Delaying cataract operation --Serious?

[lazybones333]

Despite my doctors recommending an operation,I have delayed my cataract operation for 3 years.

Will the delay cause irreversible and serious damage?

What is the best current procedure available -- cost is not an issue.

Thanks

[John C Hagan III, MD, FACS, FAAO]

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[ernie_mountains]

This is a long response but it is after much study.  First my conditions:

--Before surgery my eyes were about 20/350, very near sited.
-- I have minor astigmatism.
-- I had the left eye fixed with mono vision (the dominate eye).  I wish I had done this   study first.  
-- I am 70years old.  
--I am an engineer and a outdoor person, I need full coverage.

I did not like the need for mid range glasses and near reading glasses.  Try working on a electronic circuit while looking at a oscilloscope, not a good thing. I began my research.  Some of what I am saying here came out another forum on this site, and I thank all of those who participated.  I am hoping here to provide information I could not find.

The first and most important thing you want to find the lowest risk way, to make a determination of what to do with your eyes.  That process is contacts.  On my right eye, that surgery has yet to be done on, I ran the following experiments:

-four days with no glasses
-four days with my old progressive glasses with the left eye lens removed.

It appeared I could indeed even with my poor eye sight come up with a monovision eye in my dominate eye, and multifocal vision in my right eye.  I had my doctor who performed the surgery send me to an O.D. in the clinic to try different contacts in the right eye.  

The right eye testing consisted of trying monofocal for distance, mid range, and close.  Than seeing how the each worked together with the monofocal lens already in-planted.  Obviously distance was great with the distance lens, but for me I needed a pair of glasses to fix the uncovered ranges.  I was really unhappy with this combination, as I could not find anything close without corrective lenses, including my glasses.  and it took two pair to cover the full range.  We finally tried a “progressive, multifocal lens”.  The optical technology used on the contact lens was the same as used with the multifocal IOL.   The goal was to have between the eyes, clear vision with as little initial “blurring” as possible, and being able to see at least reasonably at reading depth and well at mid range.  The testing consisted of trying different combinations of power for each of the ranges and sitting for a while and testing far, mid, and near ability to see clearly and comfortably.  We ended up with mid optimized and near, close, we knew we could dial in close to very good later, but first we needed to test the tail light, head light “haloing” issue .  Again we did not try and dial near in completely.  The end result was that the test lens for the right eye only, left eye blocked was just acceptable at 16-18 inches then very clear to 8FT.  With the left dominate eye unblocked I almost immediately felt comfortable and had very acceptable vision with the exception of reading distance close where I still needed reading glasses. I found a single pair of reading glasses 1.25di (about) made my Right eye a very readable eye (the left eye required 2.5DP- 3.0DP still working on the exact power).  I have been testing for the last two days this combination outside of the office.  It is a very workable combination.  There is no taillight haloing, e.g. looking thru my dominate left eye alone, then right eye multifocal alone, then both together.  The taillights had the near the same, with no haloing.

We fine tuned the lens after three days and this will be what I have inserted later in the month. I will send results when the complete insert combination has stabilized.  At this time I will know if the IOL results and contact results are the same.  

I asked the doctor about two subjects of interest too me;

1—I asked about, the use of Crystalline (SP) lenses, he said they are risky; it has to do with the uncertainty of how strong the eye muscle is.  It is also limited to relatively low correction limits, e.g. less than 2.5DP.   This is backed up in all of the literature I have read to date.
2-- For the Multifocal lenses’ and haloing.   The problem of Haloing is not related to required DP correction factor.  My brother, with a DP correct of around 11, is a candidate.  The problem is mostly to shape (distortion) of eye and time to allow the brain to adjust to picking out the best image to "use”.

My personal belief is we who have had crappy eyes for a long time (age 13 on in my case), and have lived with just seeing thru dirty, scratched, rain drop distorted glasses, will have a easier time of it as we have had to fight the distortion for a long time.  Or another way to say it --- our brain is used to the problems and has already worked out solutions.  

This is I hope is useful information

[John C Hagan III, MD, FACS, FAAO]

The chances are very very small that any damage has occurred in the 3 year delay. The cataract may be a little more difficult to remove but this is not always the case. In my opinion the best procedure is phacoemulsification removal of cataract through a small incision, no stitch closure and use of a folding aspheric monofocal IOL.

JCH MD