IOL Implant in 1 eye and contact Lens on other eye

[Capes55]

I have a cataract in 1 of my eyes and am considering surgery, I'm a 53 year old male high myope (-9 contact lens prescription)

I wear contact lenses only, not glasses.

I do not want to have surgery on both eyes unless it's a necessity.

I've been told by several O.Ds that a person can get along quite well indefinitely with an IOL in 1 eye and a contact lens on the other eye.

However.....

another eye MD said it may cause a problem (different image sizes when viewed)

Has anyone out there had just one eye done and wore a contact lens on the other eye?

How did it work out?  Please let me know.

Thanks

[John C Hagan III, MD, FACS]

If you have surgery and opt to have an IOL put in your eye to leave you not needing glasses for distance (greater than 20 feet) that is "Plano" or 0.00 and you are -9.0 in the other eye the image size (aneisometrophia and aneisoconia) are probably too great to "fuse" (work together).  If you are 53 and don't wear even reading glasses then one of your eyes is uncorrected to allow you to read with glasses.

JodieJ a regular poster here has written a great deal about her experience with aneisoconia. you can use the archives and search feature to pull up those discussions.

She might be good enough to comment on your problem.

JCH MD

[JodieJ]

Having one eye plano and the other corrected by a contact does work well for many people with high myopia.  The only way to know how it will work for you is to try it.  Have the surgery on your first eye and then evaluate your vision with a contact in your second eye.  I suspect that you will do fine.  Glasses will not work, though.  The distance between your eye and the corrective lens will minimize the image size in that eye, thereby severely impairing your vision with both eyes.

[Capes55]

Thank you both for your help.

1 more question.....The target for my IOL is -1.5,not plano.  2 reasons...1. I have about 1.25 diopters of astigmatism and 2. The MD said if I was corrected beyond plano (farsighted) it would be very difficult for me having been very nearsighted all my life.

Does this info sound correct?

I'm totally ok with being slightly nearsighted after surgery.

Thank you again

[JodieJ]

Here are my (admittedly) biased opinions:

A target of -1.5D makes sense if you are very much opposed to being corrected beyond plano.  The odds are reasonably good that you will end up between -.5D (able to drive without correction in the daytime) and -2.5D (able to read the newspaper without correction).  I'm assuming that you are having an astigmatism-reducing procedure (such as limbal relaxing incisions).  With -1.25 D of astigmatism added to the above diopter range, you'd probably need glasses/contacts to see clearly at any distance.

It doesn't make sense to me to chose a target of -1.5D based on having 1.25D of astigmatism.  Astigmatism makes you MORE myopic.  If you were slightly farsighted (say +.75D), then having mild astigmatism might actually improve your vision.

What are you currently doing for near vision tasks?  Are both eyes corrected for distance, and you use glasses for near?  Or do you have monovision contacts?  Your corrected vision is really what you are used to (not high myopia.)  It might be advantageous to stick with the same type of correction when choosing an IOL target.  And remember, you can still wear contacts post-cataract surgery if the IOL power is a little off.

[2ndsight]

I am doing this thing with one IOL (Crystalens) corrected to near plano (20/25) and one contact lens which is -6.50. I also have 1.00 D astigmatism in the operated eye. I can see very well at all distances. I don't need any glasses to drive or do outdoor activities and I don't need them for close activities except to read small print and the computer.

I have progressive no-line bifocals with 1.50 reading correction and the correction for the astigmatism and a very slight distance correction which I don't really need.

What I will say is, there is some disparity in the size or depth perceptions of images at certain distances, with me it is some intermediate distances such as 4-10 feet away, but the glasses correct this and I also use some non-prescription bifocal sunglasses which have the effect of evening things out.

Cape I have read your posts and you know, there is really no scientific way to tell how you are going to come out of surgery, You just have to do it. Whatever you come out with, you will be able to get further vision correction with glasses, contacts or Lasik and you will also get used to your vision the way it is as time goes by.

[John C Hagan III, MD, FACS]

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[indi1664]

Hi Caper ,
                Firstly you have a very sensible surgeon....his advice to go for -1.5 is in my opinion ...Excellent ...why ...well I have just had my 2nd eye operation last Monday...I was -20 in both eyes ...yes -20 is correct....my first eye was aimed for -0.5 and ended up +0.75 ...was really dissapointed as i had totally lost my near vision....i could not even see my watch and everything upto 18inches was blurry ...mind you i also have readng prescription and this made things worse.really felt awful...I have just had 2nd eye done...we aimed for -2 with limbal incisions and feels my outcome is -1 to -1.5 (not sure as not tested as yet).

The main thing is i have gained my closeup vision and feel a great deal happier....and can get away withot glasses accept for reading and Computer.....

Now after 1st eye operation you can imagine the difference....
I could not wear normal glasses on my right eye as although this in theory should work ...i had large imbalance....
However with contact lens the balance was perfect...no problems whatsoever.....almost to the point where I chnged my mind on having 2nd eye surgery (worried i would end up plus again)...I am therefore very confident you will have no problem having one eye operated and 2nd with contact lens.

Please read my posts and the Excellent replues from Dr Haggan and Dr Kutryb....and forever helpful ...Jodie j....Dr Kutryb explains your overall precription calculation....

