Cataract Surgery: Options for Lens Replacement and Vision Clarity

Cataract lens replacement surgery?

Hello, Doctor.
I had cataract surgery on my left eye this week, and a monofocal intraocular lens was implanted without retaining any prescription.
I have -600 diopters of myopia in my left eye, with no astigmatism.
After the surgery, my distance vision is clear, but my near vision is very blurry, and I need to wear +200 reading glasses.
It is very inconvenient for my daily work, as I need to use a computer to view reports, and I cannot see them clearly.
I would like to ask the doctor:
1) Is it possible to undergo another surgery to replace the lens with a multifocal lens, or to switch to a monofocal lens that allows for clear near vision? What are the risks, and can the surgery be performed immediately?
2) If I do not replace the left eye lens, can I have a multifocal lens implanted in my right eye during surgery?
3) If a monofocal lens is implanted in the right eye, should I retain a certain prescription? How much diopter should be retained to see the reports clearly?
4) If both eyes have monofocal lenses implanted, can I later undergo laser surgery to treat presbyopia?
Thank you for your response!

Wang, 50~59 year old female. Ask Date: 2015/12/12

Dr. Wang Zhishun reply Ophthalmology

Hello, I believe your physician should have a plan regarding the condition of both of your eyes, rather than only considering distance vision in one eye.
It is advisable for you to discuss this further with your doctor.
(This needs to take into account factors such as the refractive status of both eyes, the degree of cataracts, other eye conditions, personal habits, and needs, etc., which require clinical judgment.)

Reply Date: 2015/12/12

More Info

Hello! Thank you for your questions regarding cataract surgery and lens replacement options. It sounds like you are navigating some challenges after your recent surgery, and I’m here to provide clarity on your concerns.

1. Lens Replacement Options: After cataract surgery, if you are experiencing significant difficulty with near vision due to the single-focus lens that was implanted, it is possible to consider a lens exchange. However, this procedure does come with risks, including the potential for complications such as infection, retinal detachment, or further vision impairment. The timing of such a surgery can vary; some surgeons may recommend waiting for a certain period post-surgery to allow the eye to heal before considering another operation. It’s crucial to have a thorough discussion with your ophthalmologist about the specific risks and benefits in your case.

2. Multifocal Lens for Right Eye: If you decide not to replace the lens in your left eye, you can still opt for a multifocal lens in your right eye during your upcoming surgery. Multifocal lenses can help provide a range of vision, allowing for clearer sight at both near and far distances. However, the effectiveness of multifocal lenses can vary from person to person, and some individuals may still require glasses for certain tasks, especially if they have high levels of astigmatism or other refractive errors.

3. Preserving Prescription in Right Eye: If you choose to have a single-focus lens implanted in your right eye, you will need to discuss with your surgeon the appropriate degree of myopia to preserve for optimal vision. The goal is to balance your vision needs, especially considering your daily activities like using a computer. Many patients find that a slight degree of myopia (around -1.00 to -2.00 diopters) can help with near vision tasks without needing reading glasses, but this is highly individual. Your surgeon will assess your specific visual requirements and lifestyle to recommend the best approach.

4. Laser Surgery for Presbyopia: If both eyes are fitted with single-focus lenses, it is indeed possible to consider laser surgery (like LASIK or PRK) later on to address presbyopia, which is the age-related loss of near vision. However, the success of such procedures can depend on various factors, including the health of your cornea and the specific characteristics of your eyes. It’s essential to have a comprehensive evaluation to determine if you are a suitable candidate for laser correction after cataract surgery.

In summary, while there are options available to improve your vision post-cataract surgery, each choice comes with its own set of considerations. It’s essential to have an open dialogue with your ophthalmologist to discuss your symptoms, lifestyle needs, and the potential risks and benefits of any further procedures. They can provide personalized recommendations based on your specific situation and help you make an informed decision about your vision care. Thank you for your inquiry, and I wish you the best in your recovery and vision improvement journey!

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