Reading ability after cataract and lasik surgery

I have a cataract on my left eye that needs to be removed. My right
eye is fine, but the doctor has offered several possibilities for me
to consider, one of which is to have lasik surgery on the right eye
two weeks after the cataract is removed from the left eye. This sounds
like what I want to do.

However, he has told me that my eyesight will not be "perfect" when he
is done, and I will still need glasses to read. My understanding is
that I cannot be tested and fitted with new glasses until the eyes
"stabilize" which can take 1 to 2 months. Meanwhile, I am under
contract to write a book. The manuscript is due December 15. I was
given a short turnaround time as it is, and I cannot take "1 to 2
months" off.

I need to know if I will be able to read well enough (assuming all
goes well) after both surgeries to continue with my book project? Or
should I wait a few months (the doctor said I could wait up to 6
months, but he wouldn't like to go any longer)?

At present I am seeing okay. My right eye, as I said, is fine.

If anyone has had these procedures, I would really appreciate hearing
what your vision was like during the time before you were able to get
new glasses. The brochure says I can "resume normal activities" and
"read or watch TV" -- but if I am really going to need glasses to
read, how am I supposed to read before I get the new glasses?

Thanks to anyone who can help.

With modern cataract surgery, the the eye can see fairly well once the early
healing is over, few days to a couple of weeks. A refractio is best done
once little change can be expected, 4-6 weeks out. HOWEVER, under
circumstances such as yours, you can refract as soon as 1-2 weeks. May have
to be redone at 6 weeks out, but you can work during that early time with
the glasses (ie. Write the manuscript). Technically you can work reading
from 1 eye, or if the other eye isn't way off power, you can get reading
glasses before the LASIK, and put it off til after the LASIK.

Cataract surgery almost never has to be done within a certain time frame
unless it is a "mature" cataract - not sure why he said 6 months max.

The LASIK is another story, as things will change from that also. Why would
you need LASIK done? Is there a significant refractive error?


On 7/10/04 3:35 PM, in article
(E-Mail Removed), "Scotti"
<(E-Mail Removed)> wrote:

> I have a cataract on my left eye that needs to be removed. My right
> eye is fine, but the doctor has offered several possibilities for me
> to consider, one of which is to have lasik surgery on the right eye
> two weeks after the cataract is removed from the left eye. This sounds
> like what I want to do.
>
> However, he has told me that my eyesight will not be "perfect" when he
> is done, and I will still need glasses to read. My understanding is
> that I cannot be tested and fitted with new glasses until the eyes
> "stabilize" which can take 1 to 2 months. Meanwhile, I am under
> contract to write a book. The manuscript is due December 15. I was
> given a short turnaround time as it is, and I cannot take "1 to 2
> months" off.
>
> I need to know if I will be able to read well enough (assuming all
> goes well) after both surgeries to continue with my book project? Or
> should I wait a few months (the doctor said I could wait up to 6
> months, but he wouldn't like to go any longer)?
>
> At present I am seeing okay. My right eye, as I said, is fine.
>
> If anyone has had these procedures, I would really appreciate hearing
> what your vision was like during the time before you were able to get
> new glasses. The brochure says I can "resume normal activities" and
> "read or watch TV" -- but if I am really going to need glasses to
> read, how am I supposed to read before I get the new glasses?
>
> Thanks to anyone who can help.

"David Robins, MD" <(E-Mail Removed)> wrote in message news:<BD15C879.24C81%(E-Mail Removed)>...

The LASIK is another story, as things will change from that also. Why
would you need LASIK done? Is there a significant refractive error?

===============================

Thanks for your response, Dr. Robins!

I am 53 years old. I wear very thick glasses (to put it in lay terms).
At present, my left eye can only be corrected to 20/60 because of the
cataract.

As for wanting to do the cataract surgery in 6 months or less, I
understand this is due to not wanting to wait until the cataract
hardens, making it more difficult to deal with.

I am being told that I have two options:

1. Remove the cataract from my left eye and basically return vision in
that eye to what it was before, maybe a little better. Do nothing to
the right eye (it has no sign of a cataract developing at all). Keep
wearing thick glasses as I always have. If a cataract develops in the
right eye, make that eye just a little better than it was before.

2. Remove the cataract and insert a lens that gives me much better
vision in my left eye than I had before. I would then have to wear a
contact lens in the right eye OR have Lasik on that eye because
otherwise, the two eyes would be too different from each other.

I do not want to wear a contact lens. (I don't want the hassle, plus I
tried soft lenses in the 1980s and my vision was not sharp enough with
them. I have astigmatism. I wore hard lenses in the 1960s and 1970s,
and do not want to go there again). Lasik sounds better to me than
wearing a contact lens. I would still probably need reading glasses.

