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Cataract surgery - near or distance lens?

Hello!  Seven months ago I had an emergency vitrectomy to repair a detached retina.  The surgery proved successful (thank goodness!) but I've now developed a cataract.  I've seen two highly respected cataract surgeons and to my surprise, both have recommended different procedures!  The first surgeon recommended a lens replacement for distance.  He pointed out, however, that I will need to have lasik on my "good" eye or my vision will be in conflict (right eye is currently -5.00 and left is -7.25; before surgery both were about -4.25).  I would likely only need readers if I go with this plan.  The second surgeon recommended a near vision lens replacement and leaving the "good" eye alone.  I will need corrective glasses with this procedure.  She does not believe I'll develop a cataract in the "good" eye until I'm in my 80's (I'm 63 right now).  I'm leaning toward the near lens because I'd rather not mess with my "good" eye.  The vitrectomy was traumatic enough.  At the same time it would be awesome not to need glasses, wouldn't it?  I've read Dr. Hagen's excellent article about cataract surgery, but I'd also appreciate hearing from anyone who has had cataract surgery and what your experience or advice might be.  Thank you in advance for you help!
4 Responses
Avatar universal
I have a near vision IOL at -4.0 in my LE in approximate parity with my non-operative RE at -6.0 and use contacts/glasses for distance.  Works great for me.
2 Comments
MrPresley - I thought I'd responded to your post earlier, but I don't see one here but please know how much I appreciate your response.  I'm relieved to hear that you've had success with near vision IOL.... I'm 90% sure that this is the direction I will go in.  
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177275 tn?1511755244
If you are 63 and your glasses RX before all of this was -4.25 in each eye then you would most likely been in progressive  no line multifocal glasses. If you are a 'bifocal hater" and were wearing only distance RX and removing for reading then there would have been many distances you would not have seen well and your near point for reading is awfully close.  

If you have a RD in one eye the chance of a RD in the other eye is extremely high, as high as 10-15%.    If you have cataract surgery on the "good eye" that makes it much higher still, as high as 25-30% based on what your retina looks like in both eyes.  So most physicians would feel it would be a huge mistake to operate on an eye that either has no cataract or a small cataract to balance the eyes. Moreover my experience is that myopes that are used to reading without glasses if given 0.00 (or plano) for distance (20 feet) even if 20/20 without out glasses are miserable. Starting about 15 foot and closer things are very blurry and different glasses RX are needed (no line progressive  RX  0.00 OU with +3.00 add )

However if your "good eye" was -4.25 and now is -5.00 and no surgery has been done on it the additional myopia is likely pseudo-myopia due to a nuclear cataract. I suspect you will not make it to 80 without a clinical cataract on the good eye. You indicate you have read my article about IOL power,  full monovision,  mini-monovision with distance or near bias.  To use your eyes together you likely WILL need lasik on the 'good eye"  as I doubt you would tolerate full monovision.  I suggest you get several more opinions as its a difficult situation and different solutions for different people.  I would suggest staying away from cataract surgery on a 'good eye' that does not have a clinical cataract.

2 Comments
Dr. Hagan!   Thank you for your reply.  You are truly amazing!  You were there when I was panicking about the vitrectomy healing process and my planned trip to Ireland (remember?).  Anyway, so you know, I guessed at what my prescription was before the RD (around 4.25-4.75 and each eye a bit different).  I have successfully worn no-line progressive glasses for about fifteen years now.  Before that I was happy with contacts but eventually needed readers (and constantly misplaced them!).  Then I developed dry eyes (it's always something!) making contacts uncomfortable.  So I decided just to stick with progressive glasses and I've been fine with that (unless I'm outside in the rain and they get all wet, haha).   The current prescription I listed is accurate, but about 8 weeks old.   If I wear my old pair of glasses I can see fine out of the "good" eye, so I suspect the prescription in the "good" eye has not really changed (just the optician trying to help me deal with this fast growing cataract).   I agree that I would not tolerate monovision well (I've tried it with contacts in the past).   I have been told by the opticians I've seen, and the cataract surgeons, that there is no cataract seen in the "good" eye.    So, I'm leaning toward the near vision lens with no surgery on the "good" eye.  Then continuing to wear glasses as I move along in life (if fate allows).  The surgery will be done at the Kellogg Eye Institute.  I have to tell you the patient care there has been outstanding.  But both surgeons are highly regarded around town.  If I could, however, I'd come and see you and beg you to do my surgery!   It is scary and confusing to be the one who ultimately has to make the decision on which lens to have placed in my eye.  So few people go with near focus lenses.  Again, thank you for the feedback.  You're the best!
Kellogg Eye Institute is fantastic. You are in good hand.  So you need to decide if you want to consider LASIK on the good eye to reduce the amount of myopia in that eye and thus the amount of myopia targeted in the bad eye post cataract surgery.  NOTE:  LASIK does carry a tiny risk of RD. Discuss with your surgeons.   If you plan NO LASIK on good eye then about 1.5 diopters is as much as most people can tolerate so  Bad Eye post cataract would have about 1.25 diopters less myopia than the GOOD EYE.  If you wanted LASIK then you could use any of the mini-monofocal  with distant or near bias I discussed.
Avatar universal
I agree with Mr. Presley and my doctor set me up slightly nearsighted so both eyes could work together.  I had no problem wearing glasses and I couldn't of been happier with this.  I didn't want to touch my good eye unless it needed intervention.

