First, thank you in advance for any advice or experience you might be able to share. Eight months ago, I underwent emergency eye surgery for a detached retina (vitrectomy).The retina has healed but I've now developed a cataract.I've seen two highly regarded cataract surgeons. One referred to me by my eye surgeon (retina specialist) and the other referred by a number of local optometrists. Both cataract surgeons have recommended two different plans! One surgeon recommends removing the cataract and inserting a lens for improving distance vision. My "good" eye would need Lasik surgery two weeks or so later though. Otherwise, I'm told, my eyes will be in "conflict" with each other and glasses won't remedy the problem. He believes this plan will provide me with a chance to be free of glasses, except for needing readers. The other surgeon recommends inserting a near distance lens for close up vision. I would then not need surgery on the "good" eye. Since I have been nearsighted all my life and have worn glasses/contact lenses to correct my vision, the close up lens makes sense to me. Close up vision is what I'm used to and I only have the one eye with a cataract. Everyone who has had cataract surgery seems to go with distance lenses though - and who wouldn't want to be free of glasses? What would you do? Has anyone had experience with the near vision lens? This is all so nerve wracking and I sincerely appreciate advice!
Hi mjcg
Both plans sound like good options. It will come down to your preferences.
Although mist surgeons (and people) go for a standard monofocal lens targeted for best distance there are people that prefer having it targeted for nearer (intermediate) vision. This provides very usable vision where you can see tour computer car dashboard and iPhone. There are a few who have opted for that here on the forums. If you reach out to BellaD she went with that set up and just wears glasses for TV and driving and quite enjoys that result.
You don't mention your age as that may okay a factor down the road if you don't need readers now for your good eye.
If going with a lens targeting distance why would you be considering lasik and not a contact lens? issue with lasik is that it is more difficult later when you need cataract surgery for that eye for surgeons to calculate the correct power (even if they have your pre-lasik calculations. Before going that route I would suggest you experiment with a contact lens instead.
There is a 3rd option you could consider and that is a premium lens. There are EDOF (extended depth of focus) lenses now that allow you to see all distances. I went with the Symfony lens and am glasses free since surgeries. As with anything to do with cataract surgery there is a compromise though with premium lenses and that is there tends to be more night vision issues with them (halos).
Wishing you the best as you consider all your options.
Sue - just some feedback for all here - my doctor would never recommend anything but a mono focal lens on a "compromised eye." Since, they had a detached retina and vitrectomy, I would recommend doing a lot of research before even considering anything other than a mono focal lens.
mjcj - you haven't listed your age so it's difficult to provide better feedback. We also don't know which eye is your dominant eye. It sounds like the doctor wants to do lasik because otherwise you'll have mono vision; is this correct? In general, I would also strongly research lasik since the older you are, the less likely your "good eye" will see well at all ranges and it can bring up other issues when it's time to do cataract surgery on an eye that has had lasik. I can see the predicament you are in.
You might want to consider a lens mid range as an option. Then you might use glasses for distance and in the future if/when you get cataract surgery on the good eye, you can have that set for distance. Given that your eye and/or eyes might be compromised, I would talk to your doctor and research your options carefully. I went with a mono focal for both my eyes set for distance. My left eye is set just slightly in only 1/2 diopter for slightly better near and I almost never wear glasses.
My concern with lasik is whether it could compromise your vision and/or options in the future if/when you might need cataract surgery on the good eye. I would be more inclined to go with either glasses or a contact lens in the good eye because it sounds like your doctor is saying you will have mono vision if they set the IOL for distance. But, you could consider setting that eye for a mid range lens. Also, we don't know your age or which eye is your dominant eye. It might not matter too much depending on the settings of the IOL and possible IOL in the future. They do recommend the dominant eye being set for distance if possible. It did not work out that way for me but I guess because my dominant eye was set only 1/2 diopter in, it doesn't seem to have mattered.
The last option of course is considering when you might need cataract surgery on your other eye. Again, we don't know your age and all cataracts progress at different rates depending on the individual. But, in general, common thinking today is to do it sooner rather than later. My second eye that I did about 3 weeks later only had a mild cataract but we decided to just get it done anyways since it was only going to get worse. Check with your doctor.
Good luck to you.
MJCG - just to follow up and add to my comments I too was near sighted all my life. Let me tell you, getting everything "flipped around" with your vision can psychologically be quite a shock at first. I could easily read things up close with no problem and my brain automatically knew where to hold the phone (about 5 inches from my eyes) and where to be when looking at a thermostat or looking at anything else up close. All of the sudden, that "sweet spot" changes and it takes getting used to. I'm glad it all worked out for me.
