cataract surgery lens selection

[EPW320]

I am just 57 and need cataract surgery in my left eye due to a cataract side effect of prior retinal surgery.  I am currently -9 in each eye.  I am considering an implant lens correcting my left eye to zero, and then wearing a contact lens in my right eye with glasses for reading.  However, I am concerned that vision imbalance will be a problem for me if my right eye gets tired such that I cannot wear the contact.  In view of vision imbalance, should I instead have a lens implanted in the left eye that takes it to -6, which I understand would be a tolerable (i.e., not noticeable) vision imbalance?

[Sandy Feldman, MD, MS]

Dear EPW320,

This choice is up to you and is an individual decision.  There are benefits and risks of each approach and many patients like not having to wear corrective lens in one eye.  Another option in addition to the two mentioned above would be to aim for reading vision, which would enable you to be lens free in your left eye. I would recommend that you continue to become educated and discuss the pros/cons with your doctor and his team.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[JodieJ]

I was in a situation similar to yours, being very nearsighted and having a cataract in only one eye due to retinal surgery.  I chose to get aspheric monofocal IOLs implanted in both eyes (even though one really didn't have a cataract), and my Blue Cross covered both surgeries.  I was very pleased with my outcome.  (It was a real thrill to be able to drive without glasses or contacts for the first time.)  An alternative would be to get laser vision correction (LASIK, PRK) to reduce the myopia in your second eye (and your insurance might cover the procedure).  Wearing a contact lens in that eye works for some people.  I would not recommend targeting -6 for your cataract eye, but it's certainly an option, too.  Although a 3 diopter difference between your eyes might (or might not) be tolerable, you'd be passing up a golden opportunity to have good uncorrected vision.

[EPW320]

Thanks for the advice.  It adds to my confidence to try a 0 IOL in the left eye along with a contact lens in the right eye. Later, if I feel motivated, I may try your idea of LASIK or an IOL in the right eye in lieu of the contact lens.  

[londonbridge]

Dear EPW320,
I echo JodieJ's comments completely.
I was in the exact same situation as you trying to contemplate the same options. I chose a mid distance IOL (-.25) for my nondominant IOL eye and wear a contact in my dominant eye for distance. I plan eventually to correct that eye when the cataract worsens to a plano (0 ) distance.
I have a pair of glasses with a mirage anti reflective coating that blocks the vision in one eye for when I can't wear my contact at night after 12 - 14 hours. I find that I cannot drive with this but otherwise it works well enough. I didn't do the laser because I knew I would probably do my second eye with an IOL at some point.
londonbridge

[JodieJ]

Another possible consideration:  When you develop a cataract in your 50's due to retinal surgery, you may not need cataract surgery for your second eye for 15+ years.  That's a very long time with a contact lens.

[londonbridge]

Just a comment to say that is a consideration for sure. I am beginning to weigh the pros and cons of having my second more minor cataract done sooner rather than later. Yes the contact works fine and there would be a trade off loosing the accomodation in my second eye and loss of close (very close) vision. But I would be freed of many of the hassels of contact lens wear and the imbalance in my eyes (8 diopters) whenever I wasn't wearing the contact.
londonbridge

[EPW320]

Thanks for the extra points.  Some of the hassles you mention are why a part of me says just get rid of the cataract, leave the eyes otherwise the way they are, and stick with the comfort of my glasses that I have been wearing since I was in prox second grade.  I really don't mind wearing glasses.  However, I then concluded that it can't be that hard -- for the sake of progressing toward improved vision now and into the future -- to pop in one contact in my right eye every morning to balance my vision, wear glasses to tweak for distance and provide for reading, have another pair of glasses with a blurred left lens for occasions when I may want to take the contact out, and consider clear lens exchange or LASIK in my right eye at some point if I just can't stand wearing the contact anymore.  

Am I thinking this through clearly, and is the latter choice (improved vision in the left eye) the right decision for me based upon your experiences?  (I am choosing to correct the left eye for distance rather than reading in part because I don't think I will be able to read clearly with it because of a little wrinkling/scarring effect that I suspect still remains from the prior retinal surgery).

[EPW320]

Thank you for your advice.  I have been discussing it closely with both my opthamologist and an optometrist friend of mine.

[JodieJ]

If you have some residual distortion in your left eye from past retinal problems, using only this eye for reading (i.e., monovision) might not be your best option.  At least in my case, when I use both eyes together I'm not at all aware of the residual distortion in one eye from an epiretinal membrane.  (My brain has apparently learned to screen out any distortion.)  This would not be the case, though, if I used only my "bad" eye for reading.

I think that you might want to get recommendations from more than one experienced cataract/refractive surgeon.  Setting your left IOL at plano and correcting your right eye to plano with a contact lens should work well.  Alternatively, you could target good near vision for your left IOL and correct your right eye for near vision with a contact lens (and wear progressive glasses over the contact for distance vision).

[londonbridge]

I think that if you have the chance to have improoved vision by correcting your left eye with an IOL for either distance or reading and then correct the right eye for the same with a contact should work well. Which way you go depends I think on what you would prefer to wear glasses for distance or reading. Having been nearsighted like yourself all my life, I was always struggling for good distance vision and I like having the ability to see distance without glasses. (I did do blended vision in my case intermediate/distance). Then you could always opt to do a clear lens exchange in your right eye.  I think you would be happier than correcting your cataract eye to -6. I struggled with this as well because I wanted to avoid surgery on my second eye and was concerned about the contact. The contact worked fine and I still may do the surgery anyway at some point.
londonbridge

[JodieJ]

If you're over 50, you almost certainly have the beginnings of a cataract.  Both of my eyes were billed as cataract surgery, and my insurance paid the entire cost.  (I had had retinal surgery earlier that year, so I had already reached my out-of-pocket ceiling on my insurance.)  My surgical outcome really exceeded my expectations--what an unexpected gift!  My vision with aspheric monofocal IOLs is at least as good as my best-corrected vision ever was, and I don't have the problems driving at night on dark roads that I used to.  In my case, doing both eyes worked out very well.