Refractive lens exchange vs. LASIK post-cataract surgery

I am a 54-year-old woman with symptoms of a cataract in my right eye,
resulting from a vitrectomy and epiretinal peel last January (which
restored my corrected vision to 20/15!) Both eyes have moderate/severe
myopia with astigmatism (OS/OD -5.50 -1.50 x180 +2.00 add). The
cataract surgeon I consulted agreed to my plan of implanting an
aspheric IOL (with astigmatism incisions) in that eye, which leads to
the dilemma of what to do with my eye that shows no signs of cataract.
My choices seem to be: (1) continuously wearing a contact lens in my
left eye; (2) some type of laser surgery; (3) refractive lens exchange;
(4) an implantable contact lens plus astigmatism correction. I'm
hoping to avoid an outcome that leaves me with worse vision/new
problems, yet I can't imagine wearing a contact lens continuously for
the next 10-15+ years.

There's also the issue of my vision goal for surgery. I was thinking
of aiming for mild myopia in both eyes (-.5D? -.75D? -1.00D?), hoping
that I could sometimes function without glasses/bifocal contacts. Does
this make sense? I'm also concerned about the accuracy of my
pre-cataract surgery measurements, especially given my history of
vitrectomy. Would I seem like a nut case if I requested that they be
done twice (or using two different methods?) I currently wear toric
contacts/reading glasses but want to try Triton bifocal soft lenses
post-surgery for near/intermediate vision correction. (Monovision
doesn't work for me.)

I have technical information about my choices, but would appreciate all
input based on real life experience.

Anon E. Muss wrote:

>On 21 Jun 2006 19:17:51 -0700, "Jane" <(E-Mail Removed)> wrote:
>
>
>
>>I am a 54-year-old woman with symptoms of a cataract in my right eye,
>>resulting from a vitrectomy and epiretinal peel last January (which
>>restored my corrected vision to 20/15!) Both eyes have moderate/severe
>>myopia with astigmatism (OS/OD -5.50 -1.50 x180 +2.00 add). The
>>cataract surgeon I consulted agreed to my plan of implanting an
>>aspheric IOL (with astigmatism incisions) in that eye, which leads to
>>the dilemma of what to do with my eye that shows no signs of cataract.
>>My choices seem to be: (1) continuously wearing a contact lens in my
>>left eye; (2) some type of laser surgery; (3) refractive lens exchange;
>>(4) an implantable contact lens plus astigmatism correction. I'm
>>hoping to avoid an outcome that leaves me with worse vision/new
>>problems, yet I can't imagine wearing a contact lens continuously for
>>the next 10-15+ years.
>>
>>
>
>I would attempt (1) first. If that is not tolerated, then I would
>consider a surface refractive procedure such as LASIK or PRK.
>
>

I agree with #1 first, but disagree with even considering lasik or prk.
I think at her age, doing a refractive lens exchange makes a lot of
sense, after her peripheral retina has been checked thoroughly by a
retinologist to address any risk of detachment. This of course assumes a
very nice outcome of the first eye.

I also agree with shooting for a mild myopia, around -.5 on the first
eye, and after evaluating the final outcome, decide on the other eye target.

w.stacy, o.d.