One of the reader suggested I start a second thread as the other one has become very long 
Q1- Is Mini-Monovision and Micro-Monovision same thing?
Q2- To be classed Mini-Monovision is there a min/max range of diopter difference between both eyes that needs to be achieved?
I am so drained!!!
Q1. I think people use them interchangeably but some may use the term micro to mean a smaller diopter difference.
Q2. I think it’s up to the individual/doctor to choose what’s best for them but seems like most numbers I’ve seen are in the range of .75 to 1 or 1.25 diopters difference. I think 1.5 and above is more in the monovision range. The larger the difference the more near vision you will get.
You may be drained but your discussion is going to help so many people who happen upon this forum. Thank you for continuing to share your wife’s story. We are all eager to find out what surgeon you pick, what lens you choose, and the outcome of recovery!
what is the adage, never can ask enough questions! KEEPING ASKING,
Yes thank you dearly for this because I need to know these things too, as I likely head towards different diopters in each eye eith monofocal lenses. Too many halos and ghost images.
I don’t think the name matters much, but in my case there is only a half diopter difference between eyes, so it seems like “micro” to me. Your wife’s surgeon will take all this into account when it comes time to measure and prescribe for the 2nd surgery in a few years.
Once you have your 2nd surgical consult, you will most likely feel pretty well informed and begin to relax. Health outcomes are always better when we remove worry & stress from the many variables in the equation. Soon you may have to change your name to “No Worries Husband”.
After sleeping over, the first Surgeon’s meeting (well assistant surgeon’s meeting as we never saw the actual surgeon). We both feel bit luke warm about her.
She seemed competent but was rushing though when talking with us. Also she did not ask anything about what my wife does for her work. I mean that plays a critical part in lens choice. We had to bring that topic up ourselves.
Also when I asked if the lens was hydrophobic or not. She had to look up on the IOL page to answer that.
Hoping the 2nd surgeon (recommended by eye doctor who discovered cataract) is more empathetic and engaging.
Even if we decide to go with the first clinic then it would have to be after a consultation with the actual surgeon after clarification of some points.
So if my wife’s left eye is set to monofocal no help at distance (0.00) and her right eye is untouched for 1+ years ( or more or less depending on the speed at which cataract develops in the right eye).
Q3a- What type of dynamics would be taking place with her vision? I mean left set to far and right natural lens being able to see near and far?
Q3b- And whenever the right is done, say for far but -1 to -.5 diopter difference from left. Micro/Mini Monovision. Suddenly she will go from near + far vision to mainly far only?
Came across these interesting comments below an article
**“Does Mini-Monovision Measure Up to Multifocal IOLs?” **
Dr. Edward Shen
Apr 23, 2015
I completely agree the result of this study, so I never recommend my patients to spend more unnecessary money to buy multiple focal IOL after cataract surgery.
Dr. drtarachand sharma
Mar 25, 2015
Very good option for whom multifocal can not be used. Some patients are so happy they say “Doctor you have done magic to my sight”
Dr. Bulent Ozkan
Mar 25, 2015
I advice some of my patient to have the advantages of binocular vision by correcting near with post-op -1,75 in both eye. Their vision 20/20 at 35-40 cm and are very happy to see near without glasses as most of their occuppation is required near vision and also they are not wearing glasses in distance most of time except driving, wathing tv ect. By this way of course they don’t expose to the risk of multifocal IOL or monovision approach that sometimes require correcting surgery
Katherine H
Mar 24, 2015
@Dr. Scott Corin Do a contact lens trial first, and charge a reasonable fee for the extra time put in, then charge the regular fee for monofocal IOLs. Once you know what power to go for, the surgery itself should incur no extra fees that would be charged for multifocal IOLs.
Katherine H
Mar 24, 2015
In my optometry practice I used monovision successfully for numerous presbyopic contact lens patients.
One lesson I learned rather early was that patients approached monovision correction in one of two ways: they either loved the idea of it, and eagerly wanted to try it, or they self-selected themselves out of it by literally backing away from the idea. If someone’s body language told me that they didn’t like the idea, I knew they would not succeed in any type of monovision modality.
In choosing an IOL for monovision or for a modified version like the “mini-monovision” discussed here, I would advise a surgeon (should one ever ask for my opinion) to be sure their prospective monovision user tried that modality for at least two weeks via contact lenses. It seems like a much more cost-effective way to tell if someone will adapt well to it than just doing the intraocular lens choice without even discussing it first. (And, yes, there were a couple of surgeons around my area that were doing just that. Patients were returning to me that were very unhappy with the unequal vision they had and knew nothing about monovision or that it was even an option. And this was true for cataract extraction as well as RK, and later, PRK and LASIK.)
Monovision can and does work well for some, but it just seems like a simple trial of two weeks with contact lenses first might be a good way to screen those who won’t like it on any terms.
