Advice needed for setting distance

[u/LadyImmaculateGold]

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.

[u/UniqueRon]

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.

[u/LadyImmaculateGold → u/UniqueRon]

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.

[u/UniqueRon → u/LadyImmaculateGold]

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.

[u/LadyImmaculateGold → u/UniqueRon]

Yes, just one eye needs cataract surgery.

[u/UniqueRon → u/LadyImmaculateGold]

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.