Cataract surgery in one eye only - significant myopia

[AlanRamirez]

I am 45 years old and have had extreme myopia (nearsightedness) all my life. My contact lens prescription is -11.00 in my left eye and -11.50 in my right eye. Note: My entire family has extreme myopia.

In 2012 I had a retina detachment in my LEFT EYE and had surgery with a scleral buccal done to address the retina detachment.  I have developed a subcapsular cataract in my left eye. My left eye vision was recently measured at 20/60 with a contact lens on. I have noticed that my depth perception is off because of the cataract. This becomes a concern while driving. At times I feel like the cataract causes blind spots to my left. I feel like I have to be careful when walking up and down steps as well.

Compounding this is that while the retina of my RIGHT EYE did not detach I had a PVD in that eye 6 months after the retina detachment surgery. I see significant floaters in that eye. I do not have a cataract in my right eye but as you can imagine with a 20/60 cataract in my left eye and PVD floaters in my right eye, vision can be an issue/distraction at times.

I recently saw a cataract/refractive eye surgery doctor who recommended that I have cataract surgery in my left eye. He recommended a mono-focus Toric IOL to correct astigmatism as well. The cataract could be removed and the vision could be corrected to 20/20 for distance or less to allow for midrange vision. The plan is to do the surgery on the left eye and continue wearing a contact lens in the right eye.

I am concerned because the doctor mentioned that there could be a difference in the vision of left eye after the cataract surgery and the vision of the right eye that may be a problem. As the doctor explained it - the mono focus lens to correct vision with be wide open while my left eye will be functioning with a natural lens which may cause some "shadowing."

I understand that wearing glasses would be a problem. However, I have been a contact lens wearer all my life and I am okay with wearing a contact lens in my right eye.

My questions are:
1)  Will wearing a contact lens in the right eye be fine in combination with the IOL in my left eye - particularly with the significant myopia -11.50 in my right non-cataract eye?

2)  After you have cataract surgery in one eye how do you correct vision for reading? I am still working. Reading and working on the computer is crucial for my work.

3) If I choose to correct the cataract eye with less that 20/20 distance vision what should I shoot for?

Any insights or opinions would be helpful as it will allow me to have a better discussion and make better decisions with my cataract surgeon.


~Alan



  

[AlanRamirez]

Thank you doctor Oyakawa. I really appreciate your perspective as I consider what decision to make.

[AlanRamirez]

Thank you so much for the post. I really want to feel like I am making the right decision and the discussion helps.

[Ray T Oyakawa, MD]

You have a very difficult situation with different opinions among doctors.

First, what is the visual potential in left eye?  If a RAM or PAM test shows a macular vision of 20/20 to 20/25, I would consider an accommodating IOL.  Many doctors would not want to put in a silicone IOL in a patient who had a retinal detachment in case it detaches again and needs silicone oil.  My feeling is that eyes that need silicone oil rarely recover good vision.  I had a retinal detachment and ERM peel and had a Crystalens implanted.

2) With a toric IOL you will need a reading glasses for the left eye.  However, at 45 your good eye with contact lens with still have fairly good accommodation.  You could use a reader of different powers for the right and left eye.

3)  Depends on what your needs are.  Most would not target more than -1.25 to -1.50.  This would give good intermediate vision.

Dr. O

[flossy93]

This is a very interesting question.  I'll be interested to see what the doctors on the forum recommend.

I do have one anecdotal comment to share.  The optometrist I see has a wife who was a -12D in both eyes; as I am also a high myope we often discussed her case in conjunction with my ongoing issues.

In her 40s this woman developed a cataract in one eye and had it removed and replaced with a single vision IOL.  Rather than try to correct the other eye with a contact, a few weeks later she had an implantable contact lens (ICL) placed in the other eye (without removing the natural lens in that eye, which was cataract free then).  This allowed her to have corrected vision in both eyes for distance without contacts or glasses, although she did need reading glasses for near/intermediate vision.

All went well for her and she was very happy.  That said, 8 years later she has now developed a cataract in the eye with the natural lens in place, behind the ICL that was implanted.  So she now need a surgery to remove the ICL and also remove her natural lens and replace it with an IOL of some power.  This is a more complicated surgery than a straight cataract removal/replacement.  

She told me her medical insurance paid for placement of the ICL at the time of the first cataract surgery, due to the visual disparity she otherwise would have had (with 20/20 vision in one eye and -12D in the other).  Of course, that was years ago.

Good luck with your future vision struggles.  You are not alone!