Vision Loss: Causes, Treatment Options, and Expert Advice - Ophthalmology

Causes and Management of Vision Loss

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I have been unable to see clearly even while wearing my glasses, and I have consulted two ophthalmologists.
The first doctor said, "I do not recommend getting new glasses; both eyes have cataracts, and there are no other issues.
I suggest surgery for both eyes.
However, please consult another doctor for the procedure." The second doctor stated, "The cataract in the left eye is more severe, while the right eye is very mild.
Surgery is not necessary; the poor vision is due to dry eyes, and I recommend getting new glasses." The opinions of the two doctors differ, and I am unsure how to proceed.
I have organized the relevant information below and would appreciate your guidance on the next steps.
1.
Examination Data
1.
The results for my myopia and astigmatism from two clinics were consistent, but there was fluctuation in vision.
The measurements taken a month apart showed similar myopia and astigmatism: before dilation, right eye - myopia 675, astigmatism 100; left eye - myopia 1125, astigmatism 75.
After dilation, right eye - myopia 625, astigmatism 0; left eye - myopia 725, astigmatism 50.
However, the corrected vision based on computer refraction showed significant variation over 5-6 measurements: Right: .2~.5; Left: .2~.6.
2.
Vision and Eye Health: [Links to documents]
3.
OCT Results: [Links to documents]
4.
Visual Field Test: [Links to documents]
2.
Questions:
1.
The myopia in my right eye has remained unchanged for many years, while the left eye has increased by 325 degrees over the past 3-4 years.
The difference in myopia before and after dilation is 50 degrees in the right eye and 400 degrees in the left eye.

(1) Does this indicate that "the cataract in the left eye is more severe, while the right eye is not severe"?
(2) Could the left eye's issues be due to "insufficient lens power and long-term neglect leading to degeneration" rather than solely cataracts? Is there any treatment for pseudomyopia? For example, could I use dilation to relax the left eye? Or cover the right eye to encourage the left eye to work harder?
2.
Currently, my measured vision is R: .2~.5; L: .2~.6.
The second doctor believes that the fluctuation in my corrected vision is due to dry eyes and that my right eye's cataract is not severe, so there is no reason for my vision to be as poor as the left eye with more severe cataracts.
I would like to know if my responses during the vision test were correct: when seeing images similar to the left images 1 and 2, I said, "There are overlapping images, but I can guess the opening is facing right." When seeing left images 3 and 4, despite the right side being more prominent, I said, "Both sides have openings, but it's hard to guess," and "It's too blurry, very hard to guess." When seeing the far right image, I said, "A blur, completely unable to guess."
3.
According to the OCT, the left eye's fovea is prominent but has some irregular edges, while the right eye's fovea is less distinct.
Both eyes show some red in the RNFL.
Is this typical for a 60-year-old's eyes? Is there anything specific to watch for in the right eye?
4.
During the visual field test, I felt a significant difference between my eyes, yet the results were similar, which surprised me.
My right eye detected many light spots, but my hand-eye coordination was too slow; by the time I pressed the button for the first light, the second one had already appeared.
I ended up averaging about three lights seen and pressing two.
Additionally, my right eye tends to wander away from the fixation point (likely due to the 400-degree difference in lens power between the left eye and the computer refraction, causing the right eye to be trained to compensate for the left).
I often need to remind myself to return to the center.
The left eye had longer intervals without seeing any light spots, and when I did see them, they appeared more slowly, allowing me to press one at a time without straying from the center.
However, I clearly felt that the entire visual field was darker, with concentric rings of light radiating outward, a smaller area near the nose, and the outer edge being more linear than curved.
There were several instances where the entire visual field became blurry, and once many spots appeared simultaneously, requiring me to blink repeatedly to recover.
(1) Can I understand this as: right eye fixation loss of 7/23 = 32% is due to habit, while false positive and negative errors are due to pressing too slowly? For the left eye, false positive and negative errors are due to seeing blurry or unclear images?
(2) Is the right eye's fixation loss of 32% still a valuable reference for the test results? Does the right eye's tendency to search around affect the visual field test results, causing them to be overestimated or underestimated?
(3) With VFI at 94% and 96%, and both eyes showing more black dots on the right side of the pattern deviation, does this have any particular significance?
5.
There is a strange phenomenon that I am unsure if it relates to my right eye's vision decline.
Sometimes, within 10+ or 20+ minutes of closing my eyes, I see abnormal light patterns: mostly flowing light patterns (various lines or shapes, black and white, continuously changing and expanding outward or deforming in a specific direction), resembling a computer screen saver.
I also often see a bright light filling the entire visual field or just one side, so bright that I can't help but open my eyes to check if I forgot to turn off the light.
Occasionally, I see a chaotic flickering like a broken TV.
I haven't noticed the frequency or timing of these occurrences, but they usually happen when I lie down to sleep.
If they occur, they are very noticeable with my eyes closed, but not as much when my eyes are open unless I look for them.
This symptom does not significantly interfere with my life; I can coexist with it peacefully, but I want to confirm if it relates to the decline in my right eye's vision.
6.
Should I undergo cataract surgery or get new glasses?
(1) If I have cataract surgery on the left eye and recover vision successfully, resulting in a disparity of 625~675 between the two eyes, with one eye having an IOL and the other having glasses (as I cannot wear contact lenses due to sensitivity), will I experience adaptation difficulties?
(2) If I wait until the right eye's cataract becomes more severe to have both surgeries together, will the increased hardness cause more damage to the eye during the procedure?
(3) If I postpone surgery and get new glasses, should I refer to the measurements before or after dilation? Would referencing the pre-dilation measurements lead to overcorrection and potential harm? If I reference the post-dilation measurements, will the left eye's continued inability to see clearly lead to "faster degeneration due to continued neglect"?
(4) In summary, what is the best course of action? Thank you for your patience in reviewing all this information and my questions.
I urgently need your professional insight and compassion; please advise me on the most appropriate next steps!

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Liu Xiaojie, 60~69 year old female. Ask Date: 2023/12/22