Failed At Achieving Mini-Mono; Now What?

Eye care
1

After implanting IOL's in both eyes to achieve mini-mono, I've ended up too miopic.  Scheduled for lasik "touch-up" on June 28, but not liking the options.  Can anyone advise me of a possible solution?

Briefly, I am 58, nearsighted from childhood, and was wearing progressives 24/7.  Developed cataracts in both eyes.  First surgeon was gung ho for setting distance in both eyes.  Without much thought or understanding, I had surgery on my right eye on  Dec 2015 and emerged with 20/20 vision.  But I knew immediately I could never give up the remaining close-up vision. 

After much research, I realized mini-mono was right for me and undertook a lengthy contact trial to make sure I could adapt. I did wonderfully with -1.0.  My goal was mid-range vision so I could  see my bedside clock, car dashboard/navigation, grocery shelves, and TV.  The challenging part was that I also hoped to be able to at least read an ringing cellphone ID or incoming text--if not perfectly. 

I fully accepted I would probably need glasses for reading a book or long computer screen use (I am a journalist).  It's exactly the kind of mini-mono you wanted--and got. 

So I switched surgeons, finding one who supported mini-mono, had ORA and included Lasik touch-up if goal was not reached.  On April 28th, I had the left eye done---and wouldn't you know, I ended with monovision and way too myopic (-3.0).  My eyes now don't work together, I'm utterly disoriented, and feel like I have this "white-out" blindness on my left side.  What I do have is excellent close-up--at the expense of mid-range. 

Don't really understand the optical numbers (tho' I've tried), but here's what I know:  

Right eye after IOL:    20/20 distance

Left eye after IOL:      -3.00 (goal was 250) 

Diopter difference between two eyes:  -3.5  (which is too much for them to function well together)

Surgeon recommended I do another contact trial of -1.25, -1.0, -.75 and -.50.    Turns out -.75 yields great mid-range, but I can barely read cellphone, holding it at 22-24" away (longer than my arms!)  

Is there any solution?  The journey has been so long, I've been without good vision or proper glasses for 18 mos., and I'm tired and depressed that I've ended up here--especially after all the money, time, and discomfort.

Thank you for any informed responses.  Most grateful!

 

2

I have had good experience in using monovision for many years (in combinations at different times of 2 contact lenses, one monofocal IOL and one contact lens, and now one monofocal and one Symfony). Looking at your current situation, these will be my suggestions:

1. Make sure that your right eye now does not have any farsightedness. For example, if it is +0.25 to +0.50 range, your distance vision may still be 20/20, but you may have lost some of the good vision in the 4 to 8 feet range (which you should have if the right eye is in the -0.25 to 0 range). This is probably not a major factor, but any range you lose with one eye has to compensated for by the other eye.

2. As you have already found out, having the left eye at - 0.75 provides you the capability to focus well in the 32 inches to 10 feet range, which is good, but leaves out the more important intermediate distance of about 2 feet. You will probably find that having the left eye at -1.25 or even -1.5 will work out better for the day-to-day living. The -1.25 should give you reasonably good vision from about 23 inches to 53 inches, while the -1.5 value should give reasonably good vision in the more desirable range of 20 to 40 inches.

3. There will be certain mid distance range, which will be only fair with the -1.5 (or -1.25) even when using both eyes, but you will learn to live with that quickly.

4. If your right eye is indeed slightly farsighted, you may want to try getting it to -0.25 with a contact lens while you try -1.5 for your left eye.

It is good that you can use contact lenses to test out the various combinations. Makes it much easier to make the best decision!

 

3

Unfortunately, all I can do is commiserate with you. I'm exasperated, crestfallen, and so disheartened with the eye doctors I've worked with. I have no near vision to speak of and I don't believe docs are being truthful with me. I dont believe that anyone in their right mind would say, " sign me up for the surgery that all but eliminates my near vision, makes night driving nearly impossible, and for sure I want the feature that ensures I'll see the world through a blurry haze!" I don't know how many pairs of readers I've thrown on the floor and gave them a good kick. So frustrating.

I wish you all the best. Keep us posted 😉