Cataract surgery on one or both eyes?

Eye care
1

Hi,

I've had a cataract on my right eye for a few years already. There hasn't been any significant changes in the last few years, it just does not get any worse. I've pretty much learned to live with one good eye, and the other one, that is I'd say at about 30-40% of its full capability.

There is a very mild cataract on the left eye too, which does not bother me at all, I can't even notice it. It's also been status quo for years. I'd like to have surgery on my bad (right) eye, but I'm not sure what to do exactly.

My prescription glasses are -3.25 L and -4.0 R, progressive lenses. So there is no way to "zero" the right eye, without having the surgery on the good left eye too, because of vision imbalance (anisometropia). So, as my ophthalmologist says, I have 2 options. Either I have surgery on my right eye only, and bring the prescription to about -2, or I "zero" the right eye, and have another surgery a month later, on the "good" left eye, bringing it to zero as well. Obviously, the first option would require me to keep on wearing glasses, and the second, if everything goes well, might get rid of the glasses, with the exception of the need for reading glasses.

Frankly, I have no idea how to proceed. I was postponing going to the surgery, thinking that my good eye will start developing cataract more rapidly, and I'd have to have both done. But the way it is, I just don't know if I should only have an operation on the eye that needs it, and leave the other one as is, at the same time leaving the idea that one day I could throw away my glasses.

Any feedback will be highly appreciated, especially if you have, or had the same dilemma: surgery on one eye only, or both, even the one without cataract.

Thanks!

2

You didn't state this in your email, but I'm assuming you are unable to wear a contact lens in your "good" eye? That would eliminate anisometropia. You could also do Lasik in the "good" eye to correct it close to the target for the post cataract surgery. 

3

Whatever you do, there are going to be some compromises.

Firstly, even if you have cataract surgeries in both eyes and get monofocal lenses set for plano or zero, you are going to need reading glasses. So, you won't be doing with the glasses completely.

If you do get the cataract surgery done only for the right eye and set it for -2.0 D (as one of the options which your surgeon has suggested), you should have have to use glasses for reading or for looking at the computer etc and will need glasses only for seeing well at distance. You should not have to use progressive glasses. Thus, on the whole, you will still be much better off than you are now.

When in a few years, you do need to have a cataract surgery in the left eye, then you will still have the choice of picking up a lens and prescription for that eye, which minimizes the use of glasses (if needed at all)

4

Your bad (right) eye is at about 30-40% of its full capability.

Your good (left) eye has a very mild cataract (on the left eye too)

Are you male? and around 40 years old?

5

I had to rush out just now.  Neighbor wanted to borrow our heater. smile   Your age group can help others in examples more relevant to you.

6

Sorry, I forgot to mention my age. I am a 63-year old male. Started wearing glasses at the age of 18 (something around -1, or -1.25 D, I don't quite remember). It started increasing gradually over the years, until I finally stabilized to where I am now, some 20-ish years ago. Of course, with age came the need for reading glasses as well (15-20-ish years ago), and I opted for progressive lenses, and have been pretty happy with them ever since.

Thank you all who replied. Here's a few more questions I have. related to some of your replies:

@derek40125 - I have never used contact lenses, so I really don't know if I'd feel comfortable with them, or not. Would a contact lens really completely eliminate anisometropia, if I bring my right (bad) eye to zero, and have -3.25 D contact lens in my left eye? Also, would Lasik be any better, compared to just doing cataract surgery on both eyes? Not sure I see an advantage going that way.

@at201 - If I do the right eye only, and set it for -2.0 D, and the left eye stays at -3.25 D, why do you think I wouldn't need any glasses for reading, or computer? Do you think that a pair of glasses (-3.25 L and -2.0 R), no progressives of course, would be sufficient for all my needs (glasses for distance only, and none for reading). I could live with that, but I'm not sure it would work very well for close/intermediate distance.

Thanks again for your replies, and keep them coming, please. I really don't know which way to go, and would love to hear from people who had similar dilemma, and what their experience is, going one way, or the other (doing both eyes, or the bad eye only, keeping the glasses forever). The tricky thing, as we all know, is there are no do-overs, once we make our decision.

Cheers!

7

Contact Lenses - Yes, they should completely eliminate anisometropia, at least in the correction range you are taking about. I'm personally corrected (via contact) to -4.75 in my left eye and plano (via IOL) in my right. Object sizes appear identical to me. If I wear an old pair of glasses (with the right lens removed) the difference in size is very large and I cannot tolerate this for more than a few minutes. Also, I opted for a multifocal IOL in my right eye (to get some near vision) and I paired this with a multifocal contact lens in my left and the combination works very well together. 

