Choice of IOL for unilateral cataract surgery in 50yr old contacts wearer for -8D in both eyes

Eye care
1

Hi,

I’d love to hear any advice/experience on IOL choice for unilateral cataract surgery.

I believe I am heavily short-sighted with -8D bilaterally but without astigmatism.

I am a contact lens wearer when outdoors and have worn glasses all my life for distant vision and when at home; and so, am not particularly adverse to wearing spectacles or have a great desire to be free of glasses. However, I generally read without glasses/lenses (at very short distance of course!!) and since starting to experience presbyopia, recognise that loss of reading/near vision is more upsetting than needing correction for distant vision.

I am being recommended IOL for distant vision in eye requiring cataract surgery and guess this is the conventional/standard suggestion. However, I am concerned about arrangements for reading and for that matter computer working (which forms a major part of my work) after surgery. I am comfortable continuing with contacts for outdoors in non-operated eye but generally prefer to limit time in contacts (to minimise risk any discomfort with prolonged use). Therefore, I would value any experiences/suggestions including for instance insertion of an intermediate IOL at say -6D so that I can wear glasses indoors (without imbalance in vision) and avoid prolonged use of contacts.

I daresay the non-cataract eye does have beginnings of cataract and may need surgery at some stage I guess but hopefully not, certainly not imminently and most definitely not just “to balance” my vision (as I am extremely risk adverse with regard to surgery). So, do I just go with the distance IOL and suck it up or consider what seems like a less conventional/higher risk intermediate/reading IOL.

Many thanks!

2

I have had cataract surgery in one eye, and the other is not advanced enough yet to be done. I expect to be in this limbo phase for at least a year or two. I got a monofocal set for distance in the IOL eye, and use a contact in my other eye. I use a contact that leaves me about -1.25 under corrected, and I find I can go without glasses 95% of the time. Since you already use contacts this is something you could easily trial. For example if you need a -8.0 contact, just use a -6.75 instead. And you could also try a -6.50 to see if you like that better. I do have a pair of progressives that I use for the last hour or so in the day to give my contact eye a break. I like it quite a bit, and plan to have the second eye under corrected a similar amount - mini monovision. Something to discuss with your doctor. It gives you two options. One is to go eyeglasses free with a small compromise in vision, and for those other activities that require very good close vision you just put on the glasses.

3

I had cataract surgery for my left eye several years ago and have had a cataract in my right eye for years so it really depends on the person. I also wore contacts for most of my life.

My advice is not to implant an intermediate vision IOL for the reasons you have given. Instead decide on on your plan and go in that direction. It sounds like you plan to go with a monofocal. Is that correct.

So if you plan is to get a monofocal and do monovision and this is your non dominate eye then determine the power for that IOL and go in that direction for this IOL.