Posterior subcapsular cataract, and previous RD and Scleral Buckle

I am a cytologist, and therefore use a microscope 100% of the time during work hours.  I haver ecently noticed a blurr and glare in my right eye.  I have very significant myopia, and have had both L and R retinal detachments in the last 15 yrs, treated by a Scleral Buckle procedure.  Upon noticing this vision change, I immediately saw my dr and was found to have PSC.  I am also borderline diabetic (type 2) with my last 4 pregnancies resulting in gestational diabetes.  I am under 40 yrs (38yrs) and I am concerned for my future in regards to my career as a cytotechnologist, and for the corrective procedures involved with this PSC (cataract surgery) and my existing scleral buckles, and multiple laser surgery for holes in my retina and the potential for recurrent RD and eventual blindness.  I know that this type of cataract is agressive by nature, especially with young age, and high risck factors such as, diabetes, RD and high myopia.  Can you please tell me the implications of such a scenario? Do you think I will be able to effectively continue working in my current field after surgeries? Thank you
Kristyna

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

This is the way I handle these problems. 1. I have the patient see the retina surgeon and tell the retina eye MD that cataract surgery is needed/anticipated  a. are there any areas of the retina that need laser/cryo before surgery? b. is cataract surgery "ok"  c. any special precautions to the surgeon (generally use of a "premium" multifocal/accommodating IOL is not recommended).  2. After cataract surgery when does the retina surgeon need to see the patient to re-examine the retina?

So once we talk to the retina surgeon and get this information we proceed with surgery using a aspheric monofocal IOL with a discussion of desired post op refraction 1. mini-monovision near bias  2. mini-monovision distance bias 3. near both eyes  4. distance both eyes (likely not what you will want)  

We also make the patient aware that the eye will not focus on its own like when younger and progressive no line bifocals will be necessary to balance the vision in both eyes   (even if you did not have cataracts you would need no line bifocals in your early to mid 40s due to aging (presbyopia).

This is worked well on scores and scores of patients. Close cooperation between cataract surgeon and retina surgeon is key.

The risk of a RD post surgery is less because of your buckles. The most common outcome is that you can continue your career.

JCH MD

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

This is the way I handle these problems. 1. I have the patient see the retina surgeon and tell the retina eye MD that cataract surgery is needed/anticipated  a. are there any areas of the retina that need laser/cryo before surgery? b. is cataract surgery "ok"  c. any special precautions to the surgeon (generally use of a "premium" multifocal/accommodating IOL is not recommended).  2. After cataract surgery when does the retina surgeon need to see the patient to re-examine the retina?

So once we talk to the retina surgeon and get this information we proceed with surgery using a aspheric monofocal IOL with a discussion of desired post op refraction 1. mini-monovision near bias  2. mini-monovision distance bias 3. near both eyes  4. distance both eyes (likely not what you will want)  

We also make the patient aware that the eye will not focus on its own like when younger and progressive no line bifocals will be necessary to balance the vision in both eyes   (even if you did not have cataracts you would need no line bifocals in your early to mid 40s due to aging (presbyopia).

This is worked well on scores and scores of patients. Close cooperation between cataract surgeon and retina surgeon is key.

The risk of a RD post surgery is less because of your buckles. The most common outcome is that you can continue your career.

JCH MD