cataract lens decision

[JudyLew]

I had my 1st cataract surgery about 3 weeks ago and am struggling to get my two eyes to work together.  The doctor encouraged me to not wear my glasses or to squint, but to try to let my dominant left eye release it's dominancy to the corrected right eye.  I can now see to read and do all up close activities with my left eye and no glasses.  I can not see to read or do any of the normal chores I'm accustomed to with the right eye.  I am told I now have 20/20 in the right eye.  Since I'm having so much trouble trying to get these eyes to work together, the doctor has almost insisted on a Toric lens to correct the left astimatism and the cataract, thus telling me I'll be wearing reading glasses in the future.  I would really like to know what you think about this?  I'd like to have the cataract removed and prefer a lens to allow me to keep my good reading eye.  It appears that the doctors would like me to be "glasses" free, but that's not my goal.  If I have to wear glasses to drive or for long distance vision, that's fine with me.  It's the up close things that matter the most.  Is it possible to fix this left eye and allow me to see up close and how can I make a case with the doctor?  Thank you so much for any information you might offer and I hope I'm not confusing you with this question.  Judy in Pa.

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

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[03Maddie]

I am so glad that I read your note.  I am one week post op from my left eye cataract surgery.  I am 56 years old (also early cataracts).  My left eye is my dominant eye, so it was corrected to 20/20--which I love!   However, I had worn contacts (gas permeables) which corrected my astigmatism perfectly, and had mono vision (left eye for distance, and right for close)  with no reading glasses needed.  I also loved that (hate searching for reading glasses).  

I had a toric lenses implant which has made my distance vision so very clear!   Now, as I have my right eye corrected, I want to again have the mono vision.  However,  since I'm so very near-sighted in my right eye, I'm concerned that the difference in steps between my 2 eyes will be too great for them to correct, as I was corrected before.   As you know, the implant does not accommodate any flexibility in distance to close work.  

My question is, which you might be able to answer:  Can you wear a contact that will improve close reading after cataract surgery?  (Again--I absolutely hate having to grab reading glasses just to see anything).  I will be seeing my surgeon later this week, before ordering the lense, so I wanted to know if that is an option, before I go for the appointment.  Thank you, and I do hope you are able to get you eyesight improved to your liking, as well!  Good luck!  

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

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[Occupant]

It depends, e.g. I have readers that are in focus at about 10"-16", intermediate glasses (for computer work) at about 22"-32" and without glasses about 40" to infinity. I can no longer do any close up work without perhaps a magnifying glass. But my ophthalmologist warned me about this: "After the surgery you will no longer be able to see what you can see now. Since you are so myopic you can see things without glasses that ordinary people can't, but after the surgery you are going to be just like the rest of us". I could, of course, have requested that the lenses being put in meet any of the above choices, but since this is an inexact science I could have wound up with lenses that would be in focus let's say from 16"-22" and I would have to have a pair of distance glasses in addition to the two pairs I have now. So I opted for distance
vision.

[lorac0813]

Hi JudyJ, it's a major decision that's for sure! I still can't understand  - id the doctors can put in lenses that are corrected for distance - couldn't they then put in lenses that were corrected for close distance?so As long as you had those "close" lenses implanted, you would never lose your close vision. Doesn't that soudn reasonable?

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

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[JudyLew]

LoraC,  Thank you so much for your reply to me.  I went back and read your story and I will also be praying for you.  I'm still very leery about any decision and am sure praying the God gives me a clear answer, cause the doctor's have me confused.  I have a very well known/accomplished and highly respected Opthalmologist here in Pa.  However, he's very busy and has many helpers.  I've seen 4 different doctors since my first visit and although the surgeon is the top dog, I haven't seen him since immediately following the 1st surgery.  I'm now thinking after yesterday's phone conversation with Dr. # 3 that I'll stick with my decision to have a Toric lens implanted and already realize I'll need at the very least "readers".  I like having this second sight, but it'll disappear as soon as my God given natural lens goes.  It is a major life-changing decision and I've tried to do my homework.  This lens costs a lot of money and that's ok IF it's the right choice.  Anyone with good eye sight should thank God daily.  This gives me a heart for the blind that I've never really had before.  I guess God got my attention for sure.  This site is great for sharing and it allows all of us to realize we're not alone.  I hope you're seeing better today.    

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

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[lorac0813]

Hi JudyLew, I just this minute read your posts and your situation is almost exactly the same as what was happening with me just a month ago so please listen to my story before you make a decision!

I'm 52 years old and I must have had the "second vision" thing going on because I could see things fine close up but needed glasses for everything else. I was diagnosed with early onset cataracts in both eyes a couple of years ago and they were getting worse so I chose to have them taken out and my eyes corrected for distance.

