This is a 2 part question
I recently went to the opthomologist and was told that my right eye’s cataract is severe enough so that Medicare will cover the cost of a standard IOC lens.
It will be several years before my left eye’s cataract will require surgery.
For right now I get along fine with glasses ( I realize most of my vision is through my left eye, as the right sight is cloudy)
The opthomologist is recommending toric for my right eye because of an astigmatism.
My prescription for my right eye is: SPH: -0.25; CYL +0.50; Axis x085
I did not think my astigmatism is all that bad where I need a special lens for it.
So my first question is: Should I wait until my left eye’s cataract worsens before I have cataract surgery ?
My second question is: If I have surgery just on my right eye and have a toric lens installed will I be asking for trouble with vision ? (I am thinking double vision as my left eye will be corrected with glasses)
What is your best corrected distance vision in each eye? If you can still correct with glasses I would wait on both eyes. . O.5D probably doesn't call for a Toric. I think that's probably too little to worry about. . Also there is no way to know when your other eye will be bad enough. It could be months. It could be a decade. Cataracts progress differently for everyone. . Bottom line though, if you can still get good vision with glasses and you are not being impeded in any significant way for work, driving, or hobbies, I'd wait. Personally.
Your correction in your right eye is pretty minor. I also am a bit surprised that it would need a toric lens. Have they done the detailed eye measurements with an IOLMaster or Lenstar instrument, and the Pentacam? They can't predict the residual astigmatism until they take those measurements. If they have you should ask to see the numbers. Normally a toric is not considered unless the predicted residual cylinder is 0.75 D or greater. And with some IOLs the minimum is 1.0 D before correction is used. The reason is that this is the minimum correction IOLs can do. But, it is possible you have astigmatism in your cornea which is being corrected by the opposite angle astigmatism in the lens. I think that is fairly rare, but it can happen. When it does instead of astigmatism going down with cataract surgery it can go up. . The other thing to think about is whether or not you plan to wear glasses after surgery. If you plan to wear glasses then it is probably not worth the extra cost to get a toric. The astigmatism can be easily corrected and more accurately with an eyeglass lens. And, the surgery itself can cause some astigmatism, so the eyeglass lens corrects for that as well. But, if your long term plan is to be eyeglasses free and astigmatism is greater than 0.75 D then it is worthwhile to get a toric. . My thoughts are that it is not worth putting up with bad vision and it would be better to go ahead with cataract surgery if your vision is significantly impacted in the cataract eye. You may want to think ahead as to what your final solution for vision is. If you plan to do mini-monovision for example you may want to think about which eye you want as your distance eye. In other words have a plan for both eyes even though you are only going to do one now. . One being able to cope with one eye having an IOL and the other eye needing eyeglass correction it will depend on how much correction you need for the other eye. If it is large then there can be issues. If it is very minor like your right eye then you should have no issues at all. What is your left eye prescription now?
My left eye is:sph: +1.25; cyl: +1.25; Axis : 035
In normal optometrist format with negative cylinder this converts to: Sphere +2.50 D, Cylinder -1.25, Axis 125 deg . This is more than your right eye, and this eye would seem more likely to need a toric. But, on a spherical equivalent basis it would be about +1.90 D, so not real strong. Just a guess but I suspect there would not be much issue due to the differential between the eyes. It is not dissimilar to what I had for 18 months between eyes. I did however resort to using a contact in my non operated eye.
How did you convert my script numbers to optometrist format?
The easiest way is to use an online calculator. Google this and you should find one: . Eyeglass Prescription Positive Cylinder Conversion
How different is a mini-monovision from the standard mono IOL that medicare pays for (in vision)?
Standard mini-monovision just needs standard monofocal lenses. The basic method is to correct for full distance in your dominant eye (target -0.25 D), and then target mild myopia (-1.50 D) in the non-dominant eye. It is recommended to try it first using contacts. But, that can be difficult if the cataract is advanced. So one plan would be to correct the bad eye for distance with an IOL, and then use a contact in the other eye to simulate mini-monovision. If that works ok then you target the second eye when the time comes to -1.50 D. These are all spherical equivalent numbers which correct for some astigmatism (Sphere plus 50% of the cylinder). . in vision is not a name I recognise. There is a Bausch & Lomb enVista monofocal lens that is very good. The more common ones are J&J Tecnis 1, and Alcon Clareon or AcrySof IQ. I am in Canada so not sure what medicare pays for. Depending on the province in Canada they will pay for one or more basic monofocals.
