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Dr. Dan B.
Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3141
Experience:  Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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I am years old. About 3 years ago an ophthalmologist told

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I am 69 years old. About 3 years ago an ophthalmologist told me I had the beginnings of a cataract in one eye but I was years away from having to deal with it. Last March - about 6 months ago - I noticed my vision in my right eye had sharply decreased. I had moved to a new city My new ophthalmologist said my cataract had grown large enough to make a difference but it was too early to operate. He said to check back in a year unless something happened (and he did a complete eye exam).

I have a strong eyeglasses prescription and don't wear contacts because of eye allergies. i have been able to tolerate the decrease in right eye vision although it's getting slightly worse. I finally went to an optometrist this week to see about updating my glasses prescription, which is 2.5 years old.

The optometrist I was referred to was out so i saw his colleague who seemed young and inexperienced. She said the cataract was sitting in the middle of my eye so it would be hard to correct my vision. She did say it's not that thick. I was surprised my ophthalmologist hadn't warned me. She wrote a new prescription which would be -10.25 in the right eye and -5.75 in the left She said I'd still have trouble seeing with that eye and I might get dizzy.

My prescription from 2011 was -7.50 and -4.25 (I have the whole prescription - also have astigmatism).

The optometrist office said i could come back at no charge to see a more senior optometrist with 20 years of experience and that might be a good idea.

However, i have not seen anything anywhere about dealing with correcting vision while waiting for cataract surgery. I also haven't heard of anyone with a cataract in one eye while the other seems fine.

So I'd like another opinion. I was surprised that my ophthalmologist didn't discuss this with me since the optometrist said it is difficult to correct vision with cataracts.
Submitted: 8 months ago.
Category: Eye
Expert:  Dr. Dan B. replied 8 months ago.

Dr. Dan B. : Hello and thanks for your question. Are you available to chat?
Customer:

Yes

Dr. Dan B. : A cataract is a clouding of the natural crystalline lens that is used to focus light onto your retina. When you were a baby the lens was clear but now that is becoming more cloudy it is called a cataract. Throughout much of the development of cataracts, many times vision problems suffered by patients can be improved just by changing the glasses. But after a certain advancement of the cataract, the vision cannot be improved even with a new pair of glasses. This is quite common. It is also quite common for the cataract in one eye to be more advanced than the other eye. Many people have symmetric growth of their cataracts, but I see every day people who have a cataract only in one eye, or it is only affecting them visually in one eye. This is also quite common.
Dr. Dan B. : Furthermore, as a cataract progresses, especially if it is an age-related or nuclear sclerotic cataract, as it thickens, it can cause the cumulation of more nearsightedness or myopia. This is, what I suspect, likely happening to your vision in that eye and why your glasses prescription has accumulated more nearsightedness.
Customer:

Yes - I understand this. My question is, what do I do? Return to my ophthalmologist and ask him to revisit the timing of surgery? Get slightly better glasses? Live with what I have?

Dr. Dan B. : The reason you were told that you might be dizzy by filling this new prescription, is that when the refractive error of the two eyes is significantly different, the images presented to the brain by each eye are also significantly different sized, and this causes the brain difficulty in resolving that difference and can make it seem as though you are drunk or swimming in a fishbowl. This is called anisometropia. Does all this make sense?
Customer:

Yes . However, I have heard of contact lenses where one eye was distance vision and one was reading and the brain trained itself. I also have a problem anyway since (as you can tell from my prescription) my right eye is probably legally blind and my left isn't that bad in comparison.

Customer:

What would you suggest I do - ask my opthalmologist to review the timing of the surgery? Try new glasses? Live with what I have a few more months?

Dr. Dan B. : I think either a return visit to your ophthalmologist, or maybe even a second opinion from another ophthalmologist might be the best way to go. You may find that your cataract actually then does qualify by insurance guidelines to be paid for and have it removed. If not, you may consider getting a new prescription but not have it be quite as strong or the difference not quite as great, backing off on the strength to avoid difficulty functioning with the new glasses.
Customer:

Yes that makes sense. I like the fact that my doctor isn't rushing me to surgery too soon but it may be time. It has been just over 6 months and perhaps the cataract is growing faster now. I have no idea how fast cataracts grow!

Customer:

My eyes are otherwise healthy - no glaucoma and no macular degeneration. I do see an opthalmologist each year but prefer refraction from an optometrist.

Dr. Dan B. : Yes, the arrangement in contact lenses that you describe is called monovision. Some people are able to tolerate this and ultimately use one eye for near and when eye for distance. You can try to adjust to this and see if you're able to do this just based on the natural refractive state of your eye, but it may prove to be difficult. You also, if your cataract does not qualify by vision guidelines to come out and be paid for my medical insurance, you may petition your medical insurance To approve the removal of your cataract on the basis of disabling anisometropia, especially since you're unable to work contact lenses.
Customer:

Great! I have medicare with a medigap supplement.

Dr. Dan B. : The growth of cataracts is very different from patient to patient. Most of the time slow steady progression and growth is what occurs. However, many times, I have seen patients whose cataracts take off in growth over a period of a few months, or have grown enough that they now inhibit the vision significantly and that are qualified to have it removed surgically.
Customer:

Excellent. I hope it doesn't signify anything else - my health is so good that I rarely need anything. No meds at age 69!

Dr. Dan B. : It sounds like you're pretty healthy! Do you have any other questions about this
Customer:

I think I will ask the optometrist for a reduced prescription, just in case, and also call my opthalmologist. I really like my ophthalmologist - there are 2 partners and both are extremely knowledgeable, professional and even have a sense of humor. They ahve a good rep - I live in a big city - and the surgery would be done at a big university hospital.

Dr. Dan B. : I think that sounds like a very reasonable plan. Do you have any other questions or concerns about this that I can help you with?
Customer:

No - this is very reassuring! great to get a second opinion so fast and you seem knowledgeable.

Customer:

Unless you have other suggestions, I'm satisfied.

Dr. Dan B. : Thank you. I'm glad this is been helpful. These are situations I deal with on a daily basis as a cataract surgeon. Good luck to you. Your feedback is important to me and will help me improve my encounter with future customers. Please rate your encounter with me by providing positive feedback (by pressing the smiley face); any bonus you may feel prompted to provide would be welcomed and is appreciated. If you feel like your concerns are not resolved or you have a problem or issue with anything I have said or haven’t said, please don’t issue a negative feedback rating—My goal is your satisfaction and I would rather work together to solve your concerns, until you are satisfied, than have you leave our encounter unhappy and unsatisfied. My opinion is solely informative and does not constitute a formal medical opinion or recommendation. For a formal medical opinion and/or recommendation you must see an eye doctor. Thanks for your inquiry!
Customer:

Ah - a cataract surgeon - so you know your stuff. thanks!!!

Dr. Dan B., Board Certified Ophthalmologist
Category: Eye
Satisfied Customers: 3141
Experience: Eye surgeon experienced in cataracts, glaucoma, retina & neuro-ophthalmology
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