difficult decision postponed second cataract surgery

[brianarc]

I had cataract surgery 6 days ago, had monofocal IOL implanted in left eye; on day after I realized I had made a mistake having distance lens inserted.  I am 59, have been nearsighted my whole life, wore glasses since 12, don't have problem wearing glasses.  Had surgery due to some ghosting in left eye, which appears to be due to cornea problem.  I work mostly intermediate, at computer and speaking with people 5-10 feet away.  Quite used to having glasses for driving (42 years).  I wish my MD had asked me what distance focus would be best for me; she said, "well most people have distance lens, then use readers for anything close." Yes, I know I was told about it, but I hate the reality now that I can no longer see my hands clearly with L. eye.  I have been so upset all week, and confused about what to do.  Supposed to have second surgery done tomorrow, but two days ago I cancelled this, felt I needed more time to get information and make a non-hurried decision. I called MD office, was told I could not talk with an MD, would have to come in to consult (but there was no time prior to second surgery, also why I postponed it). Another BIG of my situation is that in four weeks I am starting a new job.  I told MD this when I first met with them.  I will be working about 1.5 hours away, will need to do distance driving until I can move there, hopefully within a month of starting.  I did this surgery so my vision would be in good shape for new position, now it's messed up. (By the way, if I had been told I would not get new glasses for 6 weeks after surgery I would have never even tried to have the surgery prior to job change.)  I am hoping that getting eyeglasses for the interim can correct enough for disparity between eyes, just to help me function well enough (does not have to be perfect, but want to make sure I have adequate vision for driving and computer). I am wondering if an optometrist can make glasses that will accommodate enough for difference between the eyes (not sure of my diopters, was never given that info by MD, will ask for it when I see her in two days for consultation), so I can get through a transition period of a few months at new job/moving, then when settled can consider having second surgery in rt eye (nearsighted), for which I am considering mini-monovision which, from what I have read, best fits my needs; however, I am guessing right eye is dominant, and that was not first operated on. Would relying on glasses alone for correction, for a few months, cause any damage to eyes?  I am NOT trying to be glasses-free (by the way, MD said I would still probably need glasses for distance anyway, after surgery).  I am willing to have a pair of glasses for close/computer work, and a second pair for driving.  I just don't want to lost close vision completely in rt eye.  I would also be open to having another pair of glasses for prolonged close reading. Since surgery, the halos at night have almost doubled in left eye, and I am also scared to have anything done to right eye, as I would like to keep at least one good eye for night driving.  I feel like my current MD has made assumptions about what would be right or tolerable for me, really hope to have some dialog on my needs with her, and I am hoping for some information from this discussion list that can leave me better informed before meeting with MD/surgeon in two days.

I have been beating up on myself for not thinking this through more; I know at this point that will not help, so what I need to do is look at the situation and figure out what will give me a solution, even temporarily.

Thanks for reading, and for any help you can offer.

[SoftwareDeveloper]

re: "Would relying on glasses alone for correction, for a few months, cause any damage to eyes? "

Wearing glasses won't cause damage to your eyes. Usually glasses will work well, though it partly depends on the difference in prescriptions between the eyes. If it is too high then often contacts work better, or special glasses need to be made which account for the difference in image size produced by lenses of different powers.

Doctors prefer to wait for vision to be stable before prescribing glasses, but likely if pushed they will do so early if you are prepared that the prescription might change a bit, even though that might  require paying for another updated pair (there are some dirt cheap eyeglass places on the net, but I don't know anything about speed or quality). I don't know if   places like Lenscrafters that often   let you swap prescriptions during their initial few week period where they will redo glasses free if there are problems.

  If you were comfortable trying contact lenses (they've improved quite a bit in comfort&convenience  the last several years if you hadn't tried them recently), then many doctors will have trial lenses in stock for you to get right away and a friendly doctor might give some   now even if the prescription will change later. There are multifocal contacts that you could try which will provide some near vision.

Although you state your right eye is likely dominant, and doctors prefer to use the dominant eye for distance with monovision, what I've read suggests there usually isn't any problem having the dominant eye for the nearer vision eye and the non-dominant for distance.  Alternatively (/additionally) to monovision, you could consider something like the Crystalens to try to get more near vision, but those cost extra out of pocket, they aren't covered by insurance or government payments. There are multifocal IOLs also, but they have a higher risk of problematic halos and since you have trouble with halos even with a monofocal it doesn't seem like a good bet for you. There are other IOLs approved outside the US but not yet FDA approved, but most people aren't up for the hassle of that (I went outside the US to get  Symfony lenses).

Many people who initially see halos do see them subside over the first few months, though some never see them go away. I'll note that not all monofocals are created equal and although I haven't seen a head to head comparison, based on figures I've seen  I suspect that the Alcon monofocals are more prone to halos than the Tecnis.   They should have given you a card with information about your lens implant, I'm guessing its an Alcon monofocal, and if so you might consider whether to get a different brand for your other eye.

There are now corneal inlays like the Kamra and Raindrop that were created to give people with presbyopia better near vision (its like a small lens implanted just below the surface of the eye, which can be taken out if you don't like it) and have been tested with people with monofocal IOLs as well. The Kamra is already FDA approved, but I think it reduces low light vision a bit more than the Raindrop which is just now going through the approval process (I don't know if that means it'll likely  be approved this year or next, the FDA is slow).  I know Dr. Hagan who posted on this page isn't a fan of the idea of corneal inlays so its something you'd need to research to be sure you wish to risk it, but other surgeons think they are a good approach  and have had implanted them in their own eyes.

[SoftwareDeveloper]

I should add that I mentioned the multifocal contacts even though you have halo issues at night with your IOL already, since  you can always take  multifocal contacts out  at night if they make the halos worse (and of course you might luck out and they wouldn't give you halos).

[JohnHaganMD]

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[JohnHaganMD]

There are many posts like yours on this forum. Which is the reason I wrote this article, start by reading. When you have finished post your pre-opertive glasses prescription and if possible your vision with them. Also your post operative prescription and your vision with them.

READ CAREFULLY:  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;

[brianarc]

Thank you for responding Dr. Hagan.