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most trouble free way to correct eyes after cataract surgery in 1 eye
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most trouble free way to correct eyes after cataract surgery in 1 eye

I currently wear eyeglasses, am very miopic, and may soon need to get cataract surgery in my right eye. My left eye is around -5 diopters and my right is around -9 diopters, per the eye exam I had a couple weeks ago.My current eyeglasses correct for -5 and -7. My right eye has gotten worse in the past 7 months since I got my current eyeglasses.
The eye doctor I saw said he wouldn't give me a new prescription because the difference between my eyes is too great. He also said I had a cataract in my right eye that should be removed.

I have posted a few times here and am trying to decide what to do. I am not sure I want the hassle of contacts though I may go that way.

I am thinking of getting cataract surgery on my right eye and having it correct to within 1 diopter of my left eye only..and then continuing to wear progressive eyeglasses (for both eyes) as I have been doing since I was in 4th grade...(I am now in my early 60s).

It seems that if I have my right eye correct to near 20/20..the difference will still be too great when compared with my left eye (assuming i don't get surgery there too which probably won't be covered under Kaiser..don't know)..and I will have to wear contacts and eyeglasses..and maybe reading glasses too.

It seems that getting my right eye corrected to be close to my left eye may be the least troublesome way to go...and just maybe wear glasses all the time which I am used to.

Is this a viable alternative? Any suggestions/opinions on doing it this way? Thanks.
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Avatar_m_tn
Unless the cost is too much of a concern, you might consider just going in to an optometrist tomorrow and coming home with contact lenses you can try to decide if they are a hassle or not. Many people with eyes with different prescriptions, and many myopic people in general, find contact lenses give them better vision. Once you know if you like or don't like contacts, that makes your decision easier.

Obviously the simplest approach is to have this eye wind up as myopic as the other and just continue to wear glasses, but it seems a shame to go to the trouble of surgery and not attempt to correct your vision. I don't know if you've checked on whether insurance may cover doing the 2nd eye as well even if it doesn't have a problem cataract, or considered whether to perhaps pay to get the 2nd eye done anyway soon after, or to perhaps correct the 2nd eye with lasik (which will merely change the power of the IOL you need to use later when that eye does need surgery).

Of course if you do correct your vision, you need to decide what distance to focus it at. People who get presbyopia correcting IOLs like multifocals or the Crystalens tend to get both eyes focused for distance or perhaps some monovision with one eye set in a little nearer, as do most people with monofocals. However since monofocals don't try to give you vision throughout all ranges: near, intermediate an distance, some people choose to target monofocals at the distance they use the most and use glasses at other times. Most target their monofocals for distance (and need glasses for near and perhaps intermediate), but some target intermediate to have good household&social or computer vision (needing glasses for distance and perhaps near), and some target near to have good reading or close-up hobby vision and then wear glasses for farther out.
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Avatar_m_tn
Unless the cost is too much of a concern, you might consider just going in to an optometrist tomorrow and coming home with contact lenses you can try to decide if they are a hassle or not. Many people with eyes with different prescriptions, and many myopic people in general, find contact lenses give them better vision. Once you know if you like or don't like contacts, that makes your decision easier.

Obviously the simplest approach is to have this eye wind up as myopic as the other and just continue to wear glasses, but it seems a shame to go to the trouble of surgery and not attempt to correct your vision. I don't know if you've checked on whether insurance may cover doing the 2nd eye as well even if it doesn't have a problem cataract, or considered whether to perhaps pay to get the 2nd eye done anyway soon after, or to perhaps correct the 2nd eye with lasik (which will merely change the power of the IOL you need to use later when that eye does need surgery).

Of course if you do correct your vision, you need to decide what distance to focus it at. People who get presbyopia correcting IOLs like multifocals or the Crystalens tend to get both eyes focused for distance or perhaps some monovision with one eye set in a little nearer, as do most people with monofocals. However since monofocals don't try to give you vision throughout all ranges: near, intermediate an distance, some people choose to target monofocals at the distance they use the most and use glasses at other times. Most target their monofocals for distance (and need glasses for near and perhaps intermediate), but some target intermediate to have good household&social or computer vision (needing glasses for distance and perhaps near), and some target near to have good reading or close-up hobby vision and then wear glasses for farther out.
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Avatar_m_tn
Ok..I gone one step further. A few days ago I saw an optometrist at Kaiser (where my insurance is). He examined my eyes and determined that I do have a cataract in my right eye (which is currently -9.25 diopters) and a have a small cataract just developing in my left eye which is currently -5 diopters.His report also said that I have astigmatism in both eyes, myopia in both eyes, ANISOMETROPIA, and PRESBYOPIA. He referred me to their ophthalmology department for 2 short initial appointments (back to back). One  appt with with a technician for an A Scan (I don't know what that is)..and the 2nd appt is with an Ophthalmologist for a consult. Both appointments are scheduled for 15 minutes.