After I had the cataracts in my right eye removed I had great distance vision in that eye but like you couldn't see squat because my eyes were unbalanced. For the 2 weeks between my surgeries I couldn't see a thing! When my left eye was corrected with a lens for intermediate vision my eyes "balanced" and I could see without glasses to drive, watch TV, walk around malls, etc. HOWEVER my precious close vision is gone and ever since I have regretted my decision to have my eyes corrected for distance. Before the surgery everyone (including my surgeon) told me that it was best to get my eyes corrected for distance and that afterwards I would only need reading glasses to "read". NOT TRUE! I need reading glasses to put on makeup - to see my face close-up in the mirror - to do my nails - to cook - to eat - to do housework - to do computer work - to put on jewellry - to do the dishes - to look at things on the shelves in stores - even to pack a suitcase! In short, I need reading glasses ALWAYS, for everything. And like you, I am continually dropping things and poking myself in the eye. I can't see a thing up close.

PLEASE PLEASE think about keeping your close vision if you can!!

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

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[2ndsight]

I would also take your surgeon's advice about your astigmatism. I had a very slight amount which my surgeon felt he could not correct accurately during surgery, but it is worse after surgery (6 weeks ago.) so I may need this corrected with glasses or laser surgery later on.

[Occupant]

From what I understand, you have a cataract in your left (dominant) eye as well which will have to be taken care of in the not too distant future. I don't obviously know how this cataract is going to advance in your case. With me it took about 6 months to go from adequate vision to being declared legally blind. When I went to my optometrist in the beginning to ask for new glasses to adapt to my ever increasing nearsightedness (that's by the way why you can see up-close better), his reply was: "That would be a waste of money. Go and have the cataracts taken care of."

[JudyLew]

Dear Dr. John,  Do you have any advice for me?  Thanks

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

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[JudyLew]

Yes, you indeed seem to understand my situation.  Oddly enough I hadn't even noticed that I was able to see without my glasses, just going on about my business and not thinking about it.  UNTIL..My husband asked why in the world did I have the bifocals IF I could see so good without the glasses for reading, etc. (Not for driving of course) and then I started thinking about it and investigated.  I believe it's called second vision? Not positive but found it on the net in a female Opthamologist's site.  Anyway, my husband actually suggested the same thing that you're proposing.  I've never worn contact lenses because I've only tried once and to no avail.  However, I believe I could do this now once my vision is so much more corrected after the Toric lens is inserted.  I do believe that will be my decision in the end.  It's great having both you and Occupant's in-put.  I've been so out-of-sorts for weeks with my vision.  I can't hear, think or see right!  I know it's crazy, but it's really true. I've tripped over things and dropped more things than ever before and recently poked my left eye with a stem from a pair of reading glasses, to the point of being concerned that I really damaged that eye.  I'm seriously praying that the injury heals soon.  My goodness aren't we fortunate to have our eyes and how thankful we need to be.  Thanks You!

[2ndsight]

Judy, I know your situation to some degree, I had a very advanced cataract in my right eye which caused me to have improved close-up vision. I was like this for a couple of years and got used to being able to read and see up close without reading glasses. However I don't think the overall quality of that vision was very good. I had surgery recently in my right eye and opted for 20/20 and reading glasses. It is an adjustment but I realize now I wasn't seeing very well at all with the cataract-induced monovision.  Can you try a contact lens in your left eye for awhile to see how you like having both eyes set for distance?

[JudyLew]

Thanks for your input but I am still in a quandry.  The 20/20 in the right eye is great, no doubt.  I've worn glasses since I was a little girl and don't mind a bit wearing them forever.  However, I can see so much better right now with my left eye for everything I usually do.  I have several pairs of very good glasses with bifocals in them.  They are basically worthless right now and my naked left eye is the only real way of seeing much of anything, like eating, cooking, putting on make-up, reading, etc.  This in-between is horrible.  My surgeon is one of the best in the country, but I think he's short on time with me and he hasn't spent enough of it exploring my personal needs.  I've read that having a cataract could actually be the reason I'm able to see without my glasses.  So, I'm left wondering if when they remove that lens if I'll be back to not seeing again.  I can't see squat up close with this right eye now.  Just looking in a mirror is impossible.  At this time I'm wearing my regular glasses with both lenses in them and my left eye is so dominant that it isn't even recognizing the brand new lens in the right eye!  

[Occupant]

Since you are now 20/20 in your right eye, you will be able to see distance and, when you are driving, the dashboard well enough albeit a little bit blurry. But not the computer screen without glasses nor will you able to read without them - this is basically what you get after cataract surgery with the new lens at 20/20.  I don't think, you would want monovision to be able to read without glasses in the other eye - that is, your dominant eye would then be nearsighted. You''ll have a hard time getting used to it and may be you never will, unless you have tried it with contacts before and were happy with it. So, wear reading glasses like me.  I wanted to get my dominant eye slightly nearsighted, -1 diopter or so, but it didn't work out that way, but that would not have obviate the need for reading glasses anyway.