Wednesday, February 5, 2014

Retinal Detachment Risk after Cataract Surgery with High Myopia

Question: I am a 49 year-old male, have had cataracts in my right eye for 7 years which is also extremely myopic with a -12.00 correction. Fortunately, my left eye vision has held up, and I have been able to function normally with my left eye vision for many years. Starting last year, my left eye started to develop cataracts.  I have been myopic my whole life, and my left eye has gone from about -6.5 before I developed cataracts to -7.5 now.  With correction, I used to see 20/20 in both eyes. Now with cataracts, my vision is 20/30 in the left, and almost blind with my right.  I have also developed presbyopia so I need reading glasses in both eyes.

Because I am relatively young and myopic, my ophthalmologists have told me that I am in the high risk category for retinal detachment after cataract surgery. Therefore, I have delayed my cataract surgery for as long as possible. Given that my left eye is getting blurry and my right eye cataract is are getting dense, increasing the cataracts surgery risks, I have decided to get cataract surgery soon.  Given that my left eye is still functional, I have decided to get a cataract surgery in my right eye first, with no plans on the left eye surgery, hopefully until many years later.

I was told that I am left eye dominant, so even with near-blindness in my right eye, I have lived a normal life. If I correct the right eye vision for distance thru the cataract surgery, I was told that I would have to wear contacts on my left eye to balance out the vision. 

My question is as follows:  If I don't wear contacts, but rather wear glasses such that the left eye correction is around -3 (versus full correction of -7.5), and right eye would have no correction (except for reading glasses), would I be able to function for reading and distance?  In other words, given that I am left eye dominant, but after the cataract surgery on the right eye, I will have distance vision on the right eye and partial correction on the left eye through glasses, would my brain be able to function or will I be too dizzy?  I'm just trying to see if I can avoid wearing contacts everyday and still function. Thank you so much for your advice!

Answer: It sounds like you are getting careful consideration from your ophthalmologists who know your situation the best. The decision to have the cataract surgery in the right eye first sounds like a good idea-BUT-you may want to have a thorough evaluation of your retina by a retinal specialist if you have not already done so in order to be sure the retina will withstand the cataract operation and to determine whether any prophylactic treatments of holes, tears, weakening or degeneration might help to reduce your risk of retinal detachment. After clearance by a retinal specialist you can be more confident that you have taken any necessary precautions. Regarding the -3.00 D difference after surgery, it is likely to cause headaches and possibly dizziness if you don’t wear a contact lens. You need to know that the best result is when both eyes have had the cataract surgery and thus while delaying the left eye surgery might seem prudent, it does make things even more risky surgically the longer you delay. Of course this is up to you and your cataract surgeon. You can try the eyeglasses with the -3.00 D difference and see if you tolerate it but it is questionable.

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