53 yo seeking guidance.

Eye care
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Hi. I'm 53 and recently diagnosed with a cataract in my right eye. The left lens is clear. I just stumbled into this forum which is a wealth of knowledge. I've got a follow-up appointment in a couple days, so I'm trying to quickly get up to speed on a few things. Current prescription: OD sph -3, cyl -1.25, axis 135. OS -3, -0.25, 150. I'm trying to think through the best options. I currently wear glasses; contacts years back gave me some dry eye issues, but I haven't tried them in many years. I'd like to reduce dependence on glasses as much as I can. But since I'm only having one eye done, it sounds like that's not too likely. I work with computers every day, so good vision in that range is important. I already deal with some halos at night.

Can someone give me some starting points in what I should be considering for a lens option? Has anyone combined cataract surgery in one eye with Lasik in the other?

Thanks in advance for your thoughts on my scenario.

RichB

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Hello Rich,

Personally, I'd ask to have a consultation with a cataract person in the practice who is an expert on lens options. I did that and it helped a ton. Generally insurance only covers monofocal lens (distance or near). The premium lens are anywhere from $2500 and up out of pocket. The typical "multivocal" lenses often create glare or halos. Additionally there can be issues with mid-distance. I have a friend who got them, and she is fine for distance and near, but needs correction for mid distance (computer) and that is what she does most of the days. I chose symfony extended death of focus lenses. They were approved for use in USA a month or two prior to my surgery. You can google

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to find out the specific statistics on what percentage of people are corrected through all ranges. Generally near is the distance with issues. I has them make me a tiny bit nearsighted in my second eye so I only need readers for artwork, really fine work etc.

You can do one eye distance, one eye near, but generally it is better to trial that as not everyone tolerates that. It also decreases your depth perception.

Also ask if you have latticing, which can make you at higher risk of retina detachment, especially as you are having a cataract surgery younger, which increased your risk of retina detachment.

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If you get Lasik to correct your distance vision in your left eye, you're going to need reading glasses for that eye and probably also need glasses for the computer for that eye. I have non-toric monofocals set for distance and can see fine without glasses almost all the time, including the computer, driving and most reading of close up material unless it's extremely tiny print or if I want to read for a long time without my eyes getting tired.

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You can also consider getting a Symfony lens in your right eye and wear a contact lens for distance in your left eye, but some people can't read without glasses with Symfony lenses and even if you could, I'm not sure if they can replicate the amount of nearsightedness in someone with natural myopia. Most people who get non-toric monofocals set for distance have the same result as I had, so you might want to save the extra expense of a Symfony lens and just get that instead.

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Also, some people with non-toric monofocals for distance don't ever need glasses, even for reading, but of course you can't count on having that result.

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And I'm not talking about monovision. I don't have monovision, not even mini-monovision. I was able to read fine without glasses with my first operated eye alone by the time I had my second eye done 6 weeks later. I actually see slightly better at all distances without glasses with my first eye than my second eye, but I can still read with my second eye alone when I close my first eye. With my first eye done, I was able to drive myself to my doctor appointment the day after surgery, seeing perfectly fine without glasses (20/20), except my reading vision got better over the 6 weeks between surgeries.

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Hi Rich,

Sounds like your biggest dilemma is what combination will be the best interim compromise until eye #2 gets a symptomatic cataract (my surgeon says it’s virtually inevitable - I’ve also only needed one eye done so far). Do you currently remove your glasses to read?  How is it to read or see your cell phone with only the left eye?  

Good you are doing some research ahead of time.  I found the MDs were not helpful in selecting  targets; they often just ask if you want to see near or far, or try to oversell premium lenses. Very frustrating.

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Don't get it done unless you really have to have it done. Wait and make a very educated decision

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Hi RichBR - I had both eyes done at 53 last summer 6 weeks apart due to cataracts.  It is good you are doing your research now.  There are compromises no matter which lens you choose.  I live in Canada so my surgery was covered under Medicare.  I paid the added fee for Symfony lenses at $900 an eye.   

I too work a lot with computers and didn’t need any readers at the time and couldn’t fathom losing that ability after cataract surgery.  All accommodation is lost after surgery.

I have good all round vision and don’t need glasses at all.  I realize that is not the case for everyone.  I myself thought I would need readers more but as it turns out see well at 11 inches to distance with both eyes at plano.  I do have to put up with night vision issues.  Due to lens design see multiple concentric circles around certain lights.  I also had glare and starbursts but that has subsided.  With time those 2 issues diminish but the concentric circles are not likely to go away.

If you decide to get lasik done on good eye be aware it makes calculating power for IOL when you you need cataract surgery.  Even when they have your pre-lasik eye measurements.  I do know in countries that have national health system that cover cataract surgery if there is too great a difference between your eyes they will cover the other surgery even without presence of a cataract.  

Wish you all the best.

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Since your left eye uncorrected should give you excellent near (reading) vision, and  you mentioned computer distance vision (intermediate range) is important you might consider targeting your right eye with a monofocal toric IOL for around -1.50D or so.  That should achieve good intermediate focus in the right eye, and the difference between the right eye should not be to much to get used to.  You would need glasses only for distance like driving with this combo.  You might test it first with a contact lens simulating this in one eye.

