Cateract surgery for high myopic patient

[Patsy3033]

Hi Dr. Hagan.  My last RX for distance was RT -12.00 -3.50 031  LT  -10.00 -0.25 120. You'll recall that I've worn single vision glasses all my life. Never used a bifocal instead just sliding my glasses down my nose to use the computer and taking them off to read.  I have now visited several Cataract Surgeons and have allowed each one run their own tests to provide me with their opinion on what they would do. Believe me I have the bills to show it.  I've narrowed my choice down to two doctors.  The first doctor is very concerned about the shape of my eye and although he likes a Toric lens and has put in plenty of them has some concern about how it would work in my eye.  He feels a plain Alcon 2.5 IOL  would be a better way to go with my understanding that I would need bifocal glasses for distance and that he would not be giving me 20/20 vision.  The second eye would be done when he felt the first eye has healed and happy with the result.

The second doctor after looking at the test results taken in his office told me he would use a Toric IOL and give me 20/20 vision and do the second eye one week after the first.

Although I like the idea of getting 20/20 vision after surgery and only needing reading glasses it sounds too good to be true because of  my RX, eye shape and length.

Since I've never used reading glasses what would be wrong with having the first doctor put in IOLs for distance and for me to use reading classes for reading and computer.?   I'm so use to seeing distance clear I'm afraid that I won't be able to get used to changing the way I see now?  
  

[Patsy3033]

Thank you Dr. Hagan.for all your help. I'll post again after
having the first eye done.  

[JohnHaganMD]

Thank you

[JohnHaganMD]

First of all no surgeon can guarantee you 20/20 vision after surgery with or without glasses. Surgery is not a exact science. Many people with your high degree of myopia do not see 20/20 ever even with glasses or contact lens due to myopic macular changes or refractive amblyopia. Moreover you are at increased risk for surgery due to your long eyes and high myopia. It's possible that after surgery your vision will not be 20/20 with or without glasses. No guarentees with surgery, that's why you sign a consent form acknowledging the possibility of complications and less than full recovery.

Your LE has only 0.25 diopters of astigmatism and a spherical lens will work just fine. Your RE has enough astigmatism to justify a toric IOL.  You and your surgeon's choice.

You have spend almost all your life reading without glasses. Most myopic patients are extremely unhappy with shooting for best uncorrected distance vision (that would be 0.00 in each eye)  Most myopes are happiest with a mini-mofocal near bias.  something like -2.50 non-dominant eye and -1.00 in dominant distance glasses.  Some myopes are happy with plano in dominant eye and -1.25 in non-dominant eye.  Moreover your "old" method of slipping your glasses down your nose and reading without glasses likely will not work no matter what you target your post surgery refractive error.  You best make your peace with having to wear progressive no line multifocal glasses for some or many things.

At this point you have to make the decisions. You've done a lot of reading and research and seen several surgeons. There is no perfect solution for everyone. Moreover you can't have 2 surgeons you'll need to pick the one you feel most comfortable with.  Best of luck.