John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

Interests: Eye-Medical Blog
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Timing of Cataract Surgery and High Myopia

Apr 07, 2010 - 28 comments

There is no universal time to do cataract surgery. The cardinal rule is that when the person is unable to do the things they need to do (drive at night, read, see clearly for TV, movies, perform their work) and the things they very much enjoy doing (crafts, hunting, shooting, sports, taking trips, going to friends and church at night) and the cataract is the only problem or the main problem then surgery is indicated provided the person understands the risks and the alternative of not having surgery. (In some cases there are risks to understand of NOT having surgery such as the cataract getting to hard [increases the risk of surgery], too 'ripe' [rare in the US but a big problem in so called third world countries requires emergency surgery], not being able to pass a drivers license, pilot's license, commercial driving license, increase risk of falls and disorientation in the elderly.

If there are other problems in the eye such as macular degeneration, glaucoma, diabetic retinopathy or maculopathy, amblyopia, etc. the problems will still be present after the surgery and will affect the final result. When groups of people that have had cataract surgery get together and talk about their results the variation in the final results are usually not due to complications but that those with poor vision post operatively have other problems in their eye that the cataract surgery did not, as was not expected to help.

Having said the above a commercial pilot, over the road trucker, a person that works at night, taxi drivers, etc will need cataract surgery at a relatively early stage to do their work safely and meet their job requirements. A person in their late 80's to early 90's that doesn't drive, doesn't read, rarely goes out of their house, that has multiple other physical or mental problems will likely not be bothered by a relatively large cataract and the best course of action may be to leave that 'big' cataract alone.

With your high myopia your vision was likely never a crisp 20/20 and never will be even with successful cataract surgery due to the myopic macular degeneration---something that can worsen with time. You are also at an increased risk of retinal detachment. (please see previous postings on vitreous detachment, retinal detachment, flashes/floaters/curtain & veils) on the ophthalmology website, the eyecare patient forum, use the "search feature" on the site.

Cataract surgery, even successful small incision surgery increases the risk of retinal detachment by as much as 5-10 times normal. (rough estimates 1 in 3-4 thousand for people not having had cataract surgery and no major risk factors to 1 in 500 or even less after umcomplicated surgery). Your risk without cataract surgery can be as high as 1 in 200 to 1 in 500. After cataract surgery your risk may be as high as 2-3%.

Provided you understand these risks you would be a candidate for cataract surgery anytime your feel it is a major problem as outlined above and your eye surgeon agrees.

This is what I do in my highly myopic patients that are considering or have decided to have cataract surgery.

1. I give them detailed "informed consent"
2. I sent them to a retinal specialist for a second opinion abour cataract surgery and a special detailed examination of the retinal looking for holes, tears, thin areas, vitreous traction, existing small retinal detachments. If these are present the retinal specialist will often use laser or a freezing treatment to bolster or strengthen these areas.
3. The surgery is done using several special techniques that lower the risk of surgery in the highly myopic.
4. I see the person more often than my regular patients. The myopic patient knows the symptoms of a possible retinal detachment (flashes, sudden increase of floaters, loss of peripheral vision). I instruct the patient on "finger counting visual fields" and have them check their peripheral vision at home daily.
5. At one week and 6 weeks the patient sees the retinal specialist to repeat the special examinination of the retina looking for new problems--if present they are treated.

I believe that is the information your need. If your vision is a big problem (not a small or medium size problem) and the cataract is the main reason and you have confidence in your surgeon and the surgeon agrees that surgery would be beneficial (BUT NO SURGERY IS EVERY RISK FREE) then you may want to proceed with the surgery.. (the risks are much, much less now than say 10-15 years ago due to better techniques). Because of your age (young) your will in all likelihood need cataract surgery sometime.

Good luck.

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by MortyS, Apr 08, 2010
Thanks, Dr. Hagan, but from a patient's point of view, cataract surgery is promoted--or suggested to be--almost a slam-dunk procedure. Take a look (I'm sure you already have) at information pamphlets, cataract surgery information in general on the Web, and the often-repeated "cataract surgery is the most-performed surgery of all," and you'll see--or have seen--how a patient can go into it naively, as I did, then had a ruptured lens capsule. Even my later surgeon for my other-eye cataract surgery has a pamphlet that would put almost every potential patient at ease--which is probably the point. If I knew of possible complications before my first cataract surgery, I would STILL have had it, but I would have worried more. Personally, I like to know possibilities, even if I don't like them, but I think most people would rather not. Best wishes, Morty S.

