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Decision on cataract surgery post retina repai

I find myself in a quagmire much like many of those that came before me on this forum. The magnitude of a decision I must make within weeks and a feeling of ambiguity among the various surgeons and ophthalmologists I have seen has me desperate for guidance.
Three months ago I had surgery to repair a torn retina (corner tear far away from the macula). My surgeon made his three month checkup on me recently and discovered no scarring but a mild puckering that will be looked at again in three months for possible surgical intervention. He wants his view into my eye if surgery is needed to be as clear as possible. The gas bubble caused a cataract that he has placed me on a schedule with a cataract surgeon for repair in the 8 weeks.
His final words to me at the end of the checkup was a strong recommendation that I either switch the mono vision setup i have of the right eye for distance to the left eye that underwent  the retina surgery for the long distance. His reasoning was that the right eye sees much more detail at near vision and the left eye may never be at that level again. Or that I make both eyes long distance. In essence he wanted the left eye to have long distance capability no matter which setup.
I have worn mono vision acuvue oasys for astigmatism contacts for several years and loved the setup, never needed glasses  for any distance and could read and see long distance very well.
My visit to the optometrist yielded a differing opinion. He showed me how my right eye is the dominant one and that with some blurriness in my left eye, making it my distant one at this time anyway, would not be satisfactory. He also pointed out  that I now have a misalignment in my eyes and if both were corrected for distance I would see double vision. He changed my post surgery eye power from -2 for the left and -2.75 for the right to -2.5 for both.  Two days out from this adjustment I can generally see ok , but my distance is somewhat less sharp. Reading and computer wise, I still need to enlarge type on the computer to read it, i can read small printed type pretty good if its about 6 inches away.
Here are the questions I am trying to resolve in my decision,
1) Should I attempt to strengthen the left eye for distance even though it is somewhat blurry still? I couldn't drive with just it for distance I would have to go with both eyes set for distance for now until the cataract surgery.
2) What are the chances that the blurriness will clear up with the cataract removal? I have not been able to get a good answer on this, if the odds are very high I could make a go of using the left eye for distance if that is a preferred way.
3) What about the aspheric design lenses for implanting during cataract surgery for the left eye? Does this seem like a plausible way to go for me? If so are there contacts I could try this out on ahead of time? I go back in 10 days to the optometrist and could try something new.
4) Only one eye is planned for cataract surgery right now, the other is apparently in good shape, the right one. If I stay with the mono vision setup I have now, I think the right eye should be put back to 2.75 for more sharpness at distance, it would be a contact so could always be changed?  And the left one that will have an implant maybe should be adjusted for better reading if that is possible?

Just not sure which way to go and this decision is so permanent.
3 Responses
177275 tn?1511758844
Visionary: You would do well to carefully read this article: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You    ; Your situation is complex and there is no "pat" answer. With healthy eyes the dominant eye is generally set for distance and the non-dominant for near. You situation is more complex. Setting both eyes for distance is generally very unsatisfactory to a myopic person who is use to have good vision at near without glasses.  your optometrist may be able to use trial contacts to let you see if you have a preference. however since the operated eye has a visually significant cataract the vision at distance and near will be considerably worse than after the cataract is removed. With macular pathology (pucker/epiretinal membrane) an aspheric monofocal or toric IOL is preferred and an accommodating or multifocal IOL is not a good choice. I would suggest your report changes in your amsler grid to your retina surgeon.  This is elective surgery and you can always postpone it till you feel you understand your options and are comfortable with them.  JCH MD
Avatar universal
Hi Visionary,
Treatment for a retinal tear is frightening, and now you feel rushed.  It may not be necessary to decide so soon.  What is your best corrected vision now?  Does the pucker alter your vision?  -- what do you see when you look at an Amsler Grid (google it and download an grid.) Are lines distorted?  Are image sizes different in the eye that had surgery?  Is this newly developed cataract interfering with daily activities?  A mild pucker is unlikely to warrant a macular peel.  Perhaps you can work with your optometrist to experiment with sample contacts to make an informed decision. Unless there are very good reasons to proceed quickly, I suggest you take some time, do some research, experiment, and perhaps get a second opinion.
Best wishes.
CBCT

Avatar universal
I brought up the Amsler grid on my computer screen and with my right eye it looks normal no wavyness but with my left eye the one that was operated on the lines are very distorted and wavy. From the brief notes I found on the internet seeing distortion can denote  macular degeneration? Is it possible the optometrist with all those tests he gave to me could of missed this? Really appreciate your advice on this. As far as rushing, I have been concerned about the quality of vision through that left eye and was actually glad that the cataract surgery was being scheduled sooner. I would at least know if that was the problem with my vision. With a retina repair at the edge of my retina my understanding is that complications are minimal? I do know that in the surgery he laid down a curved arch of lazer points isolating the lift from the rest of the retina in a protective fashion. I actually have very minimal visual problems when I discovered the retina tear. Just an odd vision line when I looked towards my nose, but certainly no wavy ness like my vision is now. Should I contact the surgeon or the optometrist about this test result?
2 Comments
Further note on this..I found the blind spot Amsler test and although waviness still appeared I could see all four corners and the center dot after one of the red outlying dots was gone from my vision
and after finding examples of macular related distortions mine is very minor, there is a very minor waviness but it is not concentrated in one area but over the entire image, and extremely slight in comparison the examples
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177275 tn?1511758844
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Avatar universal
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