Some Misgivings About Cataract Surgery

[leslie57]

I'm in my early fifties and have a cataract in my left eye.  I'm right-eye dominant.  My right eye is -4.5 and my left eye is -2.25.  My optometrist thought I would be a good candidate for the Crystalens.  He referred me to one opthamologist but I went to another one who was recommended by a friend who recently had cataract surgery.  This doctor is well-known and teaches at a prominent medical school.  He also recommended the Crystalens, specifically the one that just came out (I think it's the AO).

My surgery is set for next week but I'm having second thoughts.  I love to read and I work at a computer 10 hours a day.  I've been near-sighted all my life.  It appears that after surgery, I'll have good distance vision but will need glasses for computer work and reading.  What really scares me is that after surgery I'll still need correction in my right eye and the doctor says that because of the disparity, there's a 50/50 chance I could have anisometopria and would need to wear a contact lens in that eye rather than wear glasses.  I've never liked wearing contacts.  He says that since I'm contact lens-resistant and since I have a cataract in that right eye as well (I do but it hasn't progressed to the point of bothering me yet), I'd be a good candidate for early cataract surgery on the right eye too.  After that, I wouldn't have to wear contacts, I'd just need reading glasses (even he says that the Crystalens isn't good at all distances as the manufacturer says).

Does anyone have any advice?  I'm almost ready to cancel my surgery because I'm afraid of the resulting disparity between my two eyes which will require me to wear a contact lens.

Thank you.

[JodieJ]

I developed a cataract in one eye only following retinal surgery.  I was about a -7 before surgery--really too nearsighted to be able to read comfortably without correction.  I had an aspheric monofocal IOL (my surgeon used only Alcon IOLs, so I got an AcrySof IQ) set for distance vision.  I was thrilled with the result, so 2 weeks later I got another monofocal IOL in my other eye (which didn't really have a cataract).  Because of past problems with monovision, I had both eyes set for distance vision.  My Blue Cross paid for both surgeries.  My uncorrected distance vision is 20/20 in both eyes, but I need glasses for distance/intermediate tasks.  I wasn't thrilled with the results of my retinal surgery, but cataract surgery turned out to be an unexpected gift.  I've never even had a minor problem with my implants.

Based on the vision that you're used to, I don't think you'd be happy with both eyes set for distance vision.  Leaving your left eye at -2.25 would allow you to postpone doing your right eye until you really needed cataract surgery.  Your right eye could be set for distance/intermediate vision at a later date.

[leslie57]

Thank you for your advice. I did spend a lot of time this weekend doing research and reading posts on this forum.  I'm going to review my options with another optometrist this week.  One additional question for you Jodie, I believe you said you had the surgery that you're recommending to me.  If so, what type of lenses did you have implanted and do you still need to wear glasses?  If so, for what activities?

Thank you again.

[JodieJ]

I don't work in the eye care field, but I've had a few eye conditions for which I received poor advice from the professionals I consulted.  So I started researching my problems myself, and I've learned a lot in the process.  I think your thread just got overlooked, and you should probably repost as a new thread for a professional opinion.  My main concern for you is that the new Crystalens may not meet your primary goal of being able to read without glasses.  (When implanted by an experienced surgeon, this IOL can provide excellent distance and intermediate vision, but near vision is often not good enough for prolonged reading.)  In addition, you would almost certainly have to do your right eye early.  Having one Crystalens and the other eye at -4.5 would be intolerable for just about everybody unless you wore a contact lens all the time.  And you'd end up paying several thousand dollars out-of-pocket for the Crystalens.

Please do some more research yourself before proceeding--there's loads of good information in the archives of this forum.  (Ignore the threads older than a year or so.)  You sound like a great candidate for some version of mini-monovision with a near bias using aspheric monofocal IOLs.  (With your left eye at -2.25, you could postpone your right eye surgery for many years.)  This is Dr. Hagan's preferred correction.  Dr. Oyakawa prefers the Crystalens, and he has one in his own eye.

[baggyrinkle]

Why not get both eyes done now with the aspheric mono focal IOL's as suggested. Expensive accommodating IOL's are a crap shoot. It's inevitable that your good eye will develop cataracts eventually and you could achieve a balanced vision outcome now without contacts or glasses. I just had both eyes done and am very happy with the results.  I only need cheap readers for close up reading. I can easily read my 24" computer monitor without readers. In any event, take your time making a decision and don't be intimidated by doctors selling premium lenses. Good luck and keep us posted.
Hal

[leslie57]

Thanks, Jodie.  I figured they were just tired of getting the same type of question asked over and over decided not to reply.  

I certainly will consider your suggestion and do some additional research.  It sounds like you may work in ophthamological field  and have experience in this area.  Thanks again!

[JodieJ]

I'm wondering if your thread got missed by the forum doctors, so I'm going to bounce it up to the top.

I hope you consider my suggestion of using an aspheric monofocal IOL with a target of exactly what your left eye is now (-2.25).

[jbigdan1]

Another way to look at it is you have no chioce but to have surgery are you will go blind. Just thank God you will be able to see even if you have to ware glasses. I don't mean to sound so blunt but it's true. Any way good luck to you and I hope it all works out for you.  Jbigdan

[JodieJ]

In my non-professional opinion, you will definitely have a problem post-cataract surgery with one eye near plano and the other -4.5.  One possible option would be to implant an aspheric monofocal IOL in your left eye set for about what it is now (-2.25).  When you do need cataract surgery in your right eye, you could have that eye set for intermediate vision with a monofocal IOL--giving you a nice mini-monovision correction.  You would only need glasses for distance.  (And you'd save thousands of dollars by not getting the Crystalens.)

[leslie57]

I was upset about this last night and had to take a Xanax to get to sleep.  I was thinking about it again this morning and I understand now what's really bothering me.

1. Given that I don't tolerate contacts well (unless they've improved dramatically since I wore them four years ago), I feel like I'm going down a path that will (a) require me to wear contacts until I get the right eye done (whether that's a month or even years away).  What if I'm not happy with the left eye and now, because of the contacts, I _have_ to get the right eye done right away?  I've done from a not-so-good situation to a genuinely bad situation.

2. Right now, even with the cataract, I can still lay in bed at night before going to sleep and read without wearing glasses.  Once this surgery is done, it appears that I'll never be able to do that again.  I'll always have to have a contact in my old eye (to balance out the disparity) plus wear readers in order to see close-up.  This means I'd essentially have to wear a contact lens from the time I get up until the time I go to bed.  In my previous experience with contacts, I couldn't wear them for more than four hours straight.  Now we're talking all day.

3.  I'm also anxious because I feel there wasn't a good hand-off between my surgeon and optometrist.  No one came flat out and said, "You're going to have a big disparity now between your eyes now so go see your optometrist _before_the_surgery and get some glasses to correct your vision for the days immediately after surgery.  Also get a couple of contact lens in case the eyeglasses don't work out for you."  Since I wasn't given this advice, I've lost confidence in my doctors and am starting to question everything.

Sorry for the long post but given what I do for a living, operating on my eyes is like telling a brain surgeon you're going to operate on his hands.  Time is running out so if anyone hear could give me some advice or tell me I'm not seeing things clearly (no pun intended), I'd be most grateful.