Severe myopia

[Mostexcellent]

I have severe myopia ~ -10/-11.  What is the relative risk of RD in cataract surgery (~+2/3) for a male age 55?  Should the surgery be delayed until the cataracts worsen?

[ruby2zdy]

I am -8 and -10, and show signs of weakening retinas (lattice).  I have cataracts, but I only know because my eye doctors tell me I do.  Also, I have big pupils -- larger diameter than the IOLs in low light.  

After having read about so many types of complications in this forum, I'm thinking about, when I do have noticeable problems from the cataracts, just having them removed and getting contact lenses to correct the resulting farsightedness.  I'd like to know if they would be removing the entire lens sac and if they don't, would it stick to itself (front & back) and interfere with my vision.  I'd like to leave it in so I could have the option of having implants put in later, when the diameter is bigger and the results are more consistent.  I'm also hoping that someone will develop a liquid that can be injected into the sac to replace the crystalline fluid.

I talked to a researcher at the University of Texas in Houston (or the U. of Houston -- I can't tell from my notes) who told me that they're working on a polymer to fill the lens sac rather than having an insert.  He said they have a long way to go.  

What is it that causes presbyopia?  The cilia and muscles that focus the lens must not be the cause because these are used by the Crystalens to focus.  Is it that the crystalline lens fluid becomes thicker -- too thick to accommodate?

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

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[JupiterCat]

I have severe myopia (-16 both eyes), am female, and age 55. I have worn corrective lenses since I was 3.  I also have had pathologies -- a small retinal hemorrhage about 10 years ago in one eye. It healed & left a small scar, and since has been stable. The scarring does cause some minor distortion in my vision in that eye.

A year ago I had cataract surgery. A monofocal lens was placed in the undamaged eye and the surgeon simply removed the natural lens in the damaged eye. Doing so corrected the vision in that eye to 20/40. The eye with the implant lens now sees 20/20.

The results of cataract surgery were like a miracle. I can see when I get up at night! I can go snorkeling and see the fish and coral! WoW! My eyes also look years younger since freed of the heavy gas perm contact lens I wore for decades.

The complications? The improved vision caused some intermittent double vision (that resulted from the retinal damage to the one eye) to become more pronounced.  My depth perception went to hell. So, this year I had strabismus surgery to correct my misaligned vision. I now see very well -- without glasses, except for reading fine print (although I am wearing bifocals for a while until we can be sure the eyes will stay aligned. They are doing just fine and I will be able to wear the glsses only if I wish in a few months).

The strabismus surgery and recovery has been much more painful and protracted than I had anticipated, but the cataract surgery was NOT at all painful, nor was thE recovery protracted. I walked out of the clinic ABSOLUTELY THRILLED that I could see without contact lenses.

So.. long story to say that I am someone with very serious myopia problems but who has had cataract AND eye muscle surgery without dire consequences -- like detached retinas.

A 4 to 9% (I was told 10%) risk of RD is not much considering the wonderful life-changing results of cataract surgery. And, since they can do only one eye at a time, if something does go wrong with "eye 1," you don't have to do "eye 2." You can do your worst eye first as the "guinea pig." I say find an experienced, skilled surgeon and go for it. You will be like a normal human for the first time in your life.
      

[indi1664]

Mostexcellent,read this forum thoroughly...and I think you will gladly choose Monofocal...Good luck

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

Unless you have a deep and abiding, pathological hatred of glasses get a aspherical monofocal IOL with the Tecnis being the current state of the art.

JCH III  MD

[Mostexcellent]

Any comments on mono- vs multi-focal IOL?  My concern is night glare, halos and any adverse event.  I can deal with glasses, I can't deal with physiological or anatomical aberrations.

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

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[Mostexcellent]

Thanks for the info.  I checked out Restor and they have a wide range of IO, however, they are multifocal.  I have read and heard that mutlifocal have alot of potential problems, including night glare and halos.  The monofocal seem to have the least amount of problems, similar to external contact lenses of bifocal vs monofocal.  My doc is not a big fan of the multifocal since they can't correct sever myuopic pt to 20/20 with perfect near vision.  A monofocal can, with a possible piggy-back IO, can correct far to 20/20.  I guess I will have to live with glasss for reading.

[Occupant]

Too bad that you can't edit these posts. I should have said Rezoom would be available.

[Occupant]

I had the same problem you are having, however, I waited until they told me: "You are legally blind and can't drive anymore". Not by choice, but there was always this promise, they will get the multifocal FDA approved before you have to have surgery. It never happened and I now have monofocals in both eyes. I now need reading as well glasses to sit in front of the computer. The only multifocal lens that I am aware off for your degree of myopia would be the Restor lens. But you would need some kind of glasses anyway even with a multifocal. So then the question is: "Is it worth it?".

[Mostexcellent]

My opthamologist is recommending monofocal IOL and reading glasses because of my severe myopia. He cannot promise 20/20 with the first IOL, and may have to insert a second "tandem" IOL?  Is this the best way to go?

Are there multifocal IOL appropriate for severe myopic pts that would avoid any glasses? Restor, Rezoom, Crystalens?  All these manufacturers promise great near, mid- and far-vision, but do not address the severely myopic pt, just as Lasik would not fully correct my vision to 20/20.

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

Yes the usual infection bleeding scar formation difficulty inserting the IOL, swelling of the cornea or retina, loss of the eye.

JCH III MD

[Mostexcellent]

Other than RD, ware there any other risks I should know about?

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

You should not consider surgery until you feel your vision is a moderate to big problem with daily activities. A middle age male with highly myopic eyes having cataract surgery is the highest risk catagory and the risk of an RD may be as high as 4-9%.

JCH III MD