Avatar universal
by Echoetal, Oct 28, 2010
Thank you for this  information.  I am in the process of deciding on IOL's for cataracts.  I was not happy with the first Dr. recommended by my regular eye doctor and sought a second opinion.  I was treated by Dr. Foote as an intelligent human being, educating me in the procedures and types of lens' available without strong arming.  He did offer me choices starting with the basics on up to the premium including their pros and cons.  Now it is up to me to decide.  The first Dr. didn't give me information, gave me two choices of a regular lens for distance or a premium name brand lens, ran his patients through an assembly line like process and had no time or inclination (it seemed) to discuss or inform.  I was not willing to trust my most precious gift of sight to such a person.  

I use the internet and sites such as this one to help me make decisions on which vacuum cleaner is a good value to issues on health.  Comments from the public forums run the gamete from love it to hate it and everything in between.  I take into account whether the person is just ranting or has viable information about specific issues.  Yet it is still up to me to make my own decision using my list of questions presented to my doctor and his advise to trust that I made the best choice possible at the time.  These sites cannot and do not stand in place of ones own real life physician.  People who use it as such are doing themselves more harm than good.  Thank you for your honesty.  Echoetal  

Avatar universal
by my2eyes, Oct 28, 2010
Echoetal - I would take this decision VERY seriously!  I wish that I was more informed before I had my surgery.  I had my left eye done in May, and have regretted it ever since.  I assumed that needing reading glasses meant just for reading.  Unfortunately, it means a distance of about three feet.  Also, wearing reading glasses isn't always feasible.  To put eye make-up on is just about impossible.  Shaving in the shower is now more dangerous than I imagined.  To see an alarm clock in the morning takes coordination, when I'm not fully functioning (I need to close that eye, but when half asleep I naturally close the wrong one and cannot see a thing).  Though it's humorous, it gets to be aggravating.  Also, the worst happened to me last week.  There was an eyelash in my un-operated eye and could not see from operated eye well enough to remove it.

I don't want to sound so pessimistic, I know that none of these things are the end of the world, but they are only examples and are extremely frustrating!!  Perhaps you should take into consideration your age and activities that you are involved in.  I am 36 and still have young kids, so maybe I find it more frustrating than others may.  I admit that part of the frustration is the surprise factor.  I didn't realize how much it would effect my day - all day.  I also was under the impression that my distance vision would be great, so something like an alarm clock far away would work, but it doesn't.

Please look into all options carefully!  Good luck in whatever you decide!!!

Avatar universal
by Fleetfoot197, Dec 09, 2010
my2eyes.  Have you tried a big magnifiying loop for makeup, eyelash removal etc.  You might want to give it a try.

Avatar universal
by FallsChurchVA, May 18, 2011
I'm in a quandary and would appreciate some feedback. I'm a 53 year old female with a recent diagnosis of cataracts. I have other extenuating circumstances and am having difficulty deciding on the type of IOL to get for the best long-term results based on my history. This includes:

o Life long high-end myopia (started wearing glasses in 4th grade)
o Had prior LASIK on both eyes in 1996 at Kremer Eye Associates. At that time, my RX was -15 diopters prior to LASIK
o Since LASIK, have had fluctuating and worsening vision.    
o Currently wear gas permeable contacts with monovision
o I have ruled out the asperic implants in movovision style due to several factors including issues with depth perception  
o Had recent consult with retina specialist due to some concerns my opthalmologist had and was okayed for the cataract surgery.
o I do have astigmatism (not certain of the degree)
o My job involves working on the computer 8 to 10 hours per day. I am in front of a computer screen for 40 - 50 hours per week and do not want to be constantly bothered by having to wear reading glasses.

I am leaning toward the Crystalens which will cost me $6,000. This is the same amt. I paid for LASIK. I've noticed that not once has the facility followed up to track LASIK on high myopic patients. I do not want to contend with more problems after the cataract surgery that could have been prevented?

What is the best IOL for my situation? Thanks!!!

