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Cataract surgery on one eye or both?

I'm trying to decide whether to have cataract surgery on my left eye only, or on both eyes.

I'm a 55-year-old man. Eight years ago, I had a vitrectomy and laser procedure to repair a retinal detachment in my left eye. About four years ago, a cataract in that eye was first detected. Beginning about three years ago, I developed progressive myopia, with a change of eyeglass prescription since then from -7.00 to -17.00. The best-corrected visual acuity in my left eye is now 20/50.

My right eye has a cataract, too, but it's far milder. I'm told that the right eye already fails the brightness acuity test, but the best-corrected visual acuity is still 20/20. From 2018 to 2020, the eyeglass prescription in the right eye changed from -8.00 to -9.00, perhaps related to beginning latanoprost eye drops for pigmentary glaucoma in 2018. Over the last year, though, there has been only minimal change in the eyeglass prescription for the right eye.

Because I'm so myopic, and haven't comfortably worn contact lenses for more than 20 years, having surgery on the left eye only would require a refractive target of at least -7.00 or so, to balance the right eye and avoid aniseikonia while wearing glasses.

Alternatively, surgery on both eyes would provide much more flexibility on the refractive targets, perhaps allowing me to greatly reduce the amount of time that I wear glasses.

One cataract surgeon I consulted said the decision was up to me. It was a matter of my motivation for reducing my dependence on glasses and my personal tolerance for the risks involved in surgery on two eyes, instead of one.

But another surgeon said that he wouldn't do surgery that leaves me with a -7.00 refraction in the left eye. I haven't been able to pin down his specific rationale, but I gather that he views such high myopia as a kind of disability.

I've been highly myopic since I was a teenager, and I've been wearing glasses or contacts for about 45 years now -- and almost exclusively glasses for about 20 years. It would be nice to wear glasses less, but particularly given my history of retinal detachment, I'm uneasy about taking on the risk of a second surgery that I might be able to defer for years. (I wish there were some way to predict how quickly the cataract in my right eye will progress, but I'm told that's not possible.)

Will I be making a mistake if I have cataract surgery on my left eye only, targeting continued high myopia in that eye?

Am I being too cautious about the risks of cataract surgery? (In anticipation of having cataract surgery, I consulted a retina specialist. He didn't find any problems in either eye that would further increase the risk of retinal detachment after cataract surgery.)

Might the Shaw lens (https://shawlens.com/), which claims to address aniseikonia, allow me to aim for a refractive target like -0.50 in the left eye, and then successfully wear eyeglasses with a refraction of -9.00 in my right eye?

Thanks in advance for any thoughts or advice.
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233488 tn?1310693103
You are at extremely high risk for a retinal detachment (RD) in your RE.   That risk may be as high as 6-10%,  cataract surgery dramatically increases the risk of RD even with modern small incision, no stitch surgery.  Since your RE corrects to 20/20 and the cataract will likely grown much slower than the RE due to it not having a vitrectomy, the prudent thing for most people would be just do the LE.   Most people would tolerate -7 RE and -9 LE plus a reading add.  Down the line if you need cataract surgery for sure on the RE you could target  any where between plano (0) and -1.00 and have refractive surgery on the     LE with a target of -1.50. That would be mini-monofocal distance bias.  
Helpful - 1
Dr. Hagan, thanks so much for your thoughtful reply. I really appreciate it. My cautious approach to surgery for the 20/20 RE has been informed by your enormously helpful posts and blogs in this Eye Care community. I've read as many as I could find, and I'm grateful to you for sharing your knowledge and experience.
Best of luck. Happy to help
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