IOL in one eye only

[cbny]

I am a 45 year old male with moderate to severe myopia pretty much dependent on glasses to see anything far or near.  I was also diagnosed with pigment dispersion about 20 years ago and have had my IOP monitored regularly.
In the past 6-12 months I have noticed a significant decline in the vision in my right eye and was diagnosed with Cataracts

I would really like to correct my vision.  However the complication is that I would only have an IOL in my right eye leaving a large imbalance, my glasses are spherical -5.75.  

I have done a lot of research in this excellent forum.  I am leaning towards a mini monovision maybe -0.5 and -1.25.  If  I understand correctly this would give  good distant and mid range vision but likely would need glasses for reading and small work.  I work on computers and cell phones all day so the mid range is important to me. And would like distance for sports and driving.

My question is how to handle the imbalance between the two eyes.  
Should I correct my right eye to -1.25 with a monofocal IOL and use a contact lens in my left eye to correct to -0.5.  In this case what would happen at night when I removed my contact or if I could not wear contact for some reason?  Would I be able to function with glasses that only correct my left eye  and no correction  in right?  Would I need to put a patch on my left eye?  

My other thought would be to eventually correct my left eye with Lasik, however I am concerned it will affect the IOP pressure readings and that likely eventually I will develop cataracts in my left eye and the IOP calculations could be harder.  Are these valid concerns?  Would having an IOL or ICL  put in my left eye, with no Cataracts visible be too risky?

Please let me know if you have an opinion or other things I should consider
Thanks in advance for your advice

[londonbridge]

I am am in the same situation as cdoc. I am 55 years old and had early cataracts. After having one Restor lens implanted and then explanted due to numerous problems I chose to replace the Restor with a toric monovision lens in my non dominant eye set for intermediate distance. I currently wear a contact lens in my dominant eye, set for distance. I have great distance vision, good intermediate. I wear prescription progressive lenses over my contact to sharpen up the computer and for reading. They have worked much better than over the counter. Because the difference between my eyes is so great (-.25 and -8.0) I cannot wear glasses, when I take the contact out (something you will need to consider). I do have a pair of glasses with one lens blurred out using something called a mirage coating (from Pearle Vision). After a year I found that my good IOL eye has taken over some and I can manage without the contact, when I must have a break, but still would not feel confident to drive. That is something you need to consider. I suspect most people i.e. JodieJ would opt to go ahead and have a  second IOL  rather than hassel with contacts. Eventually I will go that route, but am enjoying good vision with one monofocal and one contact. I use Acuvue Oyasis contacts which are comfortable and make sure to keep the absolutely clean and change them when required (I developed a corneal ulcer early on due to over wearing).
Good luck with whatever you decide. It sounds like you are on the right track and have an expert surgeon, which is very important.
londonbridge

[cdoc]

I, too, was in almost exactly the same situation you face now.  I'm 45 years old, -5 left and -5.5 right (and right eye has some astigmatism.)  Over the last year I had developed a cataract in my right eye that eventually progressed to the point that it was contributing nothing when I worked on the computer or read.  I had specific issues with my right eye; there is no sign of a cataract in my left eye.

I opted to have my right eye corrected to plano or slightly less with a toric lens last February.  The surgery went beautifully and my distance vision is now very sharp and clear with my right eye.

For my left I wear a contact lens pretty much full time now, with a resulting slight mini-monovision.  For distance my vision is just a joy.

Up to within 12" or so I can do things like read labels, write, use the computer unaided if I need to.  I definitely need reading glasses if I'm going to do this for an extended amount of time.  Right now I'm using over-the-counter ones, but will probably be ordering some with different powers in each eye.  I have a follow-up visit with my surgeon in a week or so.

For the longer run, I'm going to stay with the contact lenses while I consider Lasik for my left eye.  But the contact lens works very well for me so there's no rush.

My preference from the outset was good distance vision.  I don't mind wearing glasses while working on the computer, reading, or working close up, but did not want to be dependent upon them for outdoor activities.

I think my message is that the contact lens can work very well if you're okay with wearing them all the time.  At a minimum, though, it gives you a chance to evaluate alternatives after getting the cataract removed in one eye.

[JodieJ]

I was in a situation similar to yours.  I developed a cataract in one eye only following retinal surgery.  My Blue Cross paid for my cataract surgery for BOTH eyes, and this option worked out very well for me.

Glasses will not work for you after you get your first eye done, and an ICL is very problem-prone.  Your options for your left eye would be full-time contact lens wear, LASIK, or early cataract surgery.  I had measurements done for both LASIK and cataract surgery beforehand, but I was so pleased with the results of my first eye that I chose early cataract surgery.  My vision with an aspheric monofocal IOL (in the eye without a cataract) is at least as good (and slightly better at night) as my best-corrected vision before surgery.

[Val5]

A related discussion, Question on Toric IOL was started.

[jd426]

A related discussion, contact for right  eye? was started.

[Sandy Feldman, MD, MS]

Dear cbny,

I would recommend that you speak about your options with your eyeMD.  Your concerns of anisometropia or a difference in prescription between the two eyes, are justified and you do have many options.  It may take you some time for figure out the best one for you.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[cdoc]

Couldn't agree more about the utility of these forums.  I'm far better off because of what I learned here from the archived discussions (so much great stuff from JodieJ) and from direct replies to questions of my own (including some very useful information from you, londonbridge).

Cbny, best of luck with your decision and the outcomes.  Be sure to let us all know how things go.

[londonbridge]

You are very welcome. This forum including the caring people and doctors were a life saver for me and helped greatly in helping me decide to explant my Restor and go with mini-monovision.
Good luck. Sounds like you are on the right track.
londonbridge

[cbny]

Thanks for sharing your experiences and advice

On Friday when my Opthomoligst dropped a bomb shell on me and told me I had a cataract and needed surgery to correct, I knew almost nothing about cataracts.  It was a shock to me, causing all sorts of fear an anxiety.  Thru this forum and sharing people like yourselves I have learned alot and feel more confident that  I can make an informed decsion.

I cannot thank you enough

Chcuk

[JodieJ]

Both of my eyes are corrected for distance vision.  With mini-monovision (and a little luck), you would have good distance and computer vision without correction and some reading ability in good lighting.  You should discuss the refractive targets with your surgeon.  (I'd suggest a target closer to plano for your distance eye.  With a -.5 target you might not be able to drive without glasses if your outcome fell in the myopic direction.  Outcomes generally fall within .5 diopters of the target.)

I had surgeries two weeks apart, and I wore a contact lens between surgeries.  I only had to go without my contacts for a couple of weeks before getting eye measurements.  I made the decision about my second eye (cataract surgery vs. LASIK) the day after I got my first eye done.

[cbny]

Thank you very much for the reply,  this forum has been great for me to understand my options better.

Are you able to see far and intermediate distances, i,e driving and computer work without glasses?

How did you handle the time between surgeries?  Since I understand you must stop wearing contacts a week or two before surgery.

Thanks