Cataract Surgery Decision

[pollywog99]

I am a 64 year old woman with a significant cataract in my right eye and a small cataract in my left eye.  My right eye is -7.75 and my left eye is -3.25.  Three years ago my right eye was -3.00 and my left eye was -1.75.  

I prefer to go with the standard IOL's for distance and use reading glasses.  I realize that even if plano is the goal it’s possible I could still need glasses for distance.

I have consulted with two surgeons.  One surgeon says the left eye is not bad enough for surgery so he cannot just make both eyes plano.  He offered two options.  Option 1 - correct the right eye to -2.00 so that I can continue wearing glasses and avoid double vision.  Option 2 – make the right eye plano and wear a contact in the left eye until it needs surgery.  He will not do surgery on an eye that he does not think has a large enough cataract.

The other surgeon says he would do surgery on both eyes aiming for plano because it would give me the best vision for the remainder of my life.

My concern with the first surgeon is that once the right eye is made -2.00 I will always need glasses even though I will eventually need surgery on the left eye.  I do not think I can wear a contact lens based on past experience.  I’m also worried that the left eye is declining fairly fast even without a significant cataract.  What happens if it declines too far from the -2.00 eye but still does not have a “ripe” cataract?  It seems I would be taking all the risk of surgery without getting the best of the possible benefits.

I’m leaning toward the second surgeon doing both eyes, especially since I will probably require surgery for the left eye anyway.  Is there more risk doing surgery on a small cataract?

How would you handle my situation?

[Craig10x]

My dad had his recently, and they were done about 1 week apart...
In my case, i had a very fast turn-around...
My first eye was done Thursday...follow up visit Friday...second eye done on the following Monday...follow up visit Tuesday...

After having the first done i was glad that the second would be done so soon...because after the first one, i saw how quick and easy it was...I guess i was a little nervous for the first but not for the second...couldn't wait to have it done!

Dominant eye was done first...even though that eye wasn't even bad yet...they usually prefer to do it that way...

[pollywog99]

I forgot to ask how long your doctor waited between the two surgeries.  This seems to vary quite a bit; from 1 week to 2 months.

[Craig10x]

You are very welcome...and perhaps the doctor will also comment and you will get some input from others as well...

Monovision can be tricky...for some it works out great and others, it can be a bit problematic...

What is have is borderline monovison (20/150 in the non dominant eye)...when it comes to monovision, usually mini-monovision is a safer bet (that would be between 20/100 and 20/50)...

I couldn't do like you did before surgery because my non dominant eye was the eye that was so bad (so a mini monovision experiment with contacts would not have worked)...

Interesting, my doctor recently tried 20/100 (with contact lens in the eye) and the distance and mid was perfect! No struggle or blur at all...it's just that reading is partly lost and would need readers (unless i hold things a bit away from me)....so i am considering moving to mini-monovision....i do like sharp distance and mid range and that would give me that...

But since you are use to readers, going with 20/20 in both eyes (or mini-monovision if you can try that and would like it...you can't go wrong with either one, really...

[pollywog99]

Thank you for your reply.  
I've spoken to many people that have had cataract surgery but none that were given the options proposed by my first surgeon.
I tried to use monovision with contacts a few years ago and was never successful.  
Since the cataracts have grown I now use reading glasses (I wear progressives but usually took them off to read) and I think I will be okay with them.  

[Craig10x]

Your first doctor i would stay away from...i had one eye (dominant eye) where the cataract had hardly developed (but was there nonetheless) and my non dominant eye was fairly bad....my doctor did both eyes..first the dominant eye for plano (20/20) and the only reason my left eye was done for 20/150 was for "monovison"...otherwise he would have shot for 20/20....the lenses can correct for whatever they want them to be (up to 20/20) and hopefully, the "targets" are hit (as they were in my case...

So, yes...you can have both eyes done, and there is no danger in having the eye with the lesser cataract done as well (if your doctor told you that it is BS)....and it doesn't affect the final results you will have...

You would just need to decide whether to go for 20/20 in both or have the non-dominant done for monovision (to lessen your need for glasses in closer situations...

I have 20/150 done although i think i might have been happier with 20/100 in the non-dominant...but i can have it brought up to that with a "lasik enhancement" not an iol exchange...if i decide to....

As i am this way, i can see distance/mid/close  all without glasses (which i love) but i do have a slight "blurring effect" in all three ranges...

If i go go 20/100 in that eye, my distance and mid range will be super sharp...but i will be more dependent on reading glasses....

Hope that helps...