With that said, you could possibly ask your doctor to provide you a mid range "test" contact lens for your eye with the cataract to test/get a feel for what your vision would be like seeing in that range. Let me say though, I also used a test lens and my vision was a LOT better after surgery with the IOL than the test lens. This is due to the fact that the cataract just makes vision worse at ALL distances. But, a test lens might at least give you some idea. My doctor provided with with two different soft test lens to try at home about a week before my surgery. In the end, I decided against mono vision and my IOLs are only 1/2 diopter apart for "mini mono vision."
Hope that helps
Hi Sue.An thank you for your reply! I am 63 years old. I already wear progressive lenses. I'm not able to wear contacts like I used to because of dry eyes (I've just started Restasis).I will reach out to BellaD for sure. The surgeon who recommended the close up vision procedure talked about Symfony but it's at a price of $3,000/eye and I need both eyes done to see properly (insurance doesn't cover the lens unfortunately). Halos wouldn't bother me much since I've dealt with that pretty much all my life. I remember thinking how odd it was that people could see lights perfectly shaped (without glare or halos). I would certainly LOVE to be glasses free. Again, thank you so much for responding. I'm so glad I found this forum and I hope I can become a contributor down the road (and explain a successful outcome!).
hi mjcg
Sorry for the RD. Did it happen due to accident or just like that. If just like that or due to sugar chances are high that there will be RD in other eye as well followed by a cataract. In such cases the best decision is to go with monofocals like your surgeons are suggesting. Also not doing any lasik now would be recommended if it is at risk of RD and subsequent cataract surgery.
What is your prescription for the good eye? I have had cataract surgery in one eye and my other eye is about -2.5. Wearing glasses with 0 on operated eye and -2.5 on the good eye is very difficult. It makes me off balance. especially outdoors. But -2.5 on good eye and no glass on the operated eye works. I do not know if this approach works for higher refraction error on good eye.
Good luck and let us know what you decide to do.
Hi Michael - thanks for the comments. I may be wrong (and surgeons often provide conflicting info - as dies the internet). I was informed EDOF lenses were not any different than monofocal lenses in how they ate made/implanted. Younger patients are more at risk for detached retina due to the surgery itself vs lens selection. But I could be misinformed. They do however come with more night time artifacts which not everyone will want.
Hi Michael - thank you for taking time to respond!! I'm so relieved to find this help here. I'm 63 (64 in January). My left eye, the one I had the vitrectomy done on, is my dominant eye. My right eye (good eye) has taken over doing all the work now. It was quite a struggle for me the first couple of months but I think the good eye now thinks it's dominant.I've changed my eye prescription 3 times since the surgery. Currently my left eye prescription is -7.25 (used to be -4.25 at the time of the surgery) My right eye is -5.00. And my left eye sight is already blurry again. The retina detachment was caused by the vitreous fluid tugging on the retina causing a tear and then a detachment. I was "lucky" in that I didn't wait around when I saw a "black blob" blocking the vision in the corner of my eye. I went to the ER and within 24 hours was in surgery. The retinal surgeon told me I'd get a cataract within 6-24 months. Both cataract surgeons don't think I'll need cataract surgery in the good eye until I'm far into my 80's (if I make it that long). I definitely don't want mono vision because I tried that with contacts once and it didn't work for me at all. I wear progressive glasses, ok. Again, contacts I can't wear long because of dry eyes. Sorry for rambling... I've been a bit crazy since the original surgery. I knew getting old would mean aches and pains, but I never expected my vision to be at risk. I'm thankful they were able to save my sight - the surgery was only new in the 70's. Before then I would have likely lost my sight. I keep trying to remind myself of that. Still doesn't make another surgery decision any easier.
This is all good information, thank you! I did think that it would make sense to go with a close up lens since that's what I was used to. I wore contacts since I was 15. When I started needing readers (multi focal contacts never worked) and my eyes started getting dry, I just gave up and went to progressive glasses. I don't really like glasses which is why I'm tempted to get both eyes done for distance. But if I don't need surgery in the "good" eye, I should probably leave it be.
