cataract surgery - lens choice

Hi,

I'm a 52 year old who'll be having a cataract removed.  The cataract resulted from surgery to correct a macular pucker and vitrectomy.  Both of my eyes are -10 and I have some astigmatism (not sure what it is).  I don't believe this is an issue, but I also have rheumatoid arthritis which is currently in remission.  My eye doctor suggests I get a monofocal lens that corrects to -2 or -3, put a contact in the "good" eye to bring it to -2 or -3 and then wear glasses.  I've been told by another office that I should probably get an IOL in my "good" eye.  Does this sound reasonable?  Do you have any other suggestions?  I don't mind wearing glasses or contacts. I'm most interested in getting sharp vision.

Thanks very much,
Anne

[Ray T Oyakawa, MD]

The problem is the anisometropia.  Most patient can fuse a difference of about 2, may be 3 diopters of difference.

First, I will try to see if you can tolerate a contact lens.  If so, correct you cataract eye to close to plano (zero) if the dominant eye and use a contact lens in the other eye and set at about -1.5 to give some monovision.  If the cataract eye is non dominant consider setting it to -1.5.

If you cannot tolerated the contact lens.  Have the doctor do a glare test in the non cataract eye to see if there is an early cataract.  If so consider, an IOL for this eye.  If not consider LASIK correction in this eye.

Dr. O.

[JodieJ]

I was in the same situation as you, and I got very different opinions about what I should do.  I saw this as an opportunity to get rid of my high myopia, and I didn't want to wear a contact lens full-time for the next 20+ years.  (Both my parents had cataract surgery in their 70's.)  I did a lot of reading about cataract surgery, but I still wasn't sure what my new vision would be like.  So I hedged by getting measurements in my "good" eye for both LASIK and an IOL.  (My surgeon did both.)  I had an (acrylic) aspheric monofocal IOL set for distance vision implanted in my eye that had the retinal surgery, and I was very pleased with the result.  So I got a second (acrylic) aspheric monofocal IOL for my other eye.  (My retinal surgeon didn't care which IOL I got as long as it wasn't silicone.)  I had limbal relaxing incisions to eliminate my astigmatism.  My Blue Cross paid for doing both eyes.  (If you're over 50, you almost certainly have the beginnings of a cataract in your "good" eye.)

We're both at higher than average risk for retinal detachment, so you might want to get input from your retinal surgeon before proceeding.  I have one additional suggestion if you do decide on surgery for your second eye.  If your vision in the eye that had the pucker is still less than perfect, you might want to have both eyes set for the same refractive target (maybe -.50D if you want good distance vision).  This would minimize your awareness any residual distortion resulting from the pucker.



  

[enian0313]

Did you have the second aspheric monofocal IOL for your other eye set for distant vision as well? If so, do you wear glasses for close-up activities, such as reading, on computer, or put on make-up?

I remember that you had posted the measurement of both IOL lens and you are very happy with the results, but I can't find it.

Eunice