I’ve been wavering between mini-monovision and IOLs set for distance. I spoke to a friend who went with distance for both eyes. She can see within 3 feet, it is not a complete blur. That said, she uses readers for near and intermediate print. I believe I’ve read others describe having a very different experience where they feel surrounded by a blur. Would love to hear from members who went with distance and what you can see without glasses. Many thanks!
My wife went with distance and Eyhance IOLs; I went with mini-monovision. Her vision does not drop off a cliff. She has very good intermediate vision: is comfortably able to user her MacBook Air computer. Her near vision isn't good enough for her to comfortably read normal size text. If she increases the font size on her phone, however, the text becomes legible. Of course, this doesn't work for fixed-size text. Her biggest complaint is needing to put on and take off readers when working at her desk and switching from her computer screen to books and papers. Based on my pre-cataract experience with progressives and her ophthalmologist's advice, her intention is to get Shamir Computer or Workspace lenses. . It's not an issue for me because, having prioritized near and intermediate vision with the Eyhance and mini-monovision, I have very comfortable (J1) near reading, very comfortable intermediate reading (of smaller font sizes on my desktop monitor than I'd ever actually use), and lucked out with 20/25 distance vision.
The comment about everything being a blur except for distance is not accurate. For those that go for distance set lenses, they typically have good vision down to 2 to 3 feet. I seem to have been further blessed. My distance eye lets me see down to about 18". And on top of that my near eye lets me see from about 8" out to 9 feet or so. That means I see well and have good vision in both eyes from about 18" to 9 feet. For that reason I have very good depth perception in that same distance range. And this is with standard monofocal lenses.
Thanks RebDovid! I understand everyone is different, but could you share the numbers for your left and right eye? For example, -1.75D?
What I'm really trying to learn is how much difference there was between your eyes. Also, did you have experience with mini-monovision using contacts?
Would you say that distance vision works well for reading when supplemented by readers or progressives? I'm not familiar with Shamir Computer or Workspace lenses.
Wow! That's amazing! Reminds me of another question I've been pondering... When your monofocal lenses are set for distance, is your vision the same from 2-3' to infinity? Thanks again for commenting on my posts!
Yes, of course. With a distance set monofocal vision improves from the OK 20/32 point at 2-3 feet progressively to 20/20 or perhaps even 20/15 at full distance. That is unless there are other vision issues like uncorrected astigmatism. . But keep in mind the same happens with mini-monovision in the distance set eye. You may not get 20/15 as you might with both eyes set to distance, but 20/20 is realistic, providing you target -0.25 D for the distance eye.
Using spherical equivalents, that is, adding together the spherical correction and 1/2 the predicted residual astigmatism, we targeted -2.0 D for my near eye and -1.0 D for my distance eye. Due to refractive surprise, I ended up at -1.5 D and -0.5 D. ( I put the near eye first because that's was the first eye operated on. Prioritizing near and intermediate vision, we wanted two bites at the apple.) . Yes, I trialed mini-monovision with contact lenses both before surgery on my first eye and during the interval between the surgeries, which were six weeks apart. I'm sufficiently risk averse that I wanted cataract surgery to target a smaller amount of mini-monovision than I successfully trialed with contact lenses. . I'm not sure I understand your last question. When I read, my near eye is doing most of the work and I don't wear any glasses. My wife uses readers, which take away her distance vision. She doesn't need more, but the annoyance factor in having to put them on and take them off is leading her to deciding between the Shamir lenses. . You can find out about the Shamir Computer and Workspace lenses by searching Shamir Lens USA, then look for the appropriate drop down menu. Basically, the lenses are like progressives, and Shamir is a leader in the field of progressive lens design, in that they provide a no-line, continuous flow from intermediate to near vision. According to Shamir, they work from 15" and out. The Computer is supposed to work to about 5'; the Workspace, with a narrower field of vision, to about 10'. The Workspace also provides a smidge of distance vision at the top. Pre-cataract surgery, I used the Workspace lenses for working at my desk. The distance vision was so good that I occasionally forgot I wasn't wearing my everyday progressives and would find myself driving with them. In conversation with a few opticians and my wife's ophthalmologist, who also uses the Workspace, I found my experience isn't unusual.
Thanks Ron! Could you clarify if those with mini-monovision need glasses? I've heard yes and no on this...
I'd been wondering if those with IOLs set to mini-monovision need any form of glasses, which I see is yes. That said, it sounds like your wife with IOLs set for distance and without mini-monovision finds the need for readers more onerous than you do with mini-monovision and one eye set for distance. I hope I've got that straight!
Are the Shamir Computer and Workspace lenses similar to progressives without optician or optometrist involvement or do you need a prescription?
Do you have a sense of what caused the refractive surprise?
What do you mean by two bites from the same eye?
The objective of mini-monovision is to be eyeglasses free. However, there will almost always be some uncorrected error. Glasses can make that final fine tuning adjustment if you want it. I have prescription progressives but almost never wear them. About the only time would be when driving in the country in the dark. In the city day and night I am eyeglasses free. I do reach for my mild +1.25 D readers occasionally when reading very small text on paper in dimmer light. That said I can read restaurant menus in typical restaurant dim light without glasses. I would not bring glasses if I am going to be dining out. . Some target more myopia than standard mini-monovision calls for and they will most likely be stuck with glasses for distance. Not sure why they do that, as I would much rather be slightly dependent on some cheap readers than on prescription glasses. . I didn't even fill my last eyeglasses prescription as the glasses I have are close enough, and I never use them anyway.
Judith I will let Ron comment , but remember that no two eyes are the same. How well you will see after surgery varies from person to person. Ron said he was "blessed" and Rebdovid said he " lucked out." I was blessed myself, targeting binocular intermediate vision I ended up seldom needing eyeglasses.
