Cataract Surgery Needed in Only 1 Eye

[Davidm52]

I need cataract surgery in my right eye only. My opthalmologist advised that the IOL strength be nearly equal to my left eye and then glasses would be worn to correct my vision in both eyes. I spoke to a retired opthalmologist I know who said he would make the right eye as accurate as possible and compensate by wearing a contact the left eye. I wonder if any professionals could offer me some guidance on this.  Thanks for your help.


This discussion is related to How to correct vision after cataract surgery in only one eye.

[SoftwareDeveloper]

The problem is that if the prescription in both eyes is too different, then it is difficult to make glasses that will work due to the magnification of the image leaving the sizes too different (although there are some specially made eyeglass lenses that can compensate a bit for a disparity, I hadn't looked into them). Are you comfortable with contact lenses and the idea of wearing them all the time, do you usually wear them?

I rarely wore glasses before my surgery, my vision was better with contacts.. perhaps in part because my eyes were fairly different in strength. Before the cataract hit they were about -9.5D and -6D, which are different enough many people would struggle with glasses that weren't specially made. However I could wear glasses if I needed to, even if I preferred not to, people's ability to adapt does vary. It would help to know what your prescription is.

Ideally most people would prefer to be able to not need glasses once both eyes are done, which is why it makes sense to correct the first eye accurately. Since its more common, I'd guess you are myopic. If so, depending on the kind of lens you want (and which eye is dominant), it may be that the first eye could be left a bit myopic for some degree of monovision (full, micro, or mini, different people use different labels for anywhere from -0.5D to -2D of myopia, or sometimes even -2.5D) which would leave a bit less difference between the eyes. It partly depends also then on whether you are eventually going to want monovision and to what degree, depending on  whether you are getting a premium lens to help with near vision so you need less of it.

Many people adapt well to having an IOL in only one eye, others find it more of a problem to adapt to and elect to get the other eye done even if it doesn't have a problematic cataract yet. (that is what I did, even though my right eye was still 20/20 correctible I decided to go head and get it fixed instead of waiting. My case was unusual though since I travelled to Europe to get a better IOL not available in the US so it was easier to decide to get the 2nd eye done then than to need to make another trip).

One issue with adapting to only one IOL might be your age, although I haven't seen research to be sure. Most cataract patients  have already hit presbyopia  (the average age varies by country, in the US I think its early-mid 70s) so the odds are this doesn't apply to you. However I've heard of some like a 19 year old who posted on this site who struggle with a monofocal IOL in only one eye. I suspect that is because he has almost full accommodation left in his natural  eye which makes it very different from his IOL one. e.g. his eyes might be balanced at distance, but then if he tries to see really close up his natural eye could shift by say 10 diopters, which is far more than the sort of monovision most people can adapt to.. and its also not a fixed difference since it varies with the distance he is focused on.

[Davidm52]

It sounds like your choice is working for you. I will consider your suggestion as I navigate through this. Thanks.

[CBCT]

Hi David, I am not a professional, but I have had cataract surgery in both eyes and IOL exchange in both eyes.  So... I have a lot of experience with refractive mixing.  A key issue is the magnitude of difference between your IOL and your unoperated eye.  Another thing to consider is that an IOL will not accommodate like a natural lens does.  I suggest that you ask your opthamologist to provide some free trial contacts that will allow you to "test drive" the option the retired doctor recommended.  I suspect that the retired doctor may be be recommending mono vision which is distance for one eye and close for the other.  Many people are fine with this.  It didn't work for me because I lacked intermediate vision.  I ultimately chose close and intermediate and wear progressive glasses.  Best wishes.