservative.  He wants to use a 3 piece Alcon +4.5 power which would leave me at -.5  Is this too close for comfort?

As much as I would like to not have to wear a contact lens, I'm ok with it.  

How much danger with MD #2 is there of being corrected beyond plano?   I hear that calculations are less accurate with long eye balls (mine is 29.1mm axial length) I don't know and need help. He made me take my contact out(a toric lens for astigmatism, for 13 days) This MD told me last week I'm worrying too much about this and to just "let it go"  I agree BUT

I'm 53, and expect to live a long time and if somebody is going to implant a permanant lens in my eye that will be there potentially for a long time, I want to make the right decision!  and I need to make a decision very soon and then just pray and expect things to work out.
About the YAG procedure, Doc # 1 told me he's done many thousands of them and has NEVER had a YAG related   retinal detachment.  He says he uses a low power.

Are the YAG procedures really that safe?  I've heard that I am almost certain to need one.

Anyway, thank you all in advance for any counsel you can give me.

[CherylLee76]

Please see comment above to JackM829

[CherylLee76]

My Doctor said no to Piggyback lens, although there are some Doctors who say it is ok. It can cause dispersion of the iris and that would mean another surgery to remove the piggyback and more than likely the first lens. I think it is best to do an IOL exchange with a very experienced surgeon who has done many of these.

I also have had the wrong power lens implanted and not happy. My first Doctor recommended a piggyback but I went in for a second opinion and that Dr. said no.

[janellen60]

I had one eye done two weeks ago and ended up hyperopic.  I hate it hate it hate it. Piggyback lens is planned for several weeks from now.  I have concerns about the piggyback.  Is it safe? are there potential complications?

[JackM829]

My first YAG laser wasn't "strong enough". It cleared everything up but it clouded right back up again within two days. So the second YAG he went to town on my capsular bag and just shot holes through everything lol Since then I haven't clouded up again.

I had a HOYA PC-60AD monofocal. +15.50 D implanted.

I can tell a huge difference with my oprated eye and my non-operated eye. Everything is sharper, clearer, brighter. It's pretty amazing. Then again my left eye had a much larger cataract.

In my right eye I use a -8.00 contact lens. With that lens in , I don't really have a problem.  I actually need reading glasses to see my computer or phone with my left eye, so what I do for now is just wear a +2.5 contact lens which, again, makes everything on my screen so amazingly clear.

I can't wait to get the right eye done.

[CherylLee76]

Thanks for responding Jack. Do you know what type of lens was put in your eye?What was the strength. You went from extremely near sighted to far sighted correct? Was it hard for your eyes to adjust to each other right after the surgery? What is the other eye range? Is it myopic? Do you see a difference in color between the eyes, by closing the eye with surgery and then comparing the colors you see out of the other eye. My left cataract eye is much brighter after the surgery while the right eye is more yellow. Also did you have any issues with side flicker or edge glare from the lens? I have that right now, hoping it will get better. I wanted to be at plano, but right now I am at +1.00.
Why did you have two yag lasers done?

Thanks again for your help.
Cheryl

[JackM829]

CheryLee76 -

Actually I misunderstood my doctor. He had said I was "4 clicks" farsighted which meant i was +1.00.  I settled in at 3 clicks which is +0.75.

So they basically got me almost exactly where they wanted me. I've had two YAG lasers done on this eye and I'm extremely happy with the results.

Right now I wear a +2.5 contact to work on my computer, and take it out when doing anything distance related (walking, driving).

I can't wait to get my right eye done. They're still just holding off to make sure I don't get CME in the left eye as I had a lot of inflammation after the surgery.

[CherylLee76]

What is the Holladay II formula. On my record the dr. has using a Holladay I formula with a target of Plano.

Here are the measurements. Could you help explain them to me.

OS eye
AL: 23:15 mm (SNR=158.6)
K1: 43.77 D/7.71mm @ 3 degree
K2: 44.00 D/7.67 mm @ 93 degree
R/SE: 7.69 mm/43.89 D
Cyl: -.23 D @ 3 degree
ACD: 3.25 mm

I had the EnVista implanted> What strength of IOL would you suggest. I also had a vitrectomy in December of 2012

Thanks for your advice and comments.

[CherylLee76]

Jack,
Has the hyperopia changed from the +3 to 0 yet? I see that you had the surgery very recently. I also had cataract surgery just recently (May28, 2013) and the Dr. was shooting for plano. I also had a vitrectomy in December of 2012. I turned out to be a +1.5, one week later at +1.00. He is saying also as the eye heals it should get better but so far my vision seems so off even though my other eye is at +.75, it is hard for my eyes to adjust to each other. I also find that the cataract eye is so much clearer now, very white when looking at object while my right eye (non-operated) is very yellowish. Wondering if this could be a part of the problem of eyes working together.

[JackM829]

You're totally right about hating hyperopic.  I went from -11 to +3 in my left eye.

Being farsighted *****. Over the past week I went from +4 to +3. I was told as the eye heals I should get closer to +1 or 0. I'm hoping.

Farsightedness is no fun. Nothing is in focus.

[Capes55]

Thank you for your councel.  The MD I'm considering that wants to correct me to -.5 uses the latest version of the zeiss iol master and on my measurement sheet it says the formula they use is the Haigis formula.

I think my left eye is my dominant eye.  My right eye is the one I'm having the problem with.

Should I insist that this MD shoot for -1.25 to 1.50?  I get the impression that he tries to "nail it every time"

If he shoots for -1.5 he can implant the 1 piece acrosof IOL

Currently, he's planning to use the 3 piece alcon because it comes in lower powers.

He's planning on using a 4.5 power iol to get me to -.5  He said if he were to use the +6 power 1 piece iol (the lowest power for the alcon 1 piece) I might be a -1.5, but my astigmatism might make me a -3     I'm clueless and confused.

The 2 other Mds i've seen were going to use the following: Doc 1    a +7
                                                                                    Doc 2    a +6

Both had a target of -1.5

A concern...this latest Doc doesn't implant 3 piece iols very often..is that a problem?

Also, since I'm a high myope, I've heard surgery is a little trickier...is that true?

! other question...my right eyelid (the bad eye)  has been twitching a few times per day for about 6 months...I've heard it's stress related...It's really bugging me


Any suggestions?

Thank you again for your councel.

[Michael J Kutryb, MD]

First, make sure your surgeon is board-certified, I think that is very important because it does take a great deal of work to get that certification.  It doesn't matter which day of the week the surgery is done - that is 100% unimportant.  Personally, I would try to find the dominant eye and do the non-dominant eye first and shoot for about -1.25 to -1.50 in that eye.  Then in the dominant eye I would try fine tune the results if possible after looking at the data from the first eye and shoot for about-0.25 to -0.50 roughly in the  dominant eye - always making sure to error on the side of slight myopia and clearly avoiding any any hyperopia.  You will not like being hyperopic but won't mind being a little myopic since you have been myopic all your life.  Make sure the surgeon uses a Zeiss IOL master for your measurements, with SRK-T or Holladay II formula.  Next most accurate is immersion a-scan but IOL Master is better.   As far as the yag laser capsulotomy, that is really the very least of your worries.  I have done thousands with no problems although I clearly realize there is about a 1 in 1000 chance of a retinal detachment or dislocated lens.  It is a very, very easy procedure, but I am always super careful, and never take a good result for granted although that is what we get 99.9% of the time.  I am excited for you.  You should do great.  Stay away from hyperopia and at worst leave yourself a little nearsighted, you will be thrilled.

Michael Kutryb, MD