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Tips on Unilateral Cataracts?

Hi,

I am 51 with a PSC cataract in one eye.  I did get the comment that the other eye has a small beginning cataract as well.  I find tons of literature and discussion of bilateral IOLs but almost nothing about what to expect--and look out for--in regard to a cataract in one eye only.

I have been going back and forth thinking that I should get a Crystalens HD or a Technis multifocal, but at times reading the discussions on this site, each of the main contenders seem like either the best or the worst.

My other eye is outstanding, by the way.  I do use reading glasses, but I keep suspecting I wouldn't need to if not for the very bad cataract in the other eye.  I had to get incredibly weak reading glasses because my eyes feel like they don't want glasses.  I think I have .5 D and 1 or 1.5 D readers and one is a little too weak but not painful where the other is closer to just right and a little painful.

I am right-handed, and the cataract is in my right eye.  I don't know how to determine which is my dominant eye.

What should I expect about my vision in general after surgery?  I'm very familiar with the answer to this question for bilateral patients, but any insight directed at a unilateral patient would be much appreciated.

This is a wonderful forum.  Thanks.

Michael
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Avatar universal
You truly do give back.  Thank you.
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Avatar universal
Glad I could help. This board was a huge help to me in choosing my lenses, so I'm happy to give something back to it.

Based on the experience of a family member, and on what I have read, I would guess that your prediction would hold: That replacing no vision with some vision in your bad eye might help the good eye, and shouldn't hurt it.

Hopefully others will chime in.

As for multi-focals, I assume you are talking about Tecnis and Restor. The older Restor lenses typically had a fairly large range of intermediate vision which wasn't in clear focus. The newest model improves this (I believe by shifting the near focal point farther out a bit).

When you ask questions, be sure to be specific about which brand and model of lens(es) you are talking about. And rather than referring to the vague "intermediate" vision, it would be best to measure and then refer to specific distances of interest to you (like maybe 2 feet for computer work and 9 feet for watching TV).
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Avatar universal

Thanks, Dr. O.  I am grateful to have received your comment.

Now all you unilateral patients (and more doctors too, if I should be so lucky), don't hold back!  Please relate your experiences!
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711220 tn?1251891127
MEDICAL PROFESSIONAL
Although may surgeons  report good result with unilateral Crystalens, I find that due to the lack of accommodation in the fellow eye, the near vision is not as good.  This is still the best choice and when you have your other eye done, the accommodation in the right eye will improve.

Dr. O.
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Avatar universal

P.S.  The same question applies to the Crystalens HD: Does having a good natural eye make overall near vision good or better with a Crystalens HD or could it actually be worse (or not at all better) than it is now with my cataract?
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Avatar universal

Peakhope, as in so many other discussions on this wonderful site, your comments are much appreciated. Thank you!

Given that my other eye is quite good, any idea how my intermediate vision would be with a multi-focal?  Even with my terrible cataract, I don't wear any glasses to work on my computer, though I often have to increase the font size.

Could a multi-focal make my mid-range vision worse than it is now?  I keep wanting to think that intermediate would just be handled mainly by the good eye and the muti-focal would only make it better because the good eye would at least get a little assistance that it isn't getting now from the bad eye.  (My cataract is very opaque.)  

It seems silly, somehow, but I am very concerned about video quality on a computer.  Do the limitations of a multi-focal in mid-range show up mainly when trying to read on a computer, or would video be affected a lot too?

I hope some unilateral patients with multifocals or Crystalens HD see this topic and talk to us!

Again, peakhope, you are very kind to be so helpful on this site.  Thanks again!
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Avatar universal
Aiming a gun or camera is not a good test for eye dominance, because it relies too much on handedness and/or the design of the object itself. A telescope might be ok.

I am in the US, so know almost nothing about the Tecnis multifocal lens. And I don't know much about unilateral lenses, although my sense is that they aren't all that different. A family member got a multifocal IOL in one eye, and she is happy with it.

I chose Crystalens HD's for both my eyes, and am still happy with the decision. There is no perfect choice for everyone. Intermediate vision was most important for me, followed by distance. I hoped to avoid glasses, but would be ok using reading glasses if necessary.

Monovision did not interest me (seemed weird, wouldn't have stereo vision). Monofocal lenses would guarantee that I would need glasses for some activities. Rezoom and Restor had too much risk of severe glare. Assuming Crystalens is installed properly, the biggest complaint seemed to be that it didn't accommodate as much as promised.

So the Crystalens HD had the potential to be great, and at worst it would be about the same as a monofocal. So the potential upside seemed to outweigh the potential downside (mainly cost).

In reality, there are some extra risks with the Crystalens. Dr. Hagan's study reported lots of CL folks complaining about night vision, although in the 6 months I have been on this board I can only think of maybe one or two (and my night vision turned out great). There are rumors about needing more YAG's, or increased risk of retinal detachment. Some of us have been surprised that distant vision has not been perfect with the HD's. All of these issues, and more, should be discussed with your doctor (for any lens).

With any lens, but especially with Crystalens, it is critical to choose a doctor who has done a lot of procedures, is very knowledgeable, who communicates well, and who you trust. Skills with LRI's and/or Laser surgery are also very valuable.

And with any IOL, there are unpredictable risks and possible complications. As long as you end up being able to have good vision with glasses, consider it a success.
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Avatar universal
Thank you!  Your test for the dominant eye is wonderful, although I'm not certain that I can perform it accurately with my cataract.  I wonder if aligning my finger with a distant object now goes with the good eye so that it only appears that the good eye is dominant. My cataract has me essentially blind in the bad eye.  (I gather that PSCs are the worst!)

I sure hope we get some good responses on things to know for a unilateral cataract.

Thanks again!
Helpful - 0
Avatar universal
I am facing the same delema as you in choosing an IOL for my left eye only.  My right is just fine as yours.  I still have not made up my mind on the lens yet either.
To determine your dominate eye:
1.  extend your index finger vertically in front of your face.
2. align your finger to a distant object.
3.  Then close one eye at a time.
The eye in which the object doesn't appear to move while the other is closed is your dominate eye.
Or simply, it is the eye you use to aim a gun or look through a telescope with.
Hope that helped.
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