Need another opinion about cataract surgery?

[HighMinus]

How helpful is another MD's opinion when planning cataract surgery?
My situation is more challening than some - very extreme myopia (-18.00 in one eye and -17.00 in other eye), higher minus ye has more developed cataract starting to effect vision, history of retina holes and recent laser treatment fo one hole in the -17.00 eye, Sometimes have had itchy eyes and blepharitis. Eye health other than these issues good. Wear glasses more than contacts these days. Work full time at age 61 and need to continue working, so good vision is a must. Concerned about managing vision after surgery.
I am hearing from the retina specialist after this laser treatment not to consider multifocal IOLs. Have limited information from general MD/cataract surgeon,but he recommended multifocals first and need to consult again with this Dr.  I am also hearing my insurance does not cover any premium IOLs, Have HMO plan now and considering chainging in 6 months to PPO plan to I can pick any Dr.
Any suggestions on what to do? Any experiences similar to mine and best way to proceed.

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

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[HighMinus]

JCH MD,
I had my follow up exam with the retina specialist. The retina he did the laser treatment on 3 weeks ago shows no new holes or weakness and is stable.He just had to examine that eye. The other retina is fine.
My plan for now is to hold off on the cataract surgery for at least 3 to 6 months as I am functioning OK. My vision for work, driving, tv,etc. is OK. I know my right eye has a more dense cataract, have that ghosting issue at times for distance and that I'll need another complete retina exam before proceeding with surgery.
As for insurance, the retina specialist's office I go to accepts HMO and PPO. The major draw back to HMO for me is that I need to go back to the regular eye office through my medical group to get a referal for the next retina exam. The compleete exam and laser treatment along with follow up check was all covered by one $15 co-payment. I know if I switch to PPO for next year I can avoid the wait for the referal back to the retina specialist. PPO will also work out better if I want to get another opinion on the cataract surgery. I'll just be looking at a much higher out of pocket expense. The payroll deduction per month through my employer for PPO is a bit higher, too.
Thanks again for your comments. I find these eye care forums very helpful.
High Minus

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

There should be little reason to wear contacts after surgery. If you want to try and get along with glasses most of the time then you can shoot for "Plano window glass" in dominant eye and about -1.75 in non-dominant.

Most people drive just fine with one eye while the other is healing.

Most people would agree PPO service is better than HMO.

JCH MD

[HighMinus]

JCH MD,
Thanks for explaining the after surgery routine. I have some new questions.
Can you go back to wearing rigid gas perm. contact lenses after cataract surgery?
Is it safe to drive when depending on one eye? What about night driving?  It seems there will definitely be a 2 to 3 month period of time when my vision will be changing. I'll have one eye working better than the other.  That is one reason I am putting off surgery this summer.  I am not able to depend on my husband and friends and neighbors for transporation to work and public transportation is not very dependable or convenient.
I will be seing the retina specialist next week for a re-check of my left eye. I can ask him some more questions, too.
I also want to look into changing from HMO to PPO insurance for next January, so I will have more options on what cataract surgeon to use. More MDs prefer PPO plans. It means more out of pocket expense for the patient, but maybe more personal care?
Thanks again for your help.
HighMinus

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

Surgery usually goes like this. FIrst eye done, while its healing you depend on the unoprated eye. Aft 4-5 weeks you get new glasses for surgerized eye and take the thick minus lens out of the unoperated eye and replace with clear "windown" glass. Then second eye is done and you depend on the first operated eye. Four weeks later you get second new lens and you'r back to using both eyes. Works out well.

JCH MD

[HighMinus]

JCH MD,
Do you have any comment on how a person with my vision manages the changes after surgery on one eye while waiting to have the second eye done and still can remain active, work, drive, etc? My current Dr makes it sound so easy and that I would not need to take extended time off from work. He really has not gone over that with me.  I am sure there is a waiting period on having new glasses made
I work full time and am at a computer 8 hrs per day. I am reading about poeple posting that they have vision adjustment issues after surgery. Wearing one contact lens on the eye with pending surgery and waiting for the eye to heal that's just been operated on does not sound like a comfortable time or good plan for me at work. How can I function writing e-mails, doing spread sheets and looking at a PC all day? Office air is very dry and lighting is an issue. My eyes get tired and irritated some days now. I can't imagine the transition period being an easy time for me. I need my income and can't take months off of work. Maybe a couple of weeks at a time.
Just very nervous and plan to put off surgery for awhile. Want to consult with at least one more cataract surgeon with a complete new exam before making plans to go ahead with the -18.00 eye
Thanks,
HighMinus

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

I would generally tell my patients to avoid multifocal or accommodating IOLs and go with  aspheric monovision and aim for mini-monofocal with distance or near bias as you wish.

JCH MD