Paula - Falls Church, VA

Avatar universal
by hictx, Jun 05, 2011

My situation is very similar to yours.  I am very near sighted with astigmatism since 4th grade.  I wear gas permeable contacts and work in front of a computer all day.  I recently consulted a cataract surgeon.  He said I should go with the basic IOL not Crystalens.  He said Crystalens will complicate the accuracy of vision correction.  The result will not be satisfactory.  I have not made a decision yet.  I would like to hear other people's experience.

Avatar universal
by Barbarella1880, Aug 26, 2011
My situation is also similar. I'm a 53 year old female, glasses since 4th grade, very near sighted, work on computer all day. I was diagnosed with cataracts a year ago. A few months later, I was diagnosed with myopic degeneration. I put off cataract surgery for 6 months while the myopic degeneration stabilized. I'm now ready for cataract surgery. My ophthalmologist recommended a standard/basic IOL or Crystalens. I saw another doctor for a second opinion. He said he would not recommend any kind of multifocal lens, only a standard/basic lens. I didn't completely understand why, but he said something about if my myopic degeneration worsened, the multifocal lens would not allow as much light to enter my eye as the other lens.

Did you have the cataract surgery yet? Which lend did you choose and how is it going?

Avatar universal
by john171, Sep 09, 2011
Hello Doctor,

I have a lazy eye which I have had all my life. I was due to have cataract surgery in that particular eye, but chickened out when I thought it may create double vision. I notice that the eyes don't line up and the doctor said perhaps prism glasses or eye muscle operation would help IF the double vision continued for a while after the operation. Was I right in not having the op? I have lived with one good eye all my life, and I need to be without glasses for my work. I am 64.


Avatar universal
by Zeeshanhaider, Sep 24, 2011
My both eyes are highly myopic since early childhood. I was wearing glasses since then. Particlularly my left eye is very weak and I can see only 10% through this. My right eye is better but still weak. I am wearing glasses with high powered lenses. In 1995 I had Excimer laser done in both eyes which stablized the vision. In 2010 I started experiencing blurry vision and I am experiencing vision problems since then. I consulted a few opthalmologists in my area and they diagnosed that I have catracts in both eyes. SInce, I am limited to my right eye due to very weak left eye and there is a chance to retinal detachment during surgery, I am much concerned about my furture. I am willing to travel to Kansas to get an opinion with you Dr. Hagan. Is it possible that you can respond to this blog entry and I can work to get an appointment with you. My email is ***@****.  

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by sunilkhera57, Jan 07, 2012
hello Doctor,

I am 26, male. I got my specticals with minor number when I was 12 years old. Now my Right eye number is 10, and left eye number is 4. Sometime I feel double vision, All the time lot of stress on my eyes. Still  in this age number is incresing and doctors say they can't stop it. It incresed like .25, .5 1, 2, 2.5 ...........now its 10.

Doctor Please suggest I am lossing my vision.


Avatar universal
by DrForEyes, Nov 25, 2012
The idea that cataract surgery should be entertained at the age of 90 is simply wrong. Highly myopic individuals develop visually significant cataracts at an earlier age than their emmeatropic peers. Waiting twenty years longer than necessary is not good advice at all.

Modern IOL calculations and measurements provide highly accurate results.

Post LASIK patients present a different situation since IOL calculations do not have the same level of accuracy.
But these patients should already know about this since LASIK surgeons have known about this for over 15 years.

Avatar universal
by penken, Feb 08, 2014
I am happy to have found this blog. I am a 53 year old female, highly myopic.   Glasses at age 2. Which  now is thankfully is correctable with contact lenses. -19.50 in R eye and -19 in left. I also have intermittent strabismus. I did 40 weeks of vision therapy a  year  ago. I am now able to tell when my right eye is on.  I had   2 strabismus  surgeries at ages 6  & 8. Right ye turns in if it isn't on and left eye turns in when R eye is on sometimes. This being said, I have developed cataracts and I was seeing double in L eye due to cataract.  I had successful cataract surgery last week and I am thrilled to see very well in the distance range, but I am disappointed with having to wear reading glasses. I had a standard IOL put in left eye, mild astigmatism.  The glare from lights  and headlights has I improved since cataract was removed, but  some long glare is still apparent along with some halos still remaining.
I am scheduled to have the R eye done at the end of the month. I have changed my mind twice on whether to have a lens put in for near or far vision.  I met with my long time eye doc to get an opinion.  My R eye has a  moderate astigmatism which he will work on with laser to correct.  
I am concerned that my eyes will not team and I will have constant eye turning in if I choose to have near vision in right  eye. I need another opinion and was hoping you coukd give me sone advice.  Thank you for your time.  Sorry for such a long post. I am so thrilled with the technology that has changed my life, just want to make the best decision.  