Good Luck

[John C Hagan III, MD, FACS]

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[2ndsight]

just one more note on the issue of the imbalance (with one contact lens and one IOL) in light of reading indi's previous posts. first of all it is very minor, and It seems there is no exact formula for who is going to be bothered by imbalance and who isn't, the degree of myopia and contact lens prescription, etc. You just have to try it and see. There are a few other posts about this on the board. A tech assistant in my surgeon's office told me some people adjust and some don't.

[Capes55]

indi, your prescription was -20 in both eyes?  is that correct?   what is your axial length?

How bad were your cataracts?  What is your gender?  What did your MDs tell you about risk for RD?

Thank you all for your help!

[Capes55]

JodieJ,

My MD said I have a thin cornea so the relaxing incisions are not an option to correct my astigmatism so I guess I'll need to wear a toric contact lens.  Toric IOLs don't come in my prescription.  Another less conservative MD told me he could do the PRK procedure on me after cataract surgery. I have no clue who is correct.

Any suggestions?

Thanks

[JodieJ]

Why don't you wait and see (literally) your outcome before you decide about PRK.  If you don't mind wearing a toric contact, then definitely save your money.  In my case, contact lens wear has been just as comfortable after cataract surgery as before.  However, if you'd like to be able to see well without glasses/contacts, PRK could eliminate your astigmatism and any residual refractive error.  (My cousin, who also had thin corneas, had PRK and can now read the 20/10 line without correction.)

[John C Hagan III, MD, FACS]

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[indi1664]

Hi,
     male 44 yrs...-20 both eyes Incl -2 cyl RE and -1.5cyl LE ....Axial length ...dont know...sry...
Ctaracts ....LE very minor....RE no cataract...

being very high myop... risk is greater ...but health wise I am preety good ...therefore lessened the risk...but risk is always there.

Going back to jodie J comment...and my own thinking ....I would be very very surprised if you didnt get on with a contact lens ....with regard to glasses ....I totally agree with yr surgeons and Jodie J .. would definitely be a problem with imbalance.

The reason....well if you think about it ....implanted lens and contact lens line up very closely....whereas glasses and implanted or Contact lens....there is qiute a gap....

I think the main key to adjusting ...is to have the correct prescription contact lens ...this is always a big fact

Simple test...try a contact in one eye and glassses on other.... you will really notice the imbalance.....but with contacts all lines up quite well....this was my experience...as I had gap of 14 weeks from 1st op to 2nd and....glasses was IMPOSSIBLE....contact in non operated eye was fine....but this is my opinion...please research further y/self to be satisfied...

Good Luck

[John C Hagan III, MD, FACS]

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[Capes55]

Thank you both very much for your help!

[John C Hagan III, MD, FACS]

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[farsight]

I did very nicely for almost two years wearing a contact (-6.5) in my eye for monovision  following cataract surgery. So long as your eye can be corrected to 20/40 you do not need to do cataract surgery immediately. Image magnifications between the eyes will be pretty close and your brain can work it out.Remember the second eye can still accomodate and monovision is not as difficult as it will be with IOL's.  Once your cataract develops further, and it will,  that level of correction will be impossible and your combined vision will now be unacceptable. You will not be able to read comfortably. Jogging, Driving will be dangerous. When my acuity dropped off to a best corrected of 20/70 it was time to do my second eye . Eyeglasses are useless as the image size is too different for your brain to handle. I was concerned about binocular vision and depth perception so having both eyes nearly the same is critical to me.

Now that both my eyes are done, vision is improved and correctable to 20/20. Both eyes are very close, but  I am a bit farsighted and would be happier if that were not so. However - I see 20/40 uncorrected with both eyes combined and 20/20 with a cheap pair of +1 readers. Reading is +3. This is infinitely better vision than I had in the past with $700 glasses or contacts which never did correct for my astigmatism.

I do not agree with the posters who recommend progressive bifocals. They may be fine for a sedentary lifestyle but  I find them dangerous in the most simple situations - on stairs, jogging , riding a bike , etc. Once your vision is corrected to "plano" you will be able to see things directly in front of you fairly clearly at about 4 or 5 feet. In my case that means a pair of +1 glasses or contacts. This is fine for operating a car, tractor or motorbike. You can read the gauges, tune the radio, read the clock, etc. Using a camera is a bit difficult since you can see fine to focus but cannot read the  dials to make settings. I use +3 readers for that and have a monocle on order which may be a better solution that I can hang around my neck.

I can always go back to monovision with a different contact lens on one eye once my Doctor agrees that my eye has healed sufficiently. That may not be possible following some corrective procedures. I would not do anything that takes away the contact lens option for the future. Could I wear contacts following LASIK to fine tune my distance vision? I doubt it.

[John C Hagan III, MD, FACS]

There is usually no contraindication to CTL after Lasik.

JCH MD

[Capes55]

Thank you for your comment.

1 question............what is CTL?

Thanks

[John C Hagan III, MD, FACS]

Contact Lens

[bbuzz]

I had cataract surgery in January on my left eye and my vision in that eye is 20/40.  I have worn monovision contacts for years and I'm now wearing one of my old near contacts in my right eye.  I also have a reading lens for finer print and a distant lens for driving at night and playing tennis.  In my unprofessionall opinion (which doesn't mean much), if you have been wearing contacts with success, you shouldn't have any trouble wearing one contact lens after cataract surgery.  Good luck.  

[John C Hagan III, MD, FACS]

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