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Hi, I think I am in the same boat as you, late 40s with unilateral cataracts in my right eye.  I think you are in a little better position since your left eye is only -3D, mine is -5D.  I found it also very difficult to decide on the lens and focal distance as whatever I do to my right eye now it has to work in the interim when my left eye is still okay at -5D and also after the inevitable cataract surgery to my left eye who knows how many years later.

So, the first question is - Can you wait?  There are always new technologies coming out every year, especially in Europe.  My suggestion is if you are going to wait and see, at least go to a good cataract surgeon and take all necessary eye measurements first.  In my case I waited too long and the better instrument cannot penetrate pass my matured cataract and need to settle with less accurate ultrasound measurement of my eyeball length.  Lucky it turned out okay.

Also, ask your optomologist to let you try monovision, or a -1D prescription on one of your eyes.  You can see how blury distance vision is when your eye is set for -1D ( or something like -0.75D).  That will help you decide if you want to set the focal length to intermediate distances.  Same applies to monovision.  You want to try that before your right eye is too blurry to see.

As you must have know now, you have to choose between monofocal iol and multifocal/EDOF iol.   I asked myself what drives me more crazy, having to carry and switch between glasses all day or seeing a permanent, uncorrectable Halo and starburst at night. 

One thing you need to keep in mind is something called Anisometropia.  That is having a significant difference in reflective power on your left and right eyes.  If you set for Plano on your right eye, you might have problem using spectacles (your left eye is -3D, right)  and need either to wear contacts or Lasik on your left eye.  That is one reason I suggest going to your opthamologist and ask him/her to give you a contacts for your RE and see if your are okay seeing thru your spectacles with the right lens popped out. If you can get used to it, you might be able to avoid Lasik all together.

For your reference, I choose toric monofocal for my RE targetting -1D and wear contacts on my LE. LASIK on my LE is an option too but I will wait to see how the cataracts on my LE is advancing. When the time comes for my LE, I will do monovision with 0D. My RE turned out to be -0.7D after surgery. Now my RE's best focal distance is my armength. Computer vision is superb, crisp, clear and color is vibrant, couldn't believe it. I guess I have forgotten how excellent my vision used to be. Using my RE only I can see my phone fine as close as uo to 12 inches without any aid nor bigger font sizes under normal lighting conditions. Reading distance object is more difficult, but at least I can drive without much problem in the day time. I need to wait until they are closer before I can read the street signs, and I cannot read the licence plate unless the car is right in front of me. But that is a compromise I knew in advance. Again, all I am talking about using my RE only. Together with my LE everything besides reading very fine print is from good to great. I will get a pair of distance spectacles later for driving. I probably need readers too, but no immediate need as I can use my -5D LE for up closer vision when I am not wearing contacts.

Hope that it helps.

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Exactly. Although I'd never hope for a cataract in my left, in some ways it would simplify things from me. As is, they can't make too large of a correction in my right eye - so I'm pretty much assured of needing corrective lens all the time. My left lens is perfectly clear now.

My near vision is for normal book reading, but I'm to the point of using progressives for most of my work screens' distances. One of my thoughts was that I might be able work it so that distance vision would be fine without glasses (assuming lasik on left) and then just assume that I'd have them for reading. I am a heavy reader, so I'm not sure about that compromise yet...

I'm not as concerned about cost as much as finding the option that might serve me best over the next 30 years. And as you noted, my left may develop one as well. Appreciate the thoughts!

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Agree. This is something I should look into more.

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Good input, thank you.

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Thank you. I'll definitely be researching those!

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Night-Hawk pretty much said verbatim what I would recommend (assuming your left eye is good for reading right now), including the part about testing various outcomes using contact lenses (We must think alike -- for what it's worth, we've both been through single-sided cataract surgery).  I found the newer contacts are so much more comfortable that previous ones, and it would be wise to test a few combinations out before the cataract progresses too much.  I would guess that a -1.5D in that eye would give you great computer vision, and that the combination would be good for covering most intermediate/near.  If the asymmetry proves to be too much, you could always pop in a contact lens in the left eye to bring it closer to the right, then just use glasses for driving. Or, you could at any time use a contact lens for distance in the left, effectively giving you distance and intermediate/near vision.  Lots of options with that -1.5 range IOL.

If you are willing to risk the potential artifacts of a multi-focal/EDOF, you might achieve a greater uncorrected range (right eye IOL set for far and intermediate; left eye for reading), but personally, I wouldn't risk it.  I also would not opt for any type of lasik, due to the potential for compromising eventual cataract surgery.  

In my case I opted for an intermediate/near monofocal (-1.25D), and am very fortunate my other eye is already close to that (-1.5D) so I'm happy with my vision for now; only needing glasses for distance.

I agree with George05887 to take your time.  No need to rush into a decision with life-long consequences.

Good Luck!

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Thanks. Night vision is a concern because I do have a decent amount of halos now. I certainly don't want to make that worse.

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Very helpful. Appreciate the insight.

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Are halos bad now due to cataract?   My cataracts made halos and glare worse.  I would say night vision is better now than when I had cataracts.