Avatar universal
by ICUNOW, Oct 06, 2014
I am a 56 yr. old female who has been wearing glasses since the 1st grade. -12 rt. eye -8 left eye.  Slight astigmatism. I was diagnosed with cataracts last year and have decided to have the surgery since the cataracts are causing me to be more nearsighted.  I went from a -8 to a -12 in one year.  Doctor has recommended mono IOL and says sight will be corrected to a -2 approximately and  I will still need glasses but not the RX that I have worn all of my life.  He did not recommend a retina specialist as i see some have visited.  i will now seek the advise of one before having the surgery Oct. 21, 2014.  

Anyone have similar changes in vision due to the cataracts?  Any advise  

I would suggest you do visit a retina specialist prior to surgery for a detailed exam of peripheral retina and also see the retina doctor about 7-10 days post surgery. You understand you will need to have both eyes operated on for them to work together.  Generally one eye (the worst) and the second in about 3-6 weeks depending on how you heal.

Most myopes are use to glasses for distance and use to being able to see at near without glasses.  A mini-monofocal   aiming for about -2.00 in the reading eye and -1.00 in the intermediate eye would allow many near tasks to be done without glasses.   Your best vision will still come with progressive bifocals (no-line) after surgery.

Also go to my blog and read the posting about what you should know before you have cataract surgery. Follow this link http://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;


Avatar universal
by ChristineDash, Feb 08, 2015
I have a question about timing of my cataract surgery.  I am high myopic, 51 years old.  On December 3, 2014, I had surgery to repair a retinal detachment macula off.  They did a vitrectomy, scalara buckle and gas bubble.  As a result of the surgery,  the nearsightedness is much worse, the cataract is much worse, and my vision is somewhat wavy because of damage to the macula.  My retinal surgeon is very pleased with the outcome.  I am too because before the surgery I had lost all sight in the detached eye.  My retinal doctor says there is no swelling of the macula and that I could begin discussing cataract surgery with my regular ophthalmologist.  My question is how soon should I reasonably begin considering surgery?  Should I wait longer for my eye to heal?  Do you have any thoughts on lens type?  Also, because I am reluctant to have cataract surgery on my good eye before it is necessary, I am considering wearing a contact in the good after surgery. Do you have any thoughts on that and how that will affect my vision?  Thank you.

You should probably start conversation and examination by a cataract surgeon now since your retina physician gave his/her okay. You can discuss with your cataract surgeon what would be a "target" post operative refractive error. It depends on a lot of things including what your present glasses RX is, your suitability to wear contacts after cataract surgery, whether you've ever used contacts for mono-vision before, how big any cataract might be in your "good eye", your willingness to consider LASIK on the good eye after cataract surgery on the bad eye if you do not find a solution to having the eyes work together.

There are potential problems with leaving the cataract I the "bad" eye including it can make it difficult to examine the repaired retina, the cataract could get too hard and increase the risk of surgery or they eye might swing out of alignment.


Avatar universal
by zaraforty, Aug 13, 2015
I am 56, high correction, 7.5 R, 8.L with RGP lens since age 16, cataracts in both eyes, stage 2.
I do not really trust my doctor, it is a hectic practice and he does not take time to explain other than he cant correct me to 20-20 but will not tell me what he can do and leaves room so as not to answer my questions. Wants me to see a retinal specialist first I have been 2x times on referral of my optometrist who until now I did trust. I feel I am in a factory there, 4 hours today for exam and only few minutes with the MD. This is a large practice in West Bloomfield, MI. I have had 2 majpr back surgeries in the past year  including a fusion and going thru this on top of it is overwhelming and my back issues are still not resolved. Any input would be greatly appreciated. I really feel I need at least another opinion but dont know where to go in this area, metro Detroit. I have had 4 consult for my back issues so far and 2 surgeries.

