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Monofocal for cataract surgery in one eye only

I have developed a cataract in my right eye, which is probably a result of the Vitrectomy I had in 2005, due to a detached retina. Prior to having the detached retina on the right eye, I had Lasik on both eye in 1999, however I regressed completely on both eyes.  Nevertheless,  I'm at the point, where I need surgery on my right eye.  My vision on my right eye before the cataract was -4.75+1.50 125, and on my left is -5.00+2.50x088. I don't have a cataract in my left eye at this point.   My doctor has indicated that my cornea on both eyes would be too thin to consider any type of Lasik to complement the cataract surgery.  

At this point, my doctor has recommended to leave me with a post op refractive error of -2.50 using a monofocal.  Does that sound reasonable? He is concerned with both of my eyes not working together can only correct a certain amount.  Can he aim for better vision than -2.50?

Also, would it be safe to do the limbal relaxing incisions, although I have had a vitrectomy due to the detached retina?

Please advise?

10 Responses
711220 tn?1251891127
MEDICAL PROFESSIONAL
I would get a second opinion from a ophthalmologist who does premium IOLs.

I doubt your corneas are too thin to do PRK on top of the flap.  Also, it is very difficult to do the calculation for the IOL power if you had a LASIK and if you had a scleral buckle with your vitrectomy.  However,  the IOL can be exchanged in the early post operative period.  He probably mentioned that there is a higher complication rate for cataracts after a vitrectomy.

The options for you are set one eye at -2.50, set at zero and use a contact lens in the other eye or do a refractive lens exchange in the other eye after cataract surgery in the first eye.

Dr. O.




Avatar universal
My current does the premium lens and he talked about a Crystalens as an option, however, he indicated that calculating the  IOL power would be very difficult, and the results would be too unpredictable and probably not worth the risks involved.  He believe the monofocal lens produces more consistent results, given my history of lasik in 1999, and the vitrectomy in 2005.

I did go to two other ophthalmologists and they recommended the Crystalens, however, I am not sure that they considered the fact that I had had Lasik and that my cornea would be too thin..My current doctor indicated that they probably just wanted to make extra money..since he believes I am not a really good candidate.  


Given that there is a higher complication rate for cataract surgery after a vitrectomy and that it is difficult to ascertain the refractive error due the lasik, how would you recommend that I proceed???????
Should I get a 4th opinion?
Follow my docters's recommendations?
What are the risks involved with IOL exchange, once you have had cataract surgery? Will a doctor be willing to treat me, since my case would be more complicated?



Avatar universal
Part 2
Is it safe to do refractive lens exchange in the other eye "good eye"(left), although I have had Lasik and at risk of having a detached retina?
711220 tn?1251891127
MEDICAL PROFESSIONAL
The calculations are the same as any LASIK patient if you did not have a scleral buckle with the vitrectomy for a retinal detachment.  

The risk of a retinal detachment for a RLEX  or cataract surgery depends on your age and the presence or absence of a posterior vitreous detachment.  Your risk is less if you are over 50 and have a posterior vitreous detachment.  I would have a BAT test to see if the vision decreases in the left eye due to glare.  This would signify that a cataract will become significant in the near future.

Dr. O.
Avatar universal
Thanks for all the great information.  I have one more question.

Could this be my 2nd option?
..I hear others on these post, indicate that they have the option of having one eye for distance and for close up vision.  Why couldn't I have that option? So, have my right eye(the one with a cataract) set for distance.  Could it be possible for both eyes to work to together, if my left eye is -5.00+2.50x088.?? Or could I wear a contact in the left eye..with distance set for the right? Could I adjust? Or would there be too much of a disparity between both eyes? My doctor indicates that I would be probably see doubles...

I just want to make sure I understand these complicated eye issues

Thanks,

711220 tn?1251891127
MEDICAL PROFESSIONAL
In general most patients do well with up to 2.00 or 2.50 diopters of anisometropia.

If the right eye was set a zero, you left would have to be about -2.00 with a contact lens.

Dr. O.
Avatar universal
So, now I have come to a question...as to why my doctor would believe that leaving my right eye at -2.50 (so for close up) would be better than attempting to leave my right eye for distance and set it at zero...????  So, why would he think that the outcome for near vision would be best for me?

He mentioned..something that I would struggle with my eyes being so different..but if the contact is in place that wouldn't be the case is that correct?

Please help me understand.  

Thanks,
Avatar universal
Another question....

So, if I understand you correctly, if my right eye is corrected to -2.50, then I could still consider refractive lens exchange on the left eye...although my cornea is thin and previous doctors have indicated that I can not do anymore lasic?
711220 tn?1251891127
MEDICAL PROFESSIONAL
He has recommended the right to be set at -2.50 so that is will work with your left eye (-5.00 +2.50 ) has a spherical equivalent of -3.75.  Therefore both eyes would be within 2.00 diopters (-1.25 to be exact).

Dr. O.
Avatar universal
Ok now I understand..however given this recommendation..it sounds like I would give up getting distance vision in the right eye....but can be corrected with contact lens or glasses. So, I guess I would hope to correct and refine my vision on my left eye.  My surgery is scheduled for the end of this week.  

Just wondering....I noticed your in the Los Angeles area...maybe I can go in for another opinion... Would you consider recommending a Crystalens to patient who only needs it one eye..and who has had la good amount of lasik due to being very nearsided and a vitrectomy...Given my history..would the outcomes really be poor?
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