I realize that I may develop a cataract on the right eye down the road
(no sign of it yet). If that happens sooner rather than later, I will
just have to accept the fact that I sort of "wasted" the Lasik
surgery.

I was told that another option would be to do "cataract surgery" on
BOTH eyes, making them "match" vision-wise. However, the surgery on
the right eye would not be covered by surgery, as I do not currently
have a cataract on that eye. It would be much more expensive than
Lasik (which isn't covered either, but is less expensive). The benefit
would be that I would not need cataract surgery in the future on the
right eye (well, I know they can form again, but it would be somewhat
of a preemptive strike).

I am thinking my best bet may be to wait until at least November or
December to have the cataract surgery on the left eye.

Closer to that time, I can decide if I want Lasik on my right eye or
if I want just the cataract surgery on the left eye, leaving my vision
essentially the same as it was before the cataract formed. I must
admit that has a certain appeal. As I grow older, I really don't want
to add "things to remember" (like reading glasses) to my life. I don't
really want to hop in the car for a vacation and discover 300 miles
down the road that I forgot my reading glasses. I never forget my
glasses now because I can't see much of anything without them, so I
wear them all the time and I'm used to it.

Does that make sense? Again, I truly appreciate your thoughts.

Oops! I wrote: "However, the surgery on the right eye would not be
covered by surgery..."

I meant it would not be covered by insurance.

One other thing I should have said. I believe my right eye (without
the cataract) is -8. In other words, I am quite myopic. My doctor said
if I want to leave that eye alone, he might go to -7 or -6 in the left
eye, but no more. Then, if I get a cataract on the right eye, he might
go to -5 or -4 with that.

You surgeon's recommended numbers seem reasonable under the circumstances. I
wouldn't go more than 2 diopters difference from eye to eye. Remember that
as the right eye starts developing a cataract, it will likely get more
myopic first.

You mention not wearing glasses at all. Surprise! Unless you go for
monovision (1 eye for distance, 1 eye for reading power) you WILL still need
glasses, since the operations do not increase focusing.

Most mopoes should not be made plano in surgery - you surgeon, under the
best circumstances, would probably leave you a little myopic (maybe -1 D)
you have some reasonable at-home vision. If so, you will need glasses for
driving. If you don't want that you can aim for plano (zero) but I find most
lifelong myopes don't like that.

Another thing - LASIK does make it a lot harder to calculate the correct
implant power to make the eye a given power later on. You're better off with
a contact in that eye now, if you can handle it. In a myope there is a small
retinal detachment risk with either LASIK or cataract surgery.

Cataracts don't usually get that much harder in 6 months, but a high myope
like yourself any have a thinner capsular bag than others, so any
significant hardening my increase capsular tear rates. I personally haven't
had much problem in that regard.


On 7/11/04 2:23 PM, in article
(E-Mail Removed), "Scotti"
<(E-Mail Removed)> wrote:

> "David Robins, MD" <(E-Mail Removed)> wrote in message
> news:<BD15C879.24C81%(E-Mail Removed)>...
>
> The LASIK is another story, as things will change from that also. Why
> would you need LASIK done? Is there a significant refractive error?
>
> ===============================
>
> Thanks for your response, Dr. Robins!
>
> I am 53 years old. I wear very thick glasses (to put it in lay terms).
> At present, my left eye can only be corrected to 20/60 because of the
> cataract.
>
> As for wanting to do the cataract surgery in 6 months or less, I
> understand this is due to not wanting to wait until the cataract
> hardens, making it more difficult to deal with.
>
> I am being told that I have two options:
>
> 1. Remove the cataract from my left eye and basically return vision in
> that eye to what it was before, maybe a little better. Do nothing to
> the right eye (it has no sign of a cataract developing at all). Keep
> wearing thick glasses as I always have. If a cataract develops in the
> right eye, make that eye just a little better than it was before.
>
> 2. Remove the cataract and insert a lens that gives me much better
> vision in my left eye than I had before. I would then have to wear a
> contact lens in the right eye OR have Lasik on that eye because
> otherwise, the two eyes would be too different from each other.
>
> I do not want to wear a contact lens. (I don't want the hassle, plus I
> tried soft lenses in the 1980s and my vision was not sharp enough with
> them. I have astigmatism. I wore hard lenses in the 1960s and 1970s,
> and do not want to go there again). Lasik sounds better to me than
> wearing a contact lens. I would still probably need reading glasses.
>
> I realize that I may develop a cataract on the right eye down the road
> (no sign of it yet). If that happens sooner rather than later, I will
> just have to accept the fact that I sort of "wasted" the Lasik
> surgery.
>
> I was told that another option would be to do "cataract surgery" on
> BOTH eyes, making them "match" vision-wise. However, the surgery on
> the right eye would not be covered by surgery, as I do not currently
> have a cataract on that eye. It would be much more expensive than
> Lasik (which isn't covered either, but is less expensive). The benefit
> would be that I would not need cataract surgery in the future on the
> right eye (well, I know they can form again, but it would be somewhat
> of a preemptive strike).
>
> I am thinking my best bet may be to wait until at least November or
> December to have the cataract surgery on the left eye.
>
> Closer to that time, I can decide if I want Lasik on my right eye or
> if I want just the cataract surgery on the left eye, leaving my vision
> essentially the same as it was before the cataract formed. I must
> admit that has a certain appeal. As I grow older, I really don't want
> to add "things to remember" (like reading glasses) to my life. I don't
> really want to hop in the car for a vacation and discover 300 miles
> down the road that I forgot my reading glasses. I never forget my
> glasses now because I can't see much of anything without them, so I
> wear them all the time and I'm used to it.
>
> Does that make sense? Again, I truly appreciate your thoughts.