Dr. EDWIN BERCOVICI
Mar 24, 2015
I was doing mini-monovision cataract and refractive surgery during the last 20 years or so of my practice. I retired over 12 years ago. I explained the concept to my patients pre-op, and I had no complaints. Patients were generally thrilled with the results. I advised my brother to have it done with his recent cataract surgeery, but his ophthalmologist told him that he did not do that. I think that it provides for a better quality of life than correcting both eyes for distance with surgery and prescribing reading glasses.
You might come to find that eye surgeons tend to be formal and reserved. I found that they are compassionately focused on the functioning and healing of the eye – not so much the feelings of their patients. I think if they could just have conversations with your eyeball they’d prefer that. Probably why they didn’t become general practitioners, haha!
You will not have good reading vision with minimonovision, what ever you choose will always be a compromise.
Your distance vision starts somewhere around 1,5-2 meters in front of you and from this distance to eternity, is being covered by the same focal point in a monofocal lens, with clear vision all the way.
If you want to see “perfect” at 80 cm, you will need about +1,5 added to distance vision.
If you want to see “perfect” at 40 cm, you will need about +3 added to distance vision.
The added power can be done with glasses, or monovision if the brain is capable of adapting.
With monofocal lenses and monovision you need to choose, what distances are important to you.
The bigger gap between the lens focal points, the worse vision gets between the focal points.
If you make the focals points close with minimonovision, you do not feel the gap between the focal points, but you will have no reading vision, because the added power is not enough.
And if you make monovision with a big gap, you can get reading vision on one eye, but in between the zones in the midrange you will have blurry vision.
It also depends from person to person, some brains are very good at compensating, others are not, and you really do not know before after the surgery, this is one of the reasons the surgeons can not give you more precise answers to your questions.
Some brains are capable of getting a broader range from a monofocal lens than others, just like some have better voices or can run faster that others, we all have different abilities in our genes.
“You will not have good reading vision with mini-monovision, what ever you choose will always be a compromise.”
…but glasses will make up for it? Also I just don’t understand how aging will impact everything? Just need to change the strength of the glasses?
Yes, with monofocals, you can have great reading vision with glasses.
Many people think that vision change over years making you hyperopic (farsightet), but it really does not, what changes are the ability to see up close.
The ability to see up close is called accommodation. The natural lens in the eye is making this accommodation, and making sure we can see up close as well.
When we get older the lens gets stiff, and gradually we loose the ability to accommodate to see up close, but still, the far vision does not change.
When you are having your lens exchanged, at that exact moment you loose all ability to accommodate along with the operation, and that is why, with a monofocal lens set for distance, you only have distance vision, because the eye can no longer accommodate, so you can no longer see up close.
The premium lenses tries to make up for this, with clever lens technology, and tries to give you up close vision as well, but it will always be a bit of a compromise, and that is why we have some of the negative side effects on the premium lenses.
So when you get any new lens in your eye, either monofocal or premium, it does not change the rest of your life, unless you get some other type of issue or disease in your eye.
The eye that still have the natural lens will slowly loose the ability to accommodate, so in this regard, until the second eye is done, I guess you need to change glasses from time to time because of the change in the natural eye.
Danish, did you make a final decision on what you are getting or do you keep changing your mind?
**Q4- **
Shape of the IOL!!! So I see round IOLs and rectangular IOLs.
It seems square ones help with delaying/preventing PCO but increase the chance of positive dysphotopsia?
Some have substantial material outside the circular part some have thin wire like twin legs.
So what should one go for? So far my understanding is Acrylic and hydrophobic is a good combination.
Q5
I see some IOLs come with an injector. It looks like IOL exists rolled/folded inside the injector and it is injected inside the capsule and it opens up?
Are all IOLs inserted using an injector or lot of IOLs inserted manually?
In two days from now I will be getting the Zeiss AT lara (similar to Symfony) in my dominant eye.
And wait 5 weeks with the second eye, and then decide if I want another Lara, or if I will go for the Lisa Trifocal in the second eye.
Cheers
Christian
I have no idea about the shapes, but all IOL that are used on the European marked are inserted with an injector.
Some manufacturers preload the injector, in other cases the surgeon must do it in his own injector, but in any case the lens is being injected through a 2mm hole, and then unfolds in the capsular bag.
I have seen that in India you can have a “budget” job done, where they make a bigger hole and do not use injectors, probably because the lens they are using is not capable of being squeezed so much, but this procedure will give you much longer recovery time, and more risk of complications.
You are a brave guy! Hope it works out.
How did you work out your dominant eye? That basic hole in the paper test or some other sophisticated method?
Yes the square edge IOLs are more prone to positive dysphotopsia, but may help delay/prevent PCO. Round edge and silicone IOLs are best to avoid dysphotopsia, but have increased risk of PCO. There unfortunately is not one that does both. I don’t know much about the haptics except that some may be better in the event you need to do a lens exchange.
I have some positive dysphotopsia (IOL flicker) with my Alcon square edge monofocal IOL. Hoping it will be gone in time with neuroadaptation - doctor seems to think so. And I also have trace PCO already not long after surgery.
I am sure it will be fine, I am not that worried, but thanks.
Yes, the hole in the paper test worked fine for me.