I don't want to scare you but the only thing I can recommend is for you and your eye md to regularly monitor your good eye for anything abnormal.   Recently, a year to the day of my first vitrectomy/RD repair, my other eye required the same intervention.  Healing well so far, cataract surgery is in my future for that one as well.  
6 Comments
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Hello, xltjim!  Thank you for sharing your experience.  I'm so sorry that you've now had two vitrectomy/RD repairs.  I remember being so freaked out when it happened to me.  Did you get the gas bubble?  That drove me crazy, but I was glad that my sight was saved!  I wish you a speedy recovery!  The surgeon suggesting the near vision lens basically explained the same thing you had done.  Setting me up slightly nearsighted so both eyes can work together and correcting my vision with glasses (she even said I could probably wear contacts).  I think I'll always be scared now when it comes to my vision. I have been overly cautious with my sight since the original RD.  They've told me that the vitreous has already "separated" from the retina in my "good" eye (this supposedly means I'll have less of a chance of another RD in the good eye).   Anyway, I'm watching for floaters, flashes, and that "black blob" that occurred when the retina detached originally.   As a matter of fact, I have paid so close attention to my vision that I'm now one of the crazy people who say they have "visual snow."  Honestly!  My vision is like watching television... pixels everywhere.  I thought this was how everyone saw the world.   But opticians and even my surgeons don't seem to know what I'm talking about.  But there are people out there discussing it on the internet.  So it's not just me.  Anyway, I've gone off topic.  Thank you again.  I can't tell you how much I appreciate this forum.
Hello, yes I did get the gas bubble with both vitrectomies.  Currently I am at about 25% remaining and 6 weeks post op.  Feels great but the cataract is already forming.  My other eye is doing great job compensating and I am very functional.  I do get some central flickering sometimes in the first eye I had done when going from dark to brightly lit areas, but this is nothing new - had this before the surgery and nothing was found.   I had intended to catch my good eye before major surgery was required but Dr said my vitreous was very sticky and good that I caught it as fast as I did.  In any case, don;t be scared about this stuff - Live life like you always have, just be aware of anything new and call Md.   Good luck, Jim
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My non-operative RE has the same condition that resulted in my having a vitrectomy/ERM peel in my LE in the first place. So far no visual symptoms, other than a few floaters that aren't particularly bothersome and a baby cataract. It took a little over a year after my vitrectomy for the cataract to advance in my LE to the point of having to do something, which was having vision correctable only to about 20/70. Over a year and half later following the cataract surgery in that eye no indication yet that a YAG will be necessary, and corrected vision remains 20/15 to 20/20 (depending on whether I wear contacts or glasses).
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Avatar universal
Update: First of all, thank you all who responded (or read) my post. My cataract surgery was successful (and definitely not as traumatic as a vitrectomy!). I'm currently in the early post-op phase (no lifting, wearing a patch at night, etc.), but so far so good. I found a pair of old glasses that allow me to see fairly well and I will be provided with a new eyeglass prescription in just four weeks!  I think I made the right decision about the near vision lens choice and I'm pleased with how well (and clearly) I can see through my one eye again.  I so appreciate this forum and the support that is provided (especially to overly anxious posters like myself!).
2 Comments
Hey talk to a physician and not get a bill. What's not to like about that scenario?
You're amazing, Dr. Hagan!  The best of the best!
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