Cataract Surgery for High Myopia: What to Expect and How to Prepare

Q: Cataract Surgery for High Myopia: What to Expect and How to Prepare

Hello Julie： It is possible that with single vision lenses, you may not achieve the best of both worlds for seeing the dashboard clearly and seeing far without glasses. <br>If you retain a prescription of -1.00 diopters for nearsightedness, you will be able to see the dashboard b

Cataract surgery

Hello Doctor, I have high myopia and cataracts in both eyes.
My left eye has a myopia of -1200 diopters with a vision of 0.15, and my right eye has a myopia of -1400 diopters with a vision of 0.3.
I also have presbyopia of +250 diopters and astigmatism of +50 diopters in both eyes.
The doctor suggested performing surgery on my left eye first, using a monofocal aspheric intraocular lens.
I would like to know how much refractive error I should leave in my left eye if I want to see the dashboard while driving and see far without glasses, but wear reading glasses for near vision.
How should my glasses prescription be adjusted? If I can only choose to see far, how should the eye and glasses prescription be adjusted? If I wait more than six months to have surgery on my right eye, how should my glasses be adjusted during that waiting period? I cannot undergo laser treatment or wear contact lenses.
If one eye is normal and the other has -1400 diopters of myopia, what problems could arise? Can I drive? I have had floaters for many years, but there have been no abnormalities.
I also had a retinal laser repair for a tear many years ago, and there have been no issues since.
Will the condition worsen after surgery? I have many questions, and I appreciate your taking the time to answer them.

Julie, 50~59 year old female. Ask Date: 2022/08/21

Dr. Gao Pilin reply Ophthalmology

Hello Julie: It is possible that with single vision lenses, you may not achieve the best of both worlds for seeing the dashboard clearly and seeing far without glasses.
If you retain a prescription of -1.00 diopters for nearsightedness, you will be able to see the dashboard but may experience some blurriness at a distance.
If you choose to focus solely on distance vision, then you should not retain any prescription.
It is best to discuss these options with your surgeon.
After the surgery, there may be a disparity in vision between the two eyes, but you should be able to rely on the vision of your left eye for general daily activities, and you might want to try not wearing glasses initially.
However, you should be cautious while driving.
The surgery should not affect floaters or the retina.
However, after cataract removal, as your vision improves, previously unnoticed floaters may become more apparent, leading to the perception that there are more of them, but this is not actually the case.

Reply Date: 2022/08/21

More Info

Cataract surgery is a common procedure, especially for individuals with high myopia, and it can significantly improve vision. Given your specific situation, here’s what you can expect and how to prepare for your surgery.

Understanding Your Condition
You have high myopia, which means your eyes are longer than average, causing light to focus in front of the retina. This condition can lead to complications such as cataracts, which you are currently experiencing in both eyes. The degree of myopia in your left eye is -1200 diopters, and in your right eye, it is -1400 diopters. Your vision is significantly impaired, and cataract surgery can help restore clarity.

Surgical Plan
Your surgeon has recommended starting with the left eye, using a monofocal aspheric intraocular lens (IOL). This type of lens is designed to provide clear vision at a single distance, typically far away. If your goal is to drive and see the dashboard without glasses, you will need to consider how to balance your vision needs.

Preoperative Considerations
1. Targeting Post-Surgery Vision: If you want to see both distance and near without glasses, you might consider a technique called "monovision." This involves correcting one eye for distance (the left eye in your case) and leaving the other eye (the right eye) slightly myopic for near vision. However, this requires careful planning. For your left eye, you might target a vision correction of around -1.00 to -1.50 diopters, allowing you to see the dashboard clearly while still needing reading glasses for close work.

2. Eyeglass Prescription: After your left eye surgery, you will likely need a new prescription for glasses. Initially, you may need glasses that correct for distance in your left eye and reading glasses for near tasks. Once your right eye is also operated on, you can adjust the prescription based on the final outcomes of both surgeries.

3. Waiting Period for Right Eye Surgery: If you wait six months or more before having the right eye operated on, you will need to wear glasses that compensate for the -1400 diopters of myopia in that eye. This means you will likely need a strong prescription for distance vision, and you may find it challenging to see clearly with only one eye corrected.

Driving Considerations
With one eye corrected and the other still highly myopic, you may face challenges when driving. Depth perception and peripheral vision can be affected, making it potentially unsafe to drive until both eyes are corrected. It’s crucial to consult with your eye care provider about your specific situation and whether you are fit to drive.

Postoperative Care
After your surgery, you may experience some changes in your vision, including the potential for increased floaters, especially since you have a history of floaters and previous retinal issues. It's essential to monitor your vision closely and report any significant changes to your doctor. Regular follow-ups will be necessary to ensure your recovery is on track and to address any concerns.

Conclusion
In summary, cataract surgery can greatly improve your quality of life, especially with high myopia. Targeting your vision needs carefully, especially regarding the left eye, is crucial for achieving the best outcomes. Always communicate openly with your surgeon about your goals and concerns, and ensure you have a clear plan for your eyeglass prescriptions post-surgery. With proper preparation and follow-up care, you can look forward to improved vision and a safer driving experience.

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