Cataract Surgery

[Patsy3033]

I'm highly myopic in both eyes -8 & -10.75.  I also have Normal Tension Glaucoma and have developed
cataracts in both eyes.  Currently my cataracts do not bother me but they seem to bother my glaucoma
specialist a lot to the point that he wants to remove them.  He indicated if he does the cataract surgery
he will also possible do a glaucoma surgery at the same time on my right eye.  I think it would be laser
not a Trab.

I know the risks associated with cataract removal especially given my high myopia and at this point do
not agree with my glaucoma specialist that my benefit would out weigh my risk for a successful surgical
outcome.  I also have PVD's in both eyes and he told me I'd get lots more floaters following the surgery not
something I'd appreciate because of the ones I currently deal with.

If I go ahead with the cataract removal he intends to implant a corrective lens that would give me clear close
up vision extended to the distance within a 10 to 12 foot room.  I would need prescriptive lenses for my distance.
I've never heard of this.  Most if not all of my friends have implants for distance and wear reading glasses.

Currently I wear glasses for distance and a pair for reading.  For the computer I pull my distance
glasses slightly down my nose.   Not the best but I cannot get used to progressive lenses or bifocals.
Currently I'm wearing single vision Zeiss lenses in my glasses which I love and am getting along just fine.

My questions are :
(1)  Should I follow my doctors plans for me and go ahead with cataract surgery even though
my cataracts currently do not interfere with my vision?
(2)  If I have the cataracts removed how normal is it for a doctor implant lens for close up and the patient
wears glasses for distance?

P.S.  My retinas are hanging on for dear life because my high myopia.  

Would greatly appreciate replies especially about my risks and the way he would implant lenses for close up
and I'd wear distance glasses.  Having always worn distance glasses I don't know if my brain could adapt to a complete turn- a -round.

Thank you
Patsy 3033  

[Patsy3033]

Thank you so much for responding to my post.  The information you provided greatly helped me especially the question where you asked me to think about how I want to see following surgery.  Never thought I had a choice.  I cut my vision desires right out of the picture.  I now feel more empowered to ask my Glaucoma Specialist who would be doing my surgery more questions even if it means paying for additional appointments prior to surgery or paying for extended appointments.

I've decided I'm not going to rush into cataract surgery.   I like the way I see right now.  If my doctor is proposing cataract surgery because he wants to surgically treat my glaucoma then that is something else that must be discussed.  

Thanks again for putting me back in the picture.
Patsy 3033        

[wanlien3]

Generally speaking if the cataracts are not bothering the patient, they can be left alone. If your vision is stable, and your visual fields are stable, I would be inclined to leave your eyes alone for now.

As to the glaucoma surgery, nowadays we have 'MIGS', or minimally/micro invasive glaucoma surgery. There are several types of these non trab surgeries, but a fairly common one is the i-stent where they implant a metal tube into the trabecular meshwork and schlemms canal. The other possibility is laser endocyclophotocoagulation (ECP). Again if your glaucoma and visual fields are stable then you don't really need to have this done.

With regard to the targeted power of your eyes after cataract surgery, that is just down to your preference (We are talking about monofocal lens implants here). Many (but not all) short sighted people are used to the shortsighted experience, so their doctors leave them a little shortsighted after surgery.

But think about what you would most like to do without glasses after surgery.

If you would like to read without glasses, aim for something like -1.5 to -1.75D of myopia after surgery (and wear glasses for distance)

If you would like to use the computer without glasses, aim for about -1D of myopia. You will need glasses for distance, and sometimes for more close up work.

If you would like to drive without glasses, then aim for 0D of myopia and be prepared that all things nearby are going to be blurry and you will need reading glasses. This can be quite hard to get used to for some shortsighted people.

About the PVD-if you already have a complete PVD you are actually reasonably safe from retinal problems. The problem is actually in people who don't yet have a PVD or have incomplete PVDs. In these people, the vitreous is still attached in some areas to the retina. If the vitreous tries to pull itself off (such as during or after cataract surgery) then there is a risk of retinal tears and detachment. If there is a complete PVD, then there can be no further traction on the retina (except at the vitreous base) and a low risk of retinal tears/detachment. One can never be sure that a PVD is 100% complete, but if a Weiss ring is seen that floats in the midvitreous cavity, it is a pretty good sign that the vitreous is mostly, if not all off. On the other hand if there are areas of lattice degeneration, then there is a risk that abnormal vitreous adhesions exist there that could be a problem.

The gist of it is, don't worry too much, your PVDs are actually a good thing.