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by JohnHaganMD, Aug 13, 2015
I don't know why you remain under the care of doctor's you don't trust.    Trust is one of the most important elements of a doctor-patient relationship. It would be worth the time and money to drive further to find someone you trust. I especially can't imagine being operated on by someone I didn't trust.  I trust all my doctors.  Some in the past for one reason or another have made me uncomfortable or I felt we didn't communicate well and I have changed doctors.

You can go to the website of the American Academy of Ophthalmology  www.geteyesmart.org and they have an physician locator which can tell you members in your area.

Or there are certainly some in Detroit or the medical centers there. As I said you do need to have your retina checked before and after cataract surgery and when you decide to have cataract surgery you may need to go without your contacts 2-3 or more weeks till your cornea stabilizes in order to get accurate readings to determine the IOL power.


Avatar universal
by Mustsee, Oct 08, 2015
I am 47 years old, -15 left and -12 right, has myopic degeneration and cataract. My ophtha still wouldn't recommend cataract surgery yet. However, in addition to night glare and driving at night, I'm most worried about myopic degen getting worse, so am interetsed in addressing myopia and catact via cataract surgery. Would appreciate advice pls.

Avatar universal
by erotida, Aug 23, 2016
I am a 53 year old female. I had a retinal detachment on my left eye. I had the gas surgery and was very happy with the result. I had cataract surgery on both eyes. I was very very happy with the results. However, three tears later my vision started getting worse. I started noticing like fog vision, hazy etc. After going to the head of ophthalmologist at northwestern hospital,he diagnosed me with myopic macular degeneration and put me on disability. Did I mention I am a school teacher. Ok have blind spots not allowing me to see well enough that I have taken some serious falls. The last one was at school herniated two disk in my back. I find myself being very depressed not knowing when my vision will be totally gone. Is there anyway to stop this progression?

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by JohnHaganMD, Aug 23, 2016
There are two types of MMD  so called dry or non-exucative. No treatment exists. Some people have elected to take the same medications that have been shown to help age related dry macular degeneration (a multivitamin and 2 Preservision 2 supplements)day.  The other form of MMD is "wet" or exudative and it is treated with injections into they eye of avastin, lucentis or eylea.   If you got to Northwestern U Dept of Ophthalmology you are receiving good care. Ask your ophthalmologists for recommendations.

Avatar universal
by oklajohn, Apr 05, 2017
I am an  81 year old male in Oklahoma City who has worn contact lens for 60  years, daily at least 15 hours per day.  For the first 40 years, the contacts were  the old fashioned "hard" lens (not always comfortable) and the last 20 years the lens have been  RGP which have been extremely comfortable and very satisfactory visually.  

My optometrist   told me I am developing cataracts and I should  consider cataract surgery.  I have scheduled a cataract examination with a local ophthalmologist in four weeks.  I have been instructed not to wear my contacts until the examination,  I had no current glasses for backup, so my optometrist  made 2 pair of single vision glasses - none for distance and one for intermediate (computer) distance to wear until the cataract exam.  I have just started wearing them instead my contact lens.  I find them somewhat irritating, since I don't see as well with them as with my contacts.  There is also  some distortion  which I don't have with the contacts.   From what I have read on the Internet, this seems to be somewhat normal when a person switches from contacts to glasses.   My big concern now is whether I will be able to see as well after cataract surgery as I do with the contact lens.  Wearing the glasses has caused me to wonder about even having cataract surgery.

According to the optometrist's last readings,

-950 -175 x 115
-900 -200 x 045

Myopia, bilateral
Regular astigmatism, bilateral
Age-related nuclear cataract, bilateral
Dermatochalasis of right eye, unspecified eyelid
Keratoconus, unspecified, bilateral
The  ophthalmologist I will be seeing states on his website:  "From precise and predictable femtosecond laser technology to the revolutionary CATALYS® Precision Laser System, we offer our patients the perfect combination of experienced surgeons and advanced treatment options."  Knowing little about cataract surgery, this almost overwhelms me in it's bombastic terminology.  

Bottom line, should I even be considering cataract surgery at my advanced age, and how do I tell if my choice of surgeon is the correct one?  Any advice or suggestions will be appreciated.  Thanks for reading.

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by JohnHaganMD, Apr 06, 2017
First read this article I wrote carefully: http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ; Then come back and read below.