Thanks Ron! That brings to mind the suggestion by my surgeon regarding whether to pursue mini-monovision without a having a trial with contact lenses. The plan would be to have my LE corrected to -1.75D (which was the initial plan for both eyes) and then see how I like it after 6 weeks or so. However, if I do the contact lens trial on the RE after surgery to the LE and decide that mini-monovision is not for me, I'll miss the opportunity to have both eyes set for distance and will be limited to both eyes set for -1.75D which I wouldn't want. Does that make sense?
Yes, something those considering cataract surgery should definitely keep in mind! That said, how do I overcome my uncertainly and make an informed choice when I can't rely on the experience of others to guide my path?
Perhaps I haven't been clear. I don't need glasses for intermediate and near vision. Nor do I need them for driving, at least in good daylight or night time driving conditions. I'm nevertheless getting single vision glasses in a mini-monovision configuration targeted for distance and intermediate to have just in case I feel the need for glasses in less favorable driving conditions or when driving in unfamiliar areas. . The Shamir Computer and Workspace lenses are prescription lenses. As I understand it, Shamir's software uses the patient's progressive prescription to calculate the appropriate prescription for its lenses, also taking into account various measurements that the optician is supposed to do to improve the final result. If you're interested, I strongly suggest reading the Shamir webpages for the lenses and reading their on-line handout. . I really don't have any idea what caused the refractive surprise. I only know from all that I've read that ending up 0.5 D from the target is considered a reasonable result. And in my case it worked out very well indeed. . By two bites at the apple I mean that starting with the intended near eye gave us two chances to nail near vision. Even if the surgeon hit the target, it's possible that I would have been unlucky and not gotten the near vision I wanted. After all, defocus curves report mean averages; someone has to end up with worse vision than the average. Had I not gotten the desired near vision with the first eye, I at least would have had the chance to decide whether to target even greater myopia for the second eye. Bear in mind that by prioritizing near and intermediate vision I already was accepting the likelihood of needing glasses to drive and watch TV; I just lucked out in terms of ending up with 20/25 distance vision (20/20 in my distance eye). . This reasoning is why people who want mini-monovision and prioritize distance generally start with the distance eye. If the result from the first eye isn't good enough, they either can try again, and give up on mini-monovision beyond whatever turns out to be the difference between the two eyes, or settle for whatever distance vision the first eye provides and see how much intermediate/near vision they can get from the second eye.
When you say you can read fine without glasses, do you mean you can read a book for several hours comfortably? I ask because the reports I've see here that mention it usually say they have usable reading vision but to read a book like that they still use readers.
As to computer glasses, I have had them for several years now (haven't had cataract surgery and need to stop procrastinating and get it done). I use them pretty much all day for everything and even walk the dogs outside with them day and night and see well enough to do that without problems. The only time I switch to my distance contacts is for driving. Admittedly I'm not one who cares about seeing the leaves on trees individually.
Mini-monovision can't guarantee that you'll have very good vision across all three fields: distance, intermediate, and near. The best you can do--ideally with the assistance of a sympathetic, open-minded, knowledgeable surgeon and defocus curve information about the mean average visual acuities a particular IOL produces--is to maximize your chances of getting the results you want. That's why it's important to think carefully about whether distance/intermediate or near/intermediate is more important to you. After all, it doesn't matter what most people choose. What matters is what you want. . In my case, reading, especially @Bookwoman, self-reflection, and talking with my surgeon led to my eventual targets. And my surgeon was fully on-board. . If indeed having excellent distance vision is your top priority, I would not begin by targeting your first eye to -1.75 D or to any other seriously myopic target. Rather, depending on your IOL calculations, I would discuss with your surgeon whether to target the first or second minus refraction. Assuming you get desirable distance vision, you and your surgeon then can decide how much more myopic to target your second eye. . Assuming illustratively that your first eye is at -0.25 D, if you've successfully trialed a 1.75 D difference with contact lenses (both before and after the first surgery), then you reasonably could target -1.50 D or even -1.75 D for your second eye. While that can't guarantee excellent near vision--and your chances are better with Eyhance than alternatives such as Clareon or Tecnis 1--it should lock in excellent intermediate vision and give you anything from functional to excellent near vision. (I'm taking J1 near vision, which is what I measured last Friday, as being excellent.)
If you would not be happy with both eyes set to -1.75, then I would do the distance eye first and target -0.25 D. Then try contacts in the other eye to see how much myopia you like, and go for it if you like it, and if you do not, then target -0.25 D in your other eye too. . Also it is quite possible with careful selection of targets to see all distances with mini-monovision. I would be quite sure if you ended up at -1.75 in the near eye, and -0.25 D in the distance eye, you would see all distances down to about 8-10', and out to the moon very well. Mini-monovision does not need to be as complicated as some make it out to be. Those outcomes would also honour the maximum recommended differential between eyes of 1.5 D.
Thanks RebDovid! Great to know about 2 bites from the apple.
Thanks Ron! I would need to have first surgery on non-dominant LE and make this the distance eye because LE has the worst cataract. I only anticipate a contact lens trial after surgery for LE when a contact could be used on the RE as a trial.
That brings to mind choosing a cataract surgeon. How much time do you think cataract surgeons generally set aside to get to know the lifestyle and vision needs of new cataract surgery patients? I've noticed younger surgeons (late 30's - 40's) are much more helpful and better at communicating than older surgeons, at least in an academic setting. I'm wondering if it's more important to choose an extremely experienced surgeon (50's) if communication is difficult or a less experienced surgeon (30's-40's) who is great at communicating.
Thanks RebDovid! I only anticipate a trial after surgery for LE when a contact could be used on the RE as a trial.