cataract surgery question

I was examined 11/3 and scheduled for (nucleus) cataract surgery on R eye 12/10 but had a severe cold that week and had to cancel.  Exam was by an opthalmologist who does loads of surgeries and has a good reputation, but he did not dilate my pupils.  I keep thinking maybe I did not have a thorough enough exam before surgery - is dilation absolutely necessary?  RX from my eye exam a year ago was R -1.75, +1.5, 130, Add +2.50; L -1.25, +0.75, 173, Add +2.50.  Current RX is R -3.25, +1.00, 128, Add +2.50; L -1.25, +0.75 015, Add +2.50.  Big change on my R eye in one year, I presume because of the cataract.  When I got new glasses a yr ago, I did not see much better than before.  Either RX was faulty or cataract was beginning to have an effect.  The doctor (different one, also an opth) gave me a new RX  with no mention of cataracts and was sending me on my way when I told  him that he had told me a year earlier I might need cataract surgery fairly soon.  He said, oh, I'll note that on your chart - come back in 6 mos.  That's why I changed doctors.  The present doctor is now scheduling into January sometime and I am concerned about the length of time between the exam/measurements and surgery.  Is there a rule of thumb about this?  Agonized over Restor vs. monofocal (decided on mono) and at this point just feel like getting new glasses and forgetting it but I suppose that's not really an option.  Would appreciate your thoughts.  

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

1. The measurements for an implant (IOL) are radius of curvature of the cornea and axial length of eye. Those don't change hardly at all so waiting for the surgery is not a problem.

2. I would go for the monofocial IOL and glasses and forget the extra expense and risks of multifocal IOLs.

3. I suppose each MD may have their own opinion but I feel dilating the pupil is important prior to surgery to see the back of eye better, to evaluate the cataract better and to see how well the pupil dilates. If it doesn't dilate well then extra drops are ordered at the time of surgery.

JCH III MD

[cplayer]

Thanks so much for your prompt response.  The tech talked as though they would want to do the other eye as well.  Would you opt to let that one go until catract was more mature and wear glasses in the meantime, or have surgery on both eyes now? The R eye cataract was classed as a #3.  I'm not sure of the Left, but it is a somewhat lesser problem and I'm sure would not be considered for surgery if I was not  having surgery on the other eye. It might be nice to just need reading glasses after the 2nd surgery but I am not terribly averse to glasses if that would be the better option. I hear that after one eye is done, you can't wait to get the other one done, but mine don't seem to be of equal severity.   Just wanted to make sure I understood your position. Thanks again.  I feel somewhat better.

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

I feel that some cataract surgeons push their patients too hard to do both eyes very close together. We normall just schedule one eye let it heal and see how the patient is doing. We don't like to do second eye until first eye out of woods and the patient very very happy. On the average we do the second eye about 5 weeks after the first but some people wait several years before they want the other done.

JCH III MD

[cplayer]

I'm going to make an appt for a second opinion on cataract surgery (and will get my eyes dilated this time).  Do you think another refraction is necessary?  I had a refraction on 11-2-07. Thanks.