high myopia and cataract surgey

[russell903]

I have -7.75 and -7.25 myopia.  My eye doctor says I have a cataract but it's 'too early' and I should wait until both eyes are needing cataract surgery.  This doesn't make good sense to me.  I could wait for many years and never see the other lens get to the point of the problem one.  I feel that a high myope like me is MORE sensitive to changes in the lens due to cataract.  I understand that the eye doctors like to match the lens for best outcome for myopes like me.  I still see borderline 20/40 or 20/50 in the cataract eye, and 20/20 in the other eye.  But it appears the cataract is becoming more influencial on my total vision.
Two questions:
-Is it reasonable to have this cataract removed, altho the condition is considered 'too early' for my eye doctor?  (He's not looking thru my eye, he's going by some arbitrary standard)
-Wouldn't floaters be more evident if the cataract is reducing light going into the eye?  I have pvd's a plenty.

Russell903

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

Those percentages cannot be constructed for an individual.

JCH MD

[russell903]

What is the likelihood of both eyes going blind from glaucoma?  My right eye has remained very clear and unaffected, and the visual fields and acuity remain as new, eg, 20/15.  

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

Central vision is often affected in glaucoma at the very end of the disease. Rember glaucoma can make an eye stone blind.

JCH MD

[russell903]

Thanks for the concise description.  I appreciate your great explanations, as I'm sure all others do who gain your responses.  

One more question-are there glaucoma conditions where the central vision is affected, perhaps by the sunken center of the optic nerve fibre bundle?  This central affect rather than the typical tube vision effect of most glaucomas?

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

You're close.  With the older "intracapsular" cataract extraction the entire lens was removed to the eye. This left a large area for the vitreous to come forward into and there was much more post operative instability. The rate of RD after this type of surgery was as high as 2-3%.

The present extracapsular surgery removed the central anterior capsule and the nucleus and cortex of the lens but not the posterior capsule. The pocket you refer to is ust the lens capsule with the nucleus and cortex removed. This posterior capsule compartmentalizes the eye and offer a barier to stabilze the inside of the eye. Thus the RD rate after extracapsular surgery is perhaps 1 in 200-500.  HOwever the rate of RD in eyes that have not had caratact surgery is perhaps one in 5000

JCH MD

[russell903]

Thank you again for your quick response.  I thought that the lens was not totally removed when cataract surgery is done; a 'pocket' is left for the new lens to be installed.  That 'pocket' is what often needs to be YAG'd to gain more light after surgery.  But the new IOL doesnt' flex like the original lens, so the space is constant and there fore the vitreous moves forward.  Am I getting it now?

Russell903

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

Forward movement of the vitreous due to IOL being smaller than human lens.
JCH MD

[russell903]

what is the stimulus in cataract surgery that may encourage retinal detachment?  The phacoemulsification?  Swelling from the cornea slit?  Change in light intensity on the macula?  Or?  Russell903

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

Cataract surgery is appropriate when your cataracts are keeping you from doing the things you need to do and want to do and cataracts are the cause and you understand the risks involved. Only you, not the surgeon, can determine when it is a big problem for you.

For example we take off some relatively small cataracts in pilots, truck drivers, cab drivers, people that work at night and people that need excellent vision to make a living example an eye surgeon.

JCH MD

[russell903]

Thanks for your comments.  Several years ago, when the cataract was first noticed in an eye exam, my options were defined.  Due to the high myopia, it made sense to me to merely return to the original myopic condition of that eye, with an appropriate lens geometry, and continue to wear glasses.  This would hopefully reduce the dificulty of vision blending with the two eyes.  I recognized that in my case, attempting to have 20/20 vision with the operated eye was not the best option, for me.   Near, medium and long distance vision abilities were not possible due to the high myopia.
I am at a point where the darkened view in the cataract eye is no longer absorbed and muted by the better eye.  Makes for difficult daily life, particularly when the floaters/pvd are added in that cataract eye.  

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

I think you have been given good advise by your Eye MD and echoed by JodieJ.  Even with an uncomplicated surgery the risk of RD may be as high as 6-9%. If you fixed one eye they won't work well together and you likely would need the other eye done.

Wait until its a BIG problem. Then have your eyes checked before surgery by a retina surgeon and then after the operation by the retina person a week and 6-8 weeks after surgery.

JCH MD

[JodieJ]

Being male and highly myopic places you at higher risk for retinal detachment, and having cataract surgery adds to that risk.  In addition, having cataract surgery provides the possibility of having good uncorrected distance  (or good uncorrected near/intermediate) vision post-surgery.  In your case, having good uncorrected distance vision in one eye and high myopia in the other would create a big imbalance.  Some high myopes are able to cope with this type of imbalance by wearing a contact lens in their myopic eye, but this doesn't work for everyone.  So you might have to have surgery on your second eye before you really need it.  For these reasons, it's generally recommended that high myopes postpone cataract surgery for as long as possible.

If you really feel that the cataract is interfering with your ability to function in your daily life, you could consult another doctor (or two) for additional opinions.  I think you'll find that doctors don't all agree about the timing of surgery for high myopes; you can probably find one who is willing to proceed.