The directions I was given say that I am not to wear any contacts (which I don't have anyway) for about a week or so before the scan (reason not given).

So I guess I will go and see what they say. I definitely need to do something about my right eye. With my current glasses,I can't read or see well out of my right eye because my current glasses isn't strong enough for my right eye
(it is -7 diopters).

Not sure what I will do yet. I may decide to just get the cataract taken out of the right eye and corrected to within 1 diopter of my left eye and continue tow ear eyeglasses if I can. I do NOT want to get into a situation where I have to wear both contacts and eyeglasses...AND I don't want a situation where I can only use one eye for a month while I have eyeglasses made or whatever. Anyway..will see.

Given my eye condition..any suggestions on the type of IOL (or whatever it is called) to put in my right eye? Which would be better, monofocal or
multifocal intraocular lenses (ReZoom ?) ? I know nothing of these personally.

I am not sure if my left eye will also be done and if it is..how to deal with my different eyes until it is done.
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Monofocal IOLs are less expensive than multifocal IOLs; have lower complication rate, better optics, better night vision and are what I would chose if I were having cataract surgery. The ReZoom IOL is the worse of the lot and should never be used in my opinion.  The best of the "premium" IOLS in my opinion is the Crystalens.  The toric IOL is a good choice for higher degrees of astigmatism and has better optics and higher satisfaction than multifocal IOLS.  

JCH MD
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Avatar_m_tn
Ive just had multifocal lenses fitted to both eyes ten days ago and my vision both near and far is very good  No night glare or halos
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Avatar_n_tn
Being I had cataract surgery in one eye, I thought I would give you my opinion.  First the IOL I had implanted was the Tecnis 2.75 which is a MF IOL.  I wrote about why I choose that IOL and my experience here.

http://www.medhelp.org/posts/Eye-Care/Tecnis-275D-MF-IOL-Experience/show/2597910

I was the first person my doctor used that lens on.  Since then he has implanted the newly FDA approved Restor 2.5 and has done more patients with the Tecnis 2.75.  I asked him about what his patient’s results have been with those two MF and he wrote back, “So far, I'm not at all impressed with the ReStor +2.50.  It seems designed primarily as a distance lens, and the few people I've seen with it all have inadequate reading vision, even at an intermediate distance.  On another note, I'm growing to like the Tecnis +2.75 more and more. “

Now to answer some of your questions.  First IMO absolutely do not get cataract surgery unless you have to.  I know they say it is 98% successful, but this is surgery to your eyes.  Even though my eyesight is much better now I have floaters and Halos after surgery.  I am getting more and more use to them, but I would not recommend anyone getting surgery for a clear lens replacement (though you mentioned you had a slight cataract in the other eye also).  

It sounds like you need cataract surgery in the right eye.  I am confused to why you would want to make the right eye myopic to the same level as the left eye.  Maybe you can expand upon your reasoning.  I would suggest doing what I did.  I had cataract surgery in my left eye and had it set for 20/20 distance and I use a contact lens in my right eye.  BTW, my right eye also has a cataract, which needs to be removed, but I am waiting as long as possible to see if any new options come available such as the Tecnis Symfony IOL.  

Yes my right eye is still suffers from presbyopia.  But I do not think anything you do after cataract surgery in one eye will make it match to the other eye.  Your other eyes will still have some ability to adapt while your cataract IOL will not, unless you get the Crystalens IOL.  

At this point in time there are no IOL that are going to give you perfect 20 year old adaptive vision, so it is about getting the best vision you can with what is currently available.  

You said you did not want a situation where you could only see out of one eye for a month or so while a lens is made.  I can only give you my opinion, but I would not let that be a deciding factor.  My left eye had gotten so bad I normally closed my left eye to see out of my right only.  But I was waiting for the new Tecnis 2.75 lens to get FDA approved.  Personally I would focus on what you think will achieve your best vision as your choice here will be with you for the rest of your life.  And the first choice you have to make is decide which type of IOL you want, monofocal, MF, adaptive or Extended Depth of Focus.  



