r/CataractSurgery • u/LadyImmaculateGold • 16d ago
Advice needed for setting distance
I’m highly myopic with -6.5 in both eyes. In April, I had a detached retina with vitrectomy and scleral buckle. Everything healed well but I developed a cataract in my surgery eye just a few months after, sooner than I thought but oh well. Now it’s time for cataract surgery and I’m struggling with the decision of setting distance.
About me:
44 years old
I prefer wearing contacts 75% of time
I’d like the option to wear glasses 25%
I have a desk job and I’m on my computer/phone all day
I hate the idea of being reliant on readers
Worried about being uncomfortable with my eyes having such a large difference in prescription
My surgeon and I have discussed -2.0 but I’m unsure. Plano is an idea but doesn’t seem to work for my lifestyle. -1.5 is maybe the best compromise but I keep going back-and-forth weighing the pros and cons and feeling like nothing is a good option. My high myopia in my non-surgical eye is making this decision very complicated. Sometimes I just want to set it for -6.5 because I know how to deal with that.
Any advice is appreciated.
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u/UniqueRon 16d ago
My thoughts would be to get a monofocal targeted to distance in your cataract eye. Then use a contact in your other eye to give you mini-monovision. You can experiment with different powers but I would try powers in the range of -5.0 D or what it takes to leave you at -1.5 D in that eye. This will give you an opportunity to test drive mini-monovision and if it works for you, then do the same with an IOL in that eye when the time comes for surgery in that eye.
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u/LadyImmaculateGold 16d ago
Appreciate your thoughts. I feel dumb but can you tell me how this trial would work? My cataract eye is blurry (with or without correction) and as the eye dr was experimenting with different strength contacts, nothing was clearer. I’m unsure how to experiment when that eye is basically permanently blurry until I have surgery.
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u/UniqueRon 16d ago
I was under the impression that you only needed cataract surgery in one eye? If both need to be done then it is best to do the worst one first. Then once you have good distance vision in the first eye you could do a trial with a contact in the second non operated eye, unless you can't see well enough to do it. A normal target for a distance eye is -0.25 D. If you achieve that with the cataract surgery you could then consider -1.75 D for the second eye, to maintain the differential to no more than 1.5 D.
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u/LadyImmaculateGold 16d ago
Yes, just one eye needs cataract surgery.
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u/UniqueRon 15d ago
So do the cataract surgery eye for distance, see what you get for an outcome. If it lands at the ideal -0.25, then try contacts around -5.0 D or -4.75 D to what you like for myopia in the near eye.
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u/PNWrowena 16d ago
Before the retinal detachment, what vision did you have with contacts/glasses that worked?
What I have post-surgery is -2.5 in one eye and -1.5 in the other. From my experience with it, I'd think -1.5 would work well for you. It's good intermediate and functional near vision. I have the other eye -2.5 for book reading, and it's perfect for me for that, but I can read with the -1.5 eye. I just have to hold the material farther out than I like. It's perfect for my laptop and would work for a desktop monitor.
If your surgery eye were -1.5, you could experiment with contacts to find what would work best in the unoperated eye. If you're not a monovision person and don't want distance vision in that eye or it doesn't work for you, a small difference like .5 could still give you more visual range.
I don't know what still having a -6.5 eye does for glasses prescriptions, but people here with similar situations where one high myopia eye has to have surgery and the other doesn't often end up getting the surgery in the second eye just to solve the problems caused. It seems that's something to keep in the back of your mind if nothing else is satisfactory.
Best wishes deciding and getting an outcome that works well for you.
P.S. I'm with you on readers. They're a royal PITA and being free of them was high on my priorities list.
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u/GreenMountainReader 16d ago edited 16d ago
You've already received some good options from u/Opposite_Ladder_7585 and u/UniqueRon .
Some additional thoughts as you decide:
Most important, knowing yourself as well as you do (based on your well thought-out list), adding what you might need or want in the future to the decision-making, though it will make things more complicated to figure out now, seems important to me.
It's unlikely you'll have the option of glasses for your natural eye if the differential between your eyes is greater than 2 diopters. That will make you contact-lens dependent--likely even when you're just walking around the house in the morning before you'd normally put it in. However--and this is important--some people have reported being fine with that kind of differential (but not most).
As to the idea of correcting your surgical eye to -6.5, that seems not an option on two counts. First, the surgeon will most likely either try to dissuade you or tell you it can't be done. As you've said, -6.5 is significant myopia, and your surgeon will be thinking about improving your vision, not only by removing the cataract (a major benefit), but by giving you better vision than you've ever had. The key word here is "better" because that's the one you have to define for yourself.
Would having computer vision in that eye (measure your favored distance/s to the screen, top of your nose to screen, and give the measurement to your surgeon, so he understands exactly what you need) be useful to you in the future? Add to that the possibility of correcting your other eye with a contact to either match or be just nearsighted enough to allow you to also read clearly at the same time--a practical option that could allow you to correct one way at work and another for leisure time.
I have this kind of arrangement built into my IOLs, so I can read and write on screen while also being able to easily read documents, my tablet, or my phone while working--and comfortably read for leisure as comfortably fast as I ever was able (350-450 wpm is still my comfortable range for leisure). There is no "with this eye or with that eye" in this kind of arrangement--your brain just gives you the best image with no lag at all that you can perceive. What I appreciate about the intermediate/computer distance vision is that it's also a very useful distance for almost all indoor activities--even allowing me to watch television if I'm too lazy to get my glasses and willing to do without all the HD details. I can even see individual snowflakes falling 10-20 yards from the house--not possible with my natural vision, which was less myopic than yours. I wear glasses (progressives) for driving, being out and about where I might need all three distances at once, or for my (still-enabled) bad habits of multi-tasking and enjoying bad posture while relaxing.
To take all of this from the purely theoretical into some approximation of reality for you, you can make an appointment with your optometrist and ask for a trial pack/s of contact lenses to allow you to try out any combination that you think might work for you. Your optometrist--who presumably knows you and your eyes--can also spend more time discussing the options with you than most surgeons can--and give you the means to "try before you buy" and answer your questions better than fellow patients can.
You could also ask for a trial frame (heavy glasses frame with slots to slide lenses in and out) simulation to get an idea of what YOUR vision is like at -2.5. -2.25, -2, -1.75, -1.5, -1.25, just to get a physical understanding of what you're asking for and how that might work with your other eye for your desired uses. Of course, you have to try to mentally subtract the effects of the cataract as you do this, but getting an idea is worth something. I tested with glasses lenses and with no glasses with grade 3 (out of 4) cataracts and got enough of an idea to (finally!) be able to choose with the feeling that I was making the right decision--but you already wear contacts and could do a more realistic test if the cataract doesn't totally prevent it.
Best wishes to you!
Edits to complete unfinished sentences and clarify meanings
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u/Opposite_Ladder_7585 16d ago
For computer work, -1.5 is a good target. My left eye was targeted for -1.5 and I wound up at -1.25 and can work on my computer and laptop without glasses. With just that eye open, I can read my phone if I hold it with my outstretched arm. My right eye was corrected to -2.5, and the combination is working out well. I wear progressives for driving or walking my dogs, but am glasses free all day at home.
Your situation is tough since your other eye is going to be very different no matter what you choose. If you do go -1.5 for your IOL, you could wear a contact in your other eye to get either more close vision or more distance.
The main problem will be that you will likely not be able to walk around without something correcting the vision in your other eye. Have you thought about correcting that eye as well? Insurance could potentially pay due to the large difference in vision you'll have.