I had cataracts both eyes and needed the surgery last year at 53. I too always dealt with glare and this got worse with the cataracts so what I see now at night is so much better. I do drive at night and don't find the halos too distracting. I fortunately live in Canada so surgeries were completely covered by our medicare system regardless of lens selection. Paid $900 per Symfony lens so this was very affordable for me. Working full time it really is a blessing to be glasses free. I too was near sighted since 12 . Hadn't yet had to have progressives so thought of losing near vision especially didn't sit well for me.
Sounds like you would prefer to have mid to near range vision over distance. I am sure BellaD would be happy to share her story with you. It isn't an easy decision so if you have time take it to research your options.
Just my opinion - I wouldn't personally do lasik on an eye at 63. It will not correct your near vision and could likely cause an issue when it comes to cataract surgery.
One other thing you may want to ask your surgeon: often when there is too much of a difference between your eyes the surgeon can perform cataract surgeon on 2nd eye to balance them out. In Canada it is grounds to have it covered under medicare so perhaps your health plan might be same?
Good luck to you - hope it all works out.
Sorry to hear about your emergency retinal surgery. So scary. I also had that, minus the vitrectomy. A year later, I had cataract surgery on the other eye, and opted for an intermediate/near monofocal lens as Sue An mentioned. I was also used to being mildly nearsighted, and did not want distance correction as I did not want to entirely give up my near vision (I find readers are way more inconvenient than distance glasses; others feel just the opposite). A year out I am still very happy with my vision overall (about -1.25D in the cataract eye; -1.5D in the other) and would definitely do it again. If you are used to being nearsighted and are fine with wearing glasses for distance, I would strongly urge a near or intermediate correction, and avoid ANY unnecessary surgery on the other eye. For some reason, many surgeons assume everyone wants distance correction, but I can assure you many people are happier being able to read and use the computer without glasses. As others here already mentioned, it would be helpful to know your age and current Rx. While it's not possible to get individualized medical advice from lay persons in an online forum, I think it's helpful to find that others have been in your situation and have had similar questions. It's essentially a permanent decision so take your time and don't dismiss your own judgment too quickly.
Thanks BellaD - so happy to hear you are doing well!
So sorry you had the Retinal Detachment, mjcg! I've heard from various eye doctors over the years that people with high myopia (nearsightedness) are at greater risk for RD. Because my myopia was much higher than yours, my first cataract surgeon sent me to a retinal specialist before he would agree to do any cataract surgery at all. Luckily, I was ok.
There may be a silver lining for those of us with high myopia, tho. I'm not sure, but there may be a correlation with a physical measurement of the eye called axial length being longer in high myopes and the resultant depth of field achieved with a standard monofocal IOL. My sister (with an expreme prescription of -10D before cataracts) had cataract surgery on both eyes and can now see 20/20 both near and far with only standard IOL's in both eyes.
In my case (with -8D pre-cataract) I chose a standard IOL in my dominant left eye set for very mild myopia (-0.5D). The end result settled between -0.25 and -0.5D in that eye and I'm seeing 20/20 or 20/25 (varies slightly) distance, and 20/20 or 20/15 near. So I'm very happy with that choice! You may be equally lucky, don't know.:)
i chose a Symfony in my right eye set for slightly more myopia (-01.0D), and I'm getting even better near vision than in my left eye. It's still healing, so I'm not sure of final results. But so far, I'm seeing 20/25 or 20/30 distance and 20/15 or 20/12 near. I expect the distance will improve. I just finished the weeks of post-surgery eye drops a few days ago, so there will be much more healing and improvement to come.
I think that when this surgery first came out, the patients may have had different lifestyles than patients in their 60's have now. They were more inclined to blindly follow doctors' recommendations and didn't have the internet to do their own research. We are very fortunate things have changed. But not all doctors have caught up with their patients yet.:) So they just assume that people want distance in both eyes and readers for life. But I definitely prefer to have the only need for glasses to be when driving at night in an unfamiliar area! Otherwise, I don't need them.
There is a difference between mini-monovision and regular monovision. Most younger surgeons now will only recommend the "mini" version, easier to adjust to. Really worth trying the contact trial for at least a few days , before making any final decision, even with the dry eyes.
Also, I agree with others here - I wouldn't do any surgery on your good eye until you really need to. Most surgeons automatically suggest surgery as the best course of action. but it isn't always so. you may not need surgery in that eye for 5 or 10 years! By then there could be much better options available for you. Who knows? Medicare might cover "premium" lenses as a standard treatment by then. So take your time...:)
Thanks! OK except for some PCO the MD says not enough to operate yet. (Don't want to veer off topic here so I'll check out or start another thread. Did you have YAG?)