Lasik vs Cataract Surgery - First, I'd advise trying contacts to see if you can acclimate to them (give it some time). If it works for you, you can easily change your prescription and even simulate the mini-monovision setup that at201 is suggesting to see how you adapt. However, if contacts do not work and you can't adjust to the image size difference, then you'd need to decide between something like Lasik or cataract surgery. You may get differing opinions here on this but Lasik isn't as invasive and, assuming your natural lens is in good condition, you will likely retain some accommodation (which will mean an expanded range of focus). Lasik can complicate a future cataract surgery, however, but doctors understand this much better now and can take detailed measurements to aid a future cataract operation. There are side effects to both Lasik and cataract surgery so make sure you understand them before you choose one or the other. 

 

8

I was very nearsighted with a lot of astigmatism in both eyes. I’m 69 and had worn glasses or contact lenses since the 5th grade. I had been wearing mono vision ccntacts and glasses for the past 30 years. (Right eye corrected for distance and left for reading. I had no problem with either the contacts or glasses with monovision.)  I had cataracts in both eyes, the right eye being the worst. 

I had cataract surgery 2 weeks ago on my right eye which was corrected for distance. Before surgery, my vision was about 20/40 with lenses. Without lenses I couldn’t even make out the largest letter on the chart. I could barely tell it was a chart! The morning after surgery my vision in my right eye was about 20/35. Within 2 days it was better than 20/20 on a home eye chart 20 feet away. Close vision is bad, as it was before. My doctor took the right lenses out of my monovision glasses and another pair that corrected my left eye for distance, for driving. Both pairs of glasses are a problem now because of the size difference (anisometropia). My depth perception is thrown way off. I wear the monovision pair for reading with my left eye, but take them off when I get up and walk around. The pair where both were corrected for distance isn’t quite as bad. I can watch tv with them, but am better off driving with no glasses since my right eye is so good and the depth perception could be a problem when driving.

if I’m not reading I justo without any corrective lens in my left eye. 

Using a contact lens in my left eye works pretty well, not perfect, but not bad, either for reading or distance. Now I’m trying to decide whether to have the left eye corrected for distance or for reading. If for distance I would have to wear reading glasses. 

I am so amazed that my ophthalmologist was able to get such a good correction on the right eye. He didn’t promise perfect vision. Of course it’s only been 2 weeks, but the only problem is a small chance of PCO starting as I’ve noticed a slight bit of glare at night that wasn’t there initially. I hope it doesn’t get worse and require the YAG procedure.

9

I forgot to add that I have a toric implant from my cataract surgery, not a multifocal. I had heard too many complaints about the multifocals. 

10

JoanneinCA:

It sounds like you have the information you need to make this decision. I don't know exactly how bad your left eye is now, but you can clearly tell the difference in how your two eyes work together with the IOL in the right eye and both glasses and contacts in the left. If your left eye isn't too bad, wearing different contacts set for near/intermediate/far should give you a decent preview of what your vision would be like if you did the surgery and targeted your left eye for the same vision range (as the contact). Glasses are really not very good at simulating this as you can already tell.

If I were you (and assuming your left eye is good enough) I would take my time and have my optometrist give me several sample contacts with different corrections (one to match your right eye, one for maybe +0.5D to +0.1D off your right eye, and another for close). Spend a few weeks with them and see what you think. These should be free as most doctors get lots of samples and 1-day wear are relatively inexpensive and very convenient for testing. Make sure you always have some contacts that correct close to your IOL though so that you'll have no issues driving.

Everyone is different. In my case, I can tolerate a difference of maybe 0.5D to 1.0D between my eyes MAX. My IOL is set for plano and my other eye requires -4.75D contacts (so it's natural focus point is pretty close in). I take my contact out only right before I go to bed as the difference between my eyes drives me nuts very quickly. 

11

Derek, my contacts prior to surgery were 6.50D on my right eye And 4.00D on my left. This worked very well for me. (plus a bunch of correction for astigmatism) I read with my left eye and used my right for distance. My brain switched eyes seamlessly depending on whether I was looking near or far. I’m not sure what my right eye is corrected to now. I had never heard the term plano before, except in reference to a town in TX. 

What would be the advantage of not exactly matching the right eye if I’m going for distance? The contact I’m using in my left eye for distance now is actually the one for my right for before the surgery. Vision is sharp with it and maybe a little over corrected. It works pretty well but not perfect. 