Before the cataract my right eye was better at near vision and my left eye was better at distance vision. Should I stay with how the eyes worked before aging?
The convention is to use the dominant eye for distance. Point at something across the room, then close or cover your left eye. If you are still pointing at it, then your right eye is dominant. But at the end of the day I am not sure it makes much difference which eye you select for distance. My mini-monovision is crossed which means my close eye is my dominant eye, and it works. . If you are considering mini-monovision it would be helpful to tell the surgeon up front and get their advice as to which one to do for distance. Logistically it makes some sense to do the distance eye first, and if for some reason the surgeon misses, then you have the second eye to do for distance as a back up plan.
Medicare will cover a standard monofocal lens, which would include all the lenses Ron listed as well as the Eyhance, made by Johnson and Johnson.
Personally, I would get a second opinion from a cataract surgeon who is a fellowship trained Cornea/Anterior Segment specialist. They have an extra year of training in diseases of the cornea and cataract surgery. Find a surgeon who takes time to talk with you and with whom you feel comfortable.
What's the easiest way to lookup a surgeon's training such as a fellowship trained Cornea/Anterior Segment specialist ?
I had cataract surgery only in my right eye a few years ago, my left eye still does not need cataract surgery. I waited until my right eye's vision could no longer be corrected with glasses and worse than 20/40 (the driving vision requirement). Early on I had to get new Rx for my right eye for glasses often when the cataract got worse.
I have high astigmatism in my eyes, for my right eye it was about 3.0D cylinder so I went with a tecnis toric monofocal. That was successful in eliminating the initial right eye astigmatism plus its very close to plano too and the IOL has not rotated in the past few years. However I did end up with about 1.0D cylinder residual astigmatism at a totally different angle so I believe that was probably caused by the incision separately. So I get about 20/25-30 distance vision uncorrected now in my right eye which is very good compared to how it used to be. With eyeglasses compensating for the residual astigatism in that eye I get better than 20/20. I use eyeglasses normally anyway since my left eye still has about 2.0D cylinder astigmatism so gets much worse than 20/40 uncorrected.
Anyway I haven't noticed ever any effects like double vision from the toric IOL. But doubt with such a small cylinder (0.5D) it would be needed however.
If your surgeon has a website, they will usually describe what kind of training they have. Or you can just google "your city and state and Cornea/Anterior Segment cataract surgeon."
Is laser assisted cataract surgery much preferred over manual incision?
Could I gain any insight if I delayed getting the cataract surgery and tried contact lenses rather than glasses ?
Not according to the American Academy of Ophthalmology. In the Academy's Cataract in the Adult Eye Preferred Practice Pattern, approved by its board of trustees in October 2021, a distinguished panel of experts write: "Femtosecond laser-assisted cataract surgery (FLACS) increases the circularity and centration of the capsulorrhexis and the precision of the corneal incisions. It may also reduce the amount of ultrasonic energy required to remove a cataract. However, the technology is not yet cost-effective, and the overall risk profile and refractive outcomes have not been shown to be superior to that of standard phacoemulsification." (Highlighted Findings and Recommendations for Care, p. 8).
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The Academy publication also states: "A 2020 meta-analysis of 73 studies was published in the Journal of Cataract & Refractive Surgery comparing 12,769 eyes that underwent FLACS procedures with 12,274 conventional cataract procedures. It showed significantly improved uncorrected and corrected visual acuity at 1 to 3 months, along with significantly decreased cumulative dissipated energy, improved capsulorrhexis circularity, decreased central corneal thickness at 1 day and at 1 to 3 months, and decreased endothelial cell loss at both 3 to 6 weeks and at 3 months. However, anterior capsular ruptures were found to be more common with FLACS. No differences in visual acuity were found at 1 week and after 6 months, and there was no difference in posterior capsule rupture rates and endothelial cell loss after 6 months."
Sorry for the delay in responding. Yes, you can gain a lot of insight if you do a contact lens simulation before you commit to your surgery. The only issue can be vision quality to evaluate it if the cataract is very advanced.
No, the evidence is that there is no advantage to a laser incision over a manual blade.