If you are 80 see well with your contact lens and I were to ask you as a surgeon "Do you consider your vision: no problem? Small problem? Medium problem or Big Problem. Our surgeons and me (12,000 cataract surgeries) do not operate if the answer is no problem or small problem especially if you can drive at nigh comfortably.  So if no or small we would not operate on you.

Please know this. There is a significant amount over aggressive and necessary cataract surgery (for pure profit) in my opinion. Moreover there are a group of "cataract kings/queens" that serve optometric networks and kick back part of the surgical fee to the referring optometrist. This is usually not disclosed to the patient. It is unfortunately legal and is called "co-management" it is kick back money which use to be unethical. Ask your optom if he/she has a 'co-management" arrangement with the ophthamologist you were referred to. Also with reimbursement of cataract surgery going down many of the kings/queens and their staff put huge pressure on you to "upgrade" (increase their profits) by opting for femtosecond laser, ORA astigmatism measure, "preimium IOLs"

If you do see this person ask the surgeon if he has a 'comanagement' relationship with your optom. Its shameful this isn't disclosed. Also get a 2nd or 3rd opinion if you are considering cataract surgery.

Money will always corrupt some. Not saying that's what going on but I have patients every week that come in asking if they need surgery and I find "no" some of them almost don't have cataracts. The ones in MO and KS I know and we call them "chop shops"  Good luck

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by JohnHaganMD, Apr 06, 2017
sorry make that "unnecessary surgery"

Avatar universal
by miayopia, Oct 13, 2017
Hello Dr. Hagan,
What do you suggest for severely myopic patient that has cataract in 1 eye only. Both eyes are -16D. My works involves a lot of reading. From your post, it seemed i should aim for -2D in one eye for reading, and -1 for intermediate vision.
I have cataract right after macular pucker surgery so I could not how good/bad the vision in that. In that case, which one should I aim for this eye? close vision or intermediate?
Also, I'm only 30 and I'm not ready to have cataract surgery in the "good" eye at this point, given the increased risks of retinal detachment in that eye after cataract surgery. I was thinking wearing contact lens might be a solution for me to get both eyes work together (i never worn one in my life but I would do just to save my good eye). Would you think that solution is possible? If I have laser surgery to partially lower the prescription in that eye, would there be any laser technique that does not increase the risk of retinal detachment?
What types of lens should you suggest for people with high myopia?
Lastly, one RS i saw suggest having pars plana lensectomy without a len insertion to avoid risks for highly myopic eyes. What do you think about that?

Avatar universal
by davidjm, Oct 27, 2017
I would sure like to hear the answerers to the questions from "miayopia 10/13/17".  I am in a similar situation!

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by JohnHaganMD, Oct 31, 2017
Davidjm: She asked those questions in the regular forum and there were answered there. The link follows. If you still have questions post in the regular eye forum as I am often not notified of posts on the blogs.  LINK: http://www.medhelp.org/posts/Eye-Care/blurry---worse-vision-after-macular-pucker-surgery/show/2997548#post_14263846  ;

Avatar universal
by Mamorlino, May 21, 2020
I have high myopia 11.75 and -12.25. Nearsightedness caught in kindergarden at the age of 5 my mom was told I was probably born myopic. My eyes never stabilized for more then two years throughout my life. Although most changes were - .25 or -.50, then once in a while I would jump a hole -1.00 diopters within a year. I was diagnosed with degenerative myopia,  astigmatism and tilted optical discs and very bad dry eye. I recently Had cortical and post Subcapsular polar cataracts bilateral removed because my vision could no longer be corrected better then 20/70. I chose EnVista IOL MX60ET And I couldn’t be happier with my sight and sight without floaters is incredible. Even with these incredible IOLs I still needed YAG  just 2 months post first surgery and scheduled now for my second YAG surgery just 5 months after my second surgery.  Ok so that’s my story... I don’t have a question for the doctors but wanted to share my personal experience with eye problems, cataracts and yag.  Acoording to the eye chart I am seeing 20/20. It may not be as sharp as a natural 20/20 but I can see it! And I am happy with that... Yes I am now in readers but I also realize that my high myopia was correcting my close up reading vision so if my eyes were normal I would be wearing readers anyway. Well maybe one question... does the tilted optical disc have anything to do with any of these other degenerative problems?

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