Cataract surgery in one eye only - near or far

[LaynieL]

I am fairly young to be having cataract surgery (33 to be exact), but it is needed. I just had to consultation yesterday and was really hoping to get an accommodating IOL, but as I have uveitis too, I can only get a monofocal lens. The cataract is in my left eye...my right eye is nearsighted. The doctor said he was going to make my left eye farsighted. Is this the best option for me or should I have both eyes be nearsighted? I am also going to see a different doctor for a second opinion before I have surgery, but I'd like to go in armed with some questions and knowledge to make sure I am getting the best option.

[MrPresley]

I was in the same situation as you and went with having both eyes be nearsighted, with approximate parity between my left and right eyes.  I then wear contacts for distance correction.

[JohnHaganMD]

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[MrPresley]

I was in the same situation as you and went with having both eyes be nearsighted, with approximate parity between my left and right eyes.  I then wear contacts for distance correction.

[JohnHaganMD]

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[JohnHaganMD]

You should start by carefully reading this article.  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;

[LaynieL]

Thank you. I'm really thinking I would be happier having my left eye be nearsighted as well so it is as close to my right eye as possible. I really don't mind if I have to wear glasses for driving...or if I still have to wear glasses all the time. The cataract is just so bad and the doctors are unable to see into my eye to see what may be causing the inflammation. I have "leaky" blood vessels in my left eye as well. I just really want to make the decision that is going to leave me happy in the long run and I am unsure of what that will be. The first ophthalmologist didn't really discuss anything with me other than the type of lens. From what I read in the article, my right eye may also need surgery so that my eyes can work together successfully, is that right? I don't have a cataract in my right eye, but I do have some inflammation (not as bad as my left eye though).

[JohnHaganMD]

It would be helpful if you could post your glasses prescription and your vision with those glasses on.

[LaynieL]

My prescription in my right eye is sphere -0.50 cylinder -2.25 axis 175. I think glasses get my right eye to "perfect" vision or a little bit better. My left is just a balance lens because I really can't see out of the cataract at all.

[JohnHaganMD]

Since the RE does not have a cataract and not need cataract surgery you need to shoot for a IOL that will allow your eyes to work together at distance. The spherical equivalent (average) myopia in your RE is about -1.50 so it would be good to match that.  You have 2.25 diopters of astigmatism in your RE and its likely your LE has about the same.  Since you are young after surgery your RE will be able to focus up close but your LE will not since it is going to have a monofocal IOL put in it. So post op your LE will need progressive no line bifocals to see up close.

[LaynieL]

Thank you for all of your advice. I really appreciate it.
To match my RE, would I get a near or distance IOL in my LE? Also, not thrilled about having to wear bifocals...any way to avoid that, or not really?
Also, I know you haven't been able to see all of the pictures of my eyes to know exactly what is going on, but do you think if they were able to heal the inflammation, that I could get an accommodating lens, or would it not be a good option for me? The doctors I'm seeing for uveitis said there is damage to my retina, but that I have no active flare ups.
I honestly didn't know I had so many problems with my eyes until I went to the eye doctor in May (after 13 years). I was doing fine without glasses (and honestly, I still don't wear them all the time now). I thought that glasses would fix my left eye, but that was before I knew I had a cataract in that eye.
I'm just nervous that the monofocal lens and having sight back in that eye is going to drive me crazy and that I'm going to obsess over it not being like my normal sight. I'd be tempted not to get the surgery, but I know in the long run I'd probably regret that decision.

[MrPresley]

I have a near-distance IOL in my left eye which resulted in myopia of -4.5, which is at approximate parity, although slightly better than, my right eye which has never had surgery has myopia of -6.0,  Close up vision in both is fine without correction, and both eyes seem to be working together well.

[JohnHaganMD]

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[LaynieL]

Thank you MrPresley. I feel like I want my eyes to be as close as possible. I guess for now I just have to wait till Sept 11 to see the doctor for a second opinion. I'm just kind of frustrated that the first doctor decided to make my left eye farsighted without talking to me, so I really don't want to go to him for the surgery.

[JohnHaganMD]

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