The cataract in my left eye is bad enough that insurance will cover it but I really don’t notice it if I don’t compare the color and brightness with my right eye. Surgery is set for late Nov. so I have time to decide.

You’ve given me more to think about. smile

12

Congratulations on your right eye being better than 20/20 two weeks after your cataract surgery. Will you be having the same Toric lens for your left eye, when it will be operated on this coming November?

Some can see at all distance without glasses after both eyes have been implanted with Toric lenses.

I too have not heard of "plano" until I learned it from this site. smile  But I have been to Plano TX.

13

The advantage of not exactly matching the left to the right would be that you can extend your range of clear vision. You need to test this for yourself as everyone will be different. Ideally don't make a final decision until you're 6-8 weeks post surgery as your vision can change (hopefully for the better). What you want to see if how does the vision in your right eye change with distance. For example, you might be 20/15 at 20ft, 20/20 at 10 ft, 20/40 at 6 ft and similar (looking only through your right eye). If you corrected your left eye to match, then you'd end up with similar binocular vision. However, if you under-corrected your left eye by a small amount, maybe +1.0D, then the left eye would get clearest vision at maybe 10ft and you'll end up extending your overall clear range of vision. The theory is that your brain won't notice the slight under-correction in the left eye when both eyes are open (although you'd probably notice it with just your left eye open). 

You can test this yourself by reading objects at different distances to see where it starts getting blurrier. Since you already wear contacts, you can ask your optometrist to give you some samples to see what this would look like. You are saying that you're left eye contact prescription is -4.00D (I'm assuming it's minus). So, maybe you try samples of lenses that are -3.50D, -3.00D and -2.50D and see what your combined vision looks like. What you want to decide is: 1) Does it help your intermediate range vision (3 ft to 10ft)? and 2) Do you notice the reduction in clarity at distance?

The goal is to extend the range at which you don't need to wear glasses without causing any noticeable degradation. You might be able to enjoy TV more clearly or use a computer without glasses. It's worth spending some time on this before making a major decision on your other eye. Since your left eye is still functioning reasonably well AND since you can wear contacts, you have an opportunity to test some of these options (not everyone is lucky enough to be in this position). 

 

14

Derek, my right eye is between 20/20 and 20/15 at 20 feet using an eye chart hanging on the wall. The closer I get to it, the better my vision until I get to about arm’s length, and then it begins to deteriorate. This is the eye with the surgery. With my left eye, no surgery yet, I can read small print from about 6 inches away, but need glasses or contacts to read further away. With my right eye, I can’t read anything at 6 inches. But at arms length I can just make out fairly small fonts on my iPad Mini. So I take it that the distance is more fixed with the IOL, right?  How much does vision typically change beyond 2 weeks out from surgery? Is it likely to get worse? Where I am now is where I’ve been since about day 2 or 3.

 I can already read my desktop monitor with my right eye, probably because I sit back a ways from it. Far distance, like on a freeway aren’t as crisp as closer, but much better than where I was before surgery. 

I like your your idea of trying different contact lenses on the left eye, regardless of whether I go for distance or reading with that eye. I’ve been happy with monovision with contacts and glasses, but the IOL’s seem to be a little different. Is that a correct assumption?

15

Hello Joanne:

It seems like you are getting really good vision from your IOL. For your description, it sounds like you ended up a little bit nearsighted but that's really excellent range. You are still healing though so you need to wait longer to make a final assessment.

If you end up this way and you wish that the far distances could be a little sharper, the surgeon could target that with your left eye and you should not experience any problems with your blended vision because they would be so close. You'd have to wear reading glasses of course.

If reading your Ipad more clearly (at arms length) is more important than you could go the other way with your left eye and have it undercorrected a bit more to get clear vision on the Ipad. Try contacts at -3.00D and -2.50D to see if you like the blended vision. 

16

I’ve done a few tests at home, to get a better idea of what I’m dealing with. First, I printed an eye chart and tested both eyes (with glasses on). Also, ran a few online tests (there’s a pretty good one by Essilor). The eye chart was printed, as per the instructions, on the standard letter size paper, and the distance from it was 10 feet.

They all showed what I expected to see. My left (good) eye (-3.25 D) was perfect, of course with glasses on. I could easily read even the fine print, which points to 20/20 vision on my left eye, well kind of. The right (bad) eye, on the other hand, was really bad. I couldn’t even see clearly the big letter on top of the chart. Which is why I need this cataract surgery.