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Avatar_m_tn
The Technics Symfony Is the lens I had implanted in both eyes last week
There becoming a lens of choice in the UK
No glare at all or halos Good close up vision Though my surgeon couldn't promise that I would need reading glasses But that wouldn't have been an issue had I of needed readers
As I have already said sharp distance vision But the intermediate is the most impressive in my case
I was short and long sighted and astigmatism of 5.5 in one eye 4,5 in the other Both eyes are virtually the same now
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My close up vision is 20/20 but the biggest issue I have with close up vision is light.  Like all MF IOLs the light gets split, so more light needed.  I can read very small print as long as there is enough light.  I will give you a real world example from the other day.  I was installing a new door lock and mortising the latch.  Maybe a distance of 1 foot or so.  It was cloudy outside and started to rain and inside I only had a single hallway light.  I could see, but it was not clear.  I brought in a light and all cleared up.  What is your experience been with close up vision and amount of light with the Symfony lens.  BTW I am waiting for FDA approval and see the results from the FDA trials.  
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Avatar_m_tn
I started to read your post and had to double check that I hadn't
My experience is just the same Natural light is King I look at fine print on my eye drop bottle in the bathroom and struggle Take it over to the bedroom window (daylight) no problem

My distance vision at dusk is at its best Im wearing sunglasses during the day as they give me real clarity Ive started wearing a lighter shade of sun glasses But Day twelve after the op it is early days

Ive noticed that one of the eye s need some adjustment after the surgery chains are advertising the symphony lens as there lens of choice

My surgeon told me he had not had any halo issue with this lens But did warn me that 1 in 20 need some adjustment after the op
Fortunately for me he hit the spot first time with both of mine
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Avatar_f_tn
I thought I would just mention that I had cataract surgery on 29th June in UK and had a monofocal lens implanted for distance.  I had become shortsighted in both eyes due to myopic migration caused by the cataracts. The eye that is untreated is -4/-5.  Unfortunately I had a PVD in the operated eye exactly 28 days after the operation which has made thinks a little less clear , (except when I eye flick in out of the way) but before this my long and middle distance sight was amazing. It's still very good.  However, when I walk about the house at night (late sleeper), trying not to wake people up with bright lights, I find the vision with the IOL is pretty poor, even compared to the other eye (which has a large cataract). Therefore it is not just the multifocals that have this problem.  My surgeon also recommends the symphony for the other eye, but I think I am leaning towards the monofocal lens for this eye too, as I am the sole driver with 2 teenagers, and I would love to see again like I did  the first month after my surgery.  The other eye has PVD already so no danger there.  It's good to know that the symphony is often glare and halo free but there really is no guarantee.  I think anyone who is still working has to consider all the bases.  I managed to get our IT guy to ammend my work computer screen today to a white writing on black background with mauve, yellow and green headings.  This has helped me to see the screen even without glasses, at least for now.  This community has been such a great help.  Good luck with your decision.
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Yes  im only 53 So driving distance was the most important thing to me
Also getting both eyes done the same day was important to me But as you say no guarantees Although I was reassured by my surgeon when he told me that there would be no isues with distance with the symphony lens Close up and intermediate was the tricky part
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Avatar_m_tn
Hello rwbill..

You asked me " I am confused to why you would want to make the right eye myopic to the same level as the left eye. "

This is what I am thinking. If I have them correct my right eye (currently -9.25 diopters) as best as possible (lets say to 20/20 or whatever), then it will be TOO DIFFERENT from my left eye, which is -5.0 diopters..This is assuming I don't have anything done to the left eye yet. I was told there is a small cataract in my left eye as well but it is just forming. My right eye is worse.

If I have just my right eye corrected, than the difference between my two eyes will be about 5 diopters, right?..that is without wearing anything on my eyes. Don't think I want to have that as it will probably make me VERY dizzy . I don't think I want to have to depend on always wearing a contact on my left eye. What happens if a situation occurs and I don't have a contact lens for some reason..like if i am traveling and lose it?

On the other hand, while I am not crazy about wearing eye glasses, I am used to them as I have been wearing eyeglasses since I was in 4th grade and I am now in my 60s.

Not sure want I want to do yet though and need to hear what the ophthalmologist says when I see him.
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I can only tell you my situation.  My right eye contact prescription is -4.0 Pwr.   I am not sure if that is exactly diopters, but I can tell you my right eye sight is not that good and I go without my right eye contact in all the time.  I have even left the house and drove off and then realized I forgot to put my right eye contacts in.  Don't get me wrong I see better when my right eye contract is in, but some how you just get use to it and your brain gives you the better image. At least it does for me.   I have never had dizziness.  At first after surgery I notice I closed my right eye for some close up work, but I find myself doing that less and less.  

I am still in the get your IOL set to 20/20 camp.  Cataracts only get worst (well unless that new lanosterol eye drop works).  At some point you are going to need cataract surgery in the other eye and do would you at that point what to at least try and be free of glasses or contacts.

I will add one more note.  I have worn contacts since I was 16.  They have contacts you  can wear  for extended periods that might work for you.  I had problems with blood vessel growing when I did that so I stopped.  But now they have better contacts  that provide more oxygen, but I have never gone back to trying to wear them for extended periods.
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Avatar_f_tn
Hi and thanks for letting me know.  It sounds like a good result all round.
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Our practice uses Technis lens; several models; excellent results

JCHMD
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