"Scotti" <(E-Mail Removed)> wrote in message
news:(E-Mail Removed) om...
: I have a cataract on my left eye that needs to be removed.
My right
: eye is fine, but the doctor has offered several
possibilities for me
: to consider, one of which is to have lasik surgery on the
right eye
: two weeks after the cataract is removed from the left eye.
This sounds
: like what I want to do.
:
: However, he has told me that my eyesight will not be
"perfect" when he
: is done, and I will still need glasses to read. My
understanding is
: that I cannot be tested and fitted with new glasses until
the eyes
: "stabilize" which can take 1 to 2 months. Meanwhile, I am
under
: contract to write a book. The manuscript is due December
15. I was
: given a short turnaround time as it is, and I cannot take
"1 to 2
: months" off.
:
: I need to know if I will be able to read well enough
(assuming all
: goes well) after both surgeries to continue with my book
project? Or
: should I wait a few months (the doctor said I could wait
up to 6
: months, but he wouldn't like to go any longer)?
:
: At present I am seeing okay. My right eye, as I said, is
fine.
:
: If anyone has had these procedures, I would really
appreciate hearing
: what your vision was like during the time before you were
able to get
: new glasses. The brochure says I can "resume normal
activities" and
: "read or watch TV" -- but if I am really going to need
glasses to
: read, how am I supposed to read before I get the new
glasses?
:
: Thanks to anyone who can help.

Forgive me, Scotti . . . I mean no disrespect, but....

The answers you get will either serve to allay or exacerbate
your concerns, but in neither case will they have any
definite bearing on _your_ particular outcome.

I'm a (new) writer myself (certainly not a doctor), and a
patient considering a clear lens extraction/IOL (possibly
followed by a LASIK procedure), just as you are. If the
surgeon is saying that a waiting time of six months poses no
problems, and you have a manuscript due in five months,
where's the decision? Write your book, write it
_beautifully_ well, have your surgeries, and enjoy your new
vision.

Now, on a practical note, it is quite _likely_ that what the
doctor means when he/she says that you "will still need
glasses to read" is that you've reached "a certain age"
where presbyopia sets in and you need reading glasses.
Neither the cataract surgery nor LASIK will cure presbyopia.
In fact, cataract surgery increases the need for reading
glasses in that eye. If you need reading glasses now,
you'll still need them.

It's likely that simple dime-store readers (or your current
readers) will work for close work out of both eyes. You
should verify with your doctor that this is what he/she was
implying.

Best of luck,

Neil

"David Robins, MD" <(E-Mail Removed)> wrote in message news:<BD18B609.24FAB%(E-Mail Removed)>...
....You mention not wearing glasses at all. Surprise! Unless you go for
monovision (1 eye for distance, 1 eye for reading power) you WILL
still need glasses, since the operations do not increase focusing.

============

Yeah... I kind of wondered about that. So it sounds like the best case
scenario is basically that I will wear glasses that aren't as thick as
my current ones.

I've pretty much decided against Lasik in this situation. I KNOW I
will get a cataract on the other eye (at least it sure sounds like a
"given"), and it probably won't be very long before it develops.

I'm putting the whole thing off until November or December anyway. I
kind of wish I would develop a cataract in the other eye before then!
It would simplify things a lot. But my doctor said he did not think
that was likely.

Thank you again for your time. It is really helpful to get feedback
from an additional source.