Now, when it comes to reading and computer distance, this is where I’m confused what to do (operate only my right eye now, or both). While my computer distance vision (roughly around 70 cm from the 15” laptop screen), is more or less good (left eye with glasses on, right eye practically no vision). It gets tricky if I move the laptop screen closer. Nothing is readable at the normal reading distance. If I take a book, or a newspaper, I have to remove my glasses to be able to read. Anything between 30-35 cm away from the book is clear on my left eye (no glasses). Further than that, I need to put glasses on, and move the book away, by at least about the same distance (total of 70-ish cm).

In all of these tests, my bad, right eye is practically not doing anything. Pretty much legally blind on the right eye.

Again, right now, my glasses are -3.25 D (left) and -4.0 D (right), progressive lenses. So, having said all of this, if I do the surgery on my right eye only, as I mentioned in my original post, and bring it down to -2.0 D with an IOL implant, I’d obviously have to have glasses with -3.25 D (left) and -2.0 D (right). Is there a chance for me to have the need for glasses only for distance, and possibly be able to read and use a computer with no glasses at all? Would possibly a pair of progressive lens glasses be better, even after the surgery?

Sorry for the really long explanation of where I am, and what I expect to achieve. Thank you all who have the patience to read this and try to shed some light. I am inching towards the idea to do my right eye only, and keep using glasses for the rest of my life (even if I do both eyes, I’d still need reading glasses anyway). Ideally, I won’t have a problem even if my new glasses, after the operation, are with progressive lenses, provided that’s what would allow me to have the best reading/computer distance vision.

Thank you all!

17

As your surgeon says, have the surgery on the right eye only. If you don't have to, do not have surgery on the good left eye. They say, Cataracts surgery has become so common that the risks are negligible. Still there is a small risk (2 in 1,000 or something that small). 

I wanted to get rid of the specks. Had surgery on my right eye with Symfony multifocal lens couple of month ago. It went alright. So, I decided to have surgery on the left eye earlier this week. I decided to spend on Premium lens, LensX Laser, and ORA (about $6K where I live) so I could maximize the accuracy. I wanted to leave no stone unturned. Unfortunately, I had a rear capsule tear. Now, it is all cloudy and there are too many floating particles. And, they could not implant the premium multifocal lens. I will perhaps have to go through additional surgeries to fix this.

The reason I am narrating all this is that surgeries have some risk however small. If you don't have to have it, avoid it and do it only when you have to. I did not believe in this until three days ago and I will pay the price for a long time.

Best wishes and good luck to you.  

18

Sorry to hear about your horrible experience, sj82317. Decades ago, my mother had a similar experience too. There was bleeding and they could not complete the surgery. It took a few months for her eye to recover, and the second surgery was a success. At that time, I think they were only removing the cataract, her prescription glasses stayed, maybe with minor adjustments. My brother, on the other hand, had both eyes done, just a few years ago. Mind you, he had cataracts on both eyes, so he had to go for it, and luckily it went fine.

Yeah, maybe that old saying "don't fix it, if it ain't broke" isn't  there without a reason. I wish you a speedy recovery, and thank you for replying.

19

If you corrected your right eye to -2.0D you MAY be able to see clearly continuously from 30cm (left) to ~60cm (right) but you might also notice a dip in clear vision between the two eyes. Based on your description above that the clear vision in your left eye is only 30-35cm (which is pretty narrow), I think it's likely that you would notice a drop in focus at some point in this range but you'd still be giving yourself a lot more options in terms of seeing in this range without glasses (if this is where you spend most of your time visually). This would be a type of monovision and 1.25D is in the range where some people would be bothered by the difference between the eyes.

I don't believe that there is any way to determine this conclusively in advance. The good news is that the 1.25D difference between your eyes is small enough that you should do fine with glasses, even progressives if you wanted (customized for this difference between the two eyes).  

20

When I said 30-35 cm clear vision in my left eye, with no glasses, I meant it was the sweet spot. That's where I'd normally hold a book to be able to read it without glasses on my left eye. The range is probably a bit wider, by I don't think by much.

Speaking of progressives after the surgery, that could probably be the best option, if possible. Lots of times I find myself working on a computer, while at the same time there is a game going on TV. So being able to focus on both at the same time, without the need of removing and putting the glasses on all the time, would be the best. That is what I have now with these progressive lenses, even with this cataract developing. Do you think I might be able to do the same after the surgery, obviously with changed prescription for progressives?

Thanks!