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What post operative refraction error should I choose?

I am a 69 year old female, highly myopic (L eye -10.25, R eye -12.50).  Five years ago I was diagnosed with a macular pucker in my right eye, for which my retina doctor recommended observation but no surgery. I have large cataracts in both eyes, and intended to have surgery this coming year.

Unfortunately, I was diagnosed with a macular hole in my right eye in November, and will have a vitrectomy in two weeks. My retinal surgeon will have a cataract surgeon remove the cataract at the same time.

When I met with the cataract surgeon I told him that my goal was the best vision possible, and that if possible I would like to have good near vision. I also told him I did not mind wearing glasses all of the time.

He recommended -5.00 in the right eye and -2.50 in the left eye.  At the time of the appointment, I readily agreed, but having read your advise, I am concerned with this solution.  

Given that there is very strong possibility that the vision in my right eye will always be distorted by the damage caused by the macular pucker and macular hole -- I don't have a black spot, but I cannot read with my right eye  as the letters in the center of each word disappear as I scan a page -what do you recommend?
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177275 tn?1511755244
That doesn't look to me like a good solution at all since both eyes are going to need surgery. Likely the operation on your RE will be a macular hole repair.  the prognosis is based on the size and depth of the hole but they eye is likely to not have normal vision and the black spot in the center  may be there permanently although hopefully smaller and stable.  No reason to leave that eye so myopic and unbalanced with the other eye.   UNLESS the surgeons feel the prognosis for the RE is so bad they don't think it will add anything to your binocular vision and by leaving it so myopic that it will give you a lot of magnification, up close, without glasses WHEN YOU ARE NOT using your LE.  I would get a second opinion from another cataract/IOL surgeon on the desired post op refractive error in the RE.  
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Some additional comments.  You will also have the ERM removed when they do hole repair. Not having black spot is good.  Get 2nd opinion re  ideal post op uncorrected refractive errors.
First, I can't thank you enough for replying to this so promptly.  

My plan is to call or meet with the cataract surgeon and propose to keep the -2.50 in the left eye, but to change the right eye to -1.25.   I am praying that he agrees.

My problem with asking for a second opinion is that this IS my second opinion.  My small hometown doctors couldn't schedule the surgery for 4 months, and I was lucky to be able to get a second opinion from a wonderful retinal surgeon at the Wills Eye Institute in Philadelphia.  Unfortunately, the cataract doctor came along with the retinal doctor.  

Anyway, wish me luck changing his mind without insulting him.  

And please give me the name of a charity you support.  I would like to make a donation in your name.  Your generosity is a blessing to so many of us who are suffering.

Wills Eye Hospital is world famous (and their reputation well deserved)  and I have worked with many of their faculty.  -2.50 bad eye -1.25 good eye makes a LOT more sense and that would be called mini-monofocal near bias and is what I would choose if I ever need cataract surgery.   If you are feeling generous, I come from a military family and feel profoundly about supporting our military and their families, and would suggest USO or Wounded Warrior Foundation.   Thanks and best of luck.
I have made a donation to Wounded Warrior Foundation, which is also one of our favorite charities.  

Thank you, again.
Best of luck. When the process is done and the dust settles come back and post and let readers know how things turned out.
Best of luck, aqclaph. Would appreciate you feedback.  I too have one bad eye that cannot read prints (could be PVD, retina pbs at age before 5,  or just lazy eye). Had a cataract surgery on it in 2010 and now have general vision on left eye but still can't read. Then in 2017, I had a cataract surgery on my good right eye and is left very myopic at -3.50 to balance the bad eye. Would love to know if it is advisable to do PRK, but why would the cataract surgeon left me so myopic in the first place?
Leeamme:  what is your glasses RX in each eye and your vision with those glasses one?
After my second cataract surgery on my good right eye, my RX is:
OD:  SPH -3.50, CYL +0.75, AXIS 20
OS:    (? haloved)

before that in 2008, RX was:
OD: SPH -9.00, CYL +0.75, AXIS +175
OS:   ------------------------------> add +2.50
Not sure why you don't list your LE  RX.    Most people have RXs similiar in both eyes. You have high myopia (-9.00)  likely you LE is about the same.  The surgeon reduced your myopia by 66%   On your LE (OS) if that eye has good visual potential you might want to consider -1.50.    Going for none 0.00 would leave you with what is called full monovision and is hard to get used to wearing glasses and often hard to get along without glasses. Don't do PRK until your LE is fixed and you see how your do.
Thanks for the reply, Dr Hagan.
My left eye is legally blind I think. I can see shapes and colors of cars, people etc but very blur. But I cannot read with my left eye. So the eye doctor (surgeon) had all along gave me RX of only OD, with OS to match OD for balance or cosmetics.
Then you are 'one eyed'.  With your RE glasses hopefully you see 20/20 (6/6 metric). I would not do  more surgery when glasses would work fine. You should be able to read really well but the reading distance may seem to close to you. Progressive multifocal glasses should work fine.
Your reply is very assuring. Thank you, Dr Hagan. I see 20/20 with my RX glass(es) for distance. I read and work well on iPad and computer at palm's and arm's length without glass(es).
I am due for a checkup soon. One of his staff suggested PRK since the clinic is also a lasik center.  Thinking back now, the cataract surgeon (also my ophthalmologist for a long time) was displeased when he found out that his technician gave me an eye bandage (contact lens) the same day after the cataract surgery. The contact lens was great, as I could see near, intermediate and distance crystal clear;  but it caused some problem as I was still on drops and my eye was red for a few days.
Once again, thank you Dr Hagan for your valuable advice.
best of luck
It has now been 15 weeks since I had the surgery to correct the macular hole and to remove the cataract in my right eye, and 8 weeks since the surgery to remove the cataract in my left eye.

My target refraction error was -1.25 in right eye (the "bad" eye with the macular hole), and -2.50 in my left eye.  I chose this target because I wanted to be left near sighted enough to read without glasses in my good eye, and then to achieve an Rx corrected for distance in the left eye, but not so much that I would have a problem with eyeglasses (too much difference between the 2 eyes).

My current Rx is -1.75 right eye, -2.75 left eye. (I have no correction for near vision in these glasses, as my right eye is still changing, and I will wait a few more months to invest in glasses with progressive lenses.)  So an "error" of .5 in each eye, which I believe is very good.

I can read my iPad, a book in good light,  and my desktop computer, very clearly without glasses!  I can walk around the house and get dressed without glasses, but to cook, drive, clean, socialize, do anything else, I am much happier with glasses that correct my distance vision.

I still have some distortion in my right eye, but it is greatly improved.  Prior to my surgery, a car 40 feet ahead would almost disappear when I closed my left eye;  now, a car at this distance is just a bit slimmer.  Verticals are no longer broken and wavy.  
However, I have a great deal of trouble reading with this eye.

My conclusion:  it seems almost a miracle to me that these surgeries - these surgeons - were able to restore my vision to what it had been several decades ago.   My vision is not perfect.  I will have to wear glasses, and with progressives, I will wear glasses, all of the time.  

I do understand that for most people, choosing a target refraction for distance in both eyes may be the best choice.

For people like me, who have been very nearsighted most of their life, choosing the near vision refraction is highly satisfactory.

And, again, a thank you to Dr. Hagan for his incredible help.

Thank you so much for your post which I think will help a lot of people in similar circumstance. I'm delighted with your success. Made my day.
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177275 tn?1511755244
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