Cataract Surgery: When Only One Eye is Treated

Cataract surgery performed on only one eye?

Hello, doctor: I am 24, almost 25.
When I was 19, I went to an ophthalmology center for an examination and was diagnosed with cataracts, which were located right in the center of my eye.
At that time, I did not take any special measures.
In March of this year, I went for another check-up and found that my vision was indeed worse than average, so I discussed surgery with the doctor.
On March 8, I had surgery on my left eye.
Originally, my left eye had over 200 degrees of myopia and over 200 degrees of astigmatism.
The doctor insisted on using the simplest monofocal lens because he said that the failure rate and potential complications of multifocal lenses were high.
He also mentioned that he would leave me with 150-175 degrees of myopia, so I would be able to see up close without glasses and would need glasses for distance vision, which I agreed to.
1.
One month after the surgery, during the vision check, the doctor said I had 50 degrees of myopia and 300 degrees of presbyopia.
I would like to know why the results differ from what I expected.
I thought this could be accurately predicted.
2.
Since my presbyopia significantly affects my near vision and makes it difficult to see up close, I am considering not having surgery on my right eye.
The doctor said that was an option.
Currently, my left eye has 50 degrees of myopia, 225 degrees of astigmatism, and 300 degrees of presbyopia; my right eye, which has not had surgery, has 175 degrees of myopia and 300 degrees of astigmatism.
Given this situation, is it possible to avoid surgery? I feel that the difference in vision is not very significant.
When I went to get glasses, the optometrist said my vision was acceptable.
I was considering progressive lenses, and the prescription provided by the doctor indicated that both eyes should have an additional 250 degrees of presbyopia.
Would this mean that my right eye would effectively not be able to see up close? The optometrist helped me try one side with progressive lenses and the other with standard lenses, and I found both to be clear.
Is this approach feasible? The glasses will take a week to arrive.
Thank you.

Mr. Wang, 20~29 year old female. Ask Date: 2019/04/29

Dr. Cai Wenyuan reply Ophthalmology

Hello, I apologize, but it would be best to discuss your question with your attending physician.
Wishing you peace and good health.
Sincerely, Dr.
Tsai Wen-Yuan, Director of the Department of Ophthalmology, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2019/04/29

More Info

Understanding cataract surgery, especially when only one eye is treated, involves several considerations regarding vision correction, the potential for visual disparity, and the overall impact on daily life. In your case, having undergone surgery on your left eye while your right eye remains untreated presents a unique set of challenges and questions.

1. Post-Surgery Vision Expectations: After your left eye surgery, the unexpected outcomes regarding your vision—specifically the 50 degrees of nearsightedness and 300 degrees of presbyopia—can be attributed to several factors. The calculations for intraocular lens (IOL) power are based on preoperative measurements, but individual healing responses and the eye's unique anatomy can lead to variations in the final refractive outcome. It's not uncommon for patients to experience a difference between expected and actual results. The surgeon's decision to leave some degree of nearsightedness was likely intended to allow for better near vision without glasses, but it seems that the degree of presbyopia (difficulty seeing close objects) has become more pronounced than anticipated.

2. Deciding on Right Eye Surgery: Given your current situation, where your left eye has a relatively mild refractive error (50 degrees of myopia) and your right eye has a higher degree of myopia (175 degrees), you may indeed choose to forgo surgery on the right eye. The visual disparity between the two eyes may not be significant enough to warrant surgical intervention, especially if you feel comfortable with your current vision. However, it is essential to have a thorough discussion with your ophthalmologist about the potential long-term implications of leaving the right eye untreated, including how it may affect your overall visual comfort and depth perception.

3. Choosing the Right Eyeglasses: When it comes to selecting eyeglasses, your plan to use progressive lenses (also known as multifocal lenses) can be a suitable option, especially since you are experiencing significant presbyopia. The progressive lenses will allow you to see clearly at various distances, which can help mitigate the difficulties you face with near vision. The fact that your optician suggested adding +2.50 diopters for both eyes indicates they are accommodating your presbyopia needs.
However, it's important to ensure that the prescription is tailored to your specific visual requirements. Trying both progressive and single-vision lenses is a good approach, as it allows you to assess which option provides the best clarity and comfort. Keep in mind that adapting to progressive lenses can take some time, and it’s normal to experience some initial discomfort or distortion as your eyes adjust.

4. Visual Disparity and Adaptation: With one eye treated and the other untreated, your brain may adapt to the differences in vision. This adaptation can help minimize the perception of visual disparity, but it’s crucial to monitor how your vision changes over time. If you notice significant discomfort or if your vision deteriorates, it may be worth reconsidering your options for the right eye.

5. Long-Term Considerations: Lastly, while you may feel comfortable with your current vision, it's essential to have regular follow-ups with your eye care provider. They can monitor any changes in your vision and provide guidance on whether further intervention for the right eye may be necessary in the future.
In conclusion, your decision to delay surgery on the right eye seems reasonable given your current visual comfort. However, maintaining open communication with your eye care team and regularly assessing your vision will be key to ensuring the best outcomes for your overall eye health.

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