Hi Soks! The retina detachment came out of nowhere (though being nearsighted increases your chances I've been told). What do you mean by "due to sugar" - is that a cause of retina detachments? I am a sugar addict for sure... though I'm not overweight, my blood pressure is low, I exercise and am in fairly good health. -5.0 in the good eye and -7.0 in the bad eye. Both used to be around -4.25. I think my second surgeon opinion plan is to insert a lens that will equalize the sight between both eyes. I'll still need to wear glasses to get good overall vision.
Agree wholeheartedly with you about today's patients and can only see it increasing in the future. I don't believe we want to see distance well and wear readers. With smartphones and tablets and active lifestyles today's patients certainly demand more. Hopefully the selection of lenses will be greater and better as time goes on. If surgery is covered if one chooses a standard lens I really cannot see why the surgery wouldn't be covered and patient just pays for upgraded lens. That is the way it works in Canada. In fact province of Quebec I hear pays for the premium lens as well. So likely you are right and changes will come.
Haven't had a yag yet. No noticeable difference in vision however I will see my optometrist in January sometime and will get a more accurate picture of where I am . my near vision seems to have improved a bit more but when i compare distance to what my husband sees I cannot see as far (ie road signs).
Hello BellaD! I'm so happy to hear from you!! In SueAn's reply she recommended that I reach out to you. Just like you mentioned, I have also always needed vision correction for distance (I'm 63 years old now). I always wore contact lenses but then presbyopia set in (around my mid 40's) and I would purchase cheap reading glasses (mono and multi-focal contacts never worked for me). I was always losing them! And then I developed dry eyes and contacts became uncomfortable so it was easier to give them up and just wear progressive glasses. I've been ok with glasses because there are so many nice styles available, plus progressive lenses handled both the distance and close up vision for me. Anyway, I was going along with life ok and then POW this retina detachment came out of nowhere. Not an injury, it just happened. Vitreous fluid breaking up and tugging on the retina. One of those unexpected reminders about how fragile we all are. The surgery was traumatic for me, even though it wasn't life threatening. My primary care doctor told me that in his years of experience the most emotional packed surgeries involved the heart and the eyes. Makes sense with the heart being the center of love and our "souls." The eyes representing independence and our view of the world around us. So, here I am eight months later and grateful my sight was saved but terrified of another eye surgery and wondering how to truly repair my "broken eye" with cataract surgery. I find it really helpful to hear other people's experiences and can't tell you enough how much it means to me to be able to "talk" things out here. I trust both surgeons, but I am leaning toward getting the near vision lens. Retinal detachment increases if you've gone through it before and cataract surgery increases the risk more. So leaving the "good" eye alone seems to make the most sense. But I still love the idea of never needing glasses 8-)
Hello Seehernow! Yes, we are so fortunate that things have changed and new technology provides us more options (though it makes the decision tougher). I'm grateful for the internet allowing us to do research and weigh ALL our options. Do you remember when we could call the local library and ask the reference librarian questions? But only 3 questions a day? Or needing Encyclopedia's to find answers to our questions? I can't imagine not being able to find information immediately and that it's usually always updated information! I now know more about the eyeball then I ever wanted to! Vitrectomy surgery was only first conducted in the 70's - and despite how complicated it is, the actual surgery has vastly improved over the years. For instance, although I had a gas bubble inserted to help the retina heal (talk about a weird experience), I did not have to do 24 hour face down positioning for 8 weeks like the old days. Only 30 minutes of face down on the hour, every hour, for seven days. And, heck, that positioning process was hard enough! I'm just still so grateful to have not lost my sight. I must admit, I am leaning toward not having surgery on the right (good) eye. Hearing that you have done fine with the close up lens is so helpful to me... especially since the majority of people get distance corrected.
Love Canada! I'm in Michigan - so I'm a neighbor :-)You are so young to have had cataract surgery, but I'm glad to hear all has been successful for you. They say the surgery has a 98% success rate - of course, I focus on the 2% (what went wrong?!).
I'm not enthusiastic about doing lasik on my good eye at all. I do just want to see again, if at all possible, when I put my glasses on (or not). The only reason I'm considering the distance lens with lasik is because how great it would be to NOT wear glasses. As I'm writing this, it's snowing out. You know how you're outside walking in the snow or rain and the dang glasses get all covered and wet... or they fog up. Hate when that happens!
Still... I do have my sight. Something many people tend to take for granted. Not me, not any longer! 8-)