Monovision plan ?

Eye care
1

I have cataracts in both eyes and want monovision.  I saw the surgeon again today.  He had earlier said he would set the left for distance, and then we’d discuss the right after the left had healed.  That made sense but seemed pretty wide open.

Today I said, the best case possibility that you’ve outlined – that I’d need glasses for driving, the theater, extended reading, and small print – would be amazing, but I know there is variation.  I then asked how the results on the left would affect the decision on the right.  He said, you’d tell me what you’re missing – computer, or reading. 

I asked about the issue of making the eyes too different and he said he’d make the near eye mildly myopic; not too different. 

I then asked if he thought I’d be able to read my phone (big phone, big font).   He then said I would be able to see headlines (as in print), nothing too tiny. I started sharing results of contact trials and he interrupted me and sternly said he can’t get the precision of contact lenses and his concern was that I would never be satisfied. I was stunned but realize how my approach could have made me seem like the patient who wouldn’t be satisfied. I could get few words out thereafter.

I asked if it would make sense to undercorrect the left to make room for more close vision in the right; and he said that is unwise; a slippery slope.  That made sense to me because you could aim for 20/40 but if you get less, then your distance eye isn’t that helpful uncorrected. 

I am left uncertain as to what he might aim for on the right, and how conservative he would or would not be in terms of “mild myopia.”  Should I know that? 

He would use Technis monofocals:  toric in the left (distance) eye; non-toric in the right.  

Tecnis lenses may be good for monovision.  John R. Wittpenn, Jr. MD used the non-toric monofocal  lenses and  targeted 0.5 to 1.00 diopters in the near eyes of 26 patients.  The patients wound up with good distance and being able to read print; and rarely used glasses. 

My surgery date is set for tomorrow.  If I postpone it would not be until late August. 

I would appreciate your thoughts and comments.   

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I will agree with  your doctor to aim to set the left one for distance (with a slight nearsightedness of -0.25 D) and wait for the vision to settle for that. A combination of one eye for far distance and one for intermediate distance (needing glasses for reading fine print) should work out fine for most people, That much of a difference in the two eyes is easy to adjust to.

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Hi Claire -  are you having this done on a national health plan so expense is covered?  Reason I ask is often surgeons have many patients and little patience (pardon the pun).  If not and you are outlaying money for this I find your surgeon’s reaction to questions unacceptable.  It is your vision and outcome you’ll be living with rest of your life.  I would say most people deciding on monofocals do target first eye surgery for best distance - wait for healing and then any adjustments can be made with 2nd surgery.   After being on these forums and reading others experiences like Bella’s I can see the options people would prefer might differ from that strategy.

With toric monofocals you will need to decide what your preference would be unless you have experimented with full monovision with contact lenses before and know beyond a shadow of a doubt your brain and eyes could tolerate that.  A bit of mini monovision to get more range of focus than both eyes targeted the same is much more tolerable and majority of people tolerate it well and find it useful.

The question to ask yourself is would you rather wear glasses to read or to drive (and other distance activities like TV)?

Your surgeon seemed abrupt and uncaring as you grapple with this decision on what to compromise.

If you are uncertain and want to think about your options a bit more (and your vision can wait) I personally would delay the surgery.

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Hi claire5773, I would say the most disconcerting aspect of your post is the surgeon's attitude.  If you can get by safely until August, personally, I'd put the surgery off.  I'm not saying the surgeon's plan or recommendation isn't "reasonable," but it sounds as though you still have quite a few questions for your own situation.  Being rushed into a decision with lifelong consequences is not generally a good sign.  

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Claire5773 - agree with BellaD & Sue.An on the 'feeling rushed' part of this decision. Not that you can't have an explant if really unhappy with the outcome, but that would be a more involved surgery.

I'm still debating my options and BellaD & Sue.An are a couple of the folks here with great insight.  A couple of other things that are not part of your initial post that may help other members chime in

- do you know which eye is dominant? If not, do a quick search and you will see how you can quickly determine that. Reason for asking is that it seems to be a smart approach to aim for the best possible distance vision with your dominant eye if you do decide to go with monovision

- what is your current refractive prescription? Higher myopic patients may have difficulty with monovision.  Also, as Sue.An suggested, monovision can usually be simulated with contacts to see if that is something that works for you, or you find you cannot adjust to, and mini-monovision may be more of a target for you if your RX is not too severe.

Those are just a couple of thoughts from someone who is also in the evaluation of options. 

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Maryland - dominant eye is mentioned a lot and perhaps because I went with an EDOF lens it didn’t factor into the equation but due to cataracts affecting my right eye more when I did those tests myself to determine dominant eye it gave me one answer (LE) but since surgeries those same tests indicate I am RE dominant.

Just curious for anyone that wants to weigh in.  Is it possible for poorer vision in one eye to change which eye is dominant?

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Perhaps I am phrasing that wrong and it isn’t a switch in dominant eye that is occurring but the fact non dominant eye is having to carry the load?

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I don't want to be an alarmist but tread very carefully, this operation and these decisions aren't as simple as the medical professionals would have you think. You will be living with the consequences of these decisions prehaps for the rest of your life. If you aren't completely comfortable with your surgeon & his attitude now think how it will be if you run into after surgery complications. Time is on your side now, you have done the smart thing and reached out to this forum for a reason, think about it.

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Thanks for your response.

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My left eye is dominant, and I am quite nearsighted, especially due to the cataracts.  I have done a trial of monovision; it was an imperfect trial due to the cataracts but I found my eyes were quite adaptive. 

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Since the end result can be off by 0.5D from the target just due to the steps the IOLs are available, plus the unpredictability of the cornea healing, its usually advisable to target slight nearsighted for the distance eye. 

My surgeon had a target of -0.25D for my right eye, but it ended up at 0D or +0.25D plus some residual astigmatism, so I typically get about 20/25 to 20/30 for uncorrected distance vision in that eye but its correctable to 20/20 or better with glasses.

If I did it over, I would probably have set the target slightly more nearsighted like -0.50D to -1.00D since computer intermediate focus is important to me.

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Hi, I am very nearsighted and have had one cataract surgery.  I corrected for near and as a heavy phone user am delighted to still have excellent near vision.  My eyes are complicated because my non cataract eye is very very nearsighted so until I get my next surgery the needed prescriptions are  far apart and require tricky glasses.  With that said, I've been satisfied with how glasses correct my left eye for mid/far distances and my right  for reading.  Since I was happy to wear glasses all the time, I am delighted that the result was the ability to read, use my computer, and see distance with only one set of glasses. For perfect distance vision, however, I need to wear a contact in one eye and glasses. (However, I have no need for vision that perfect except at the movies) It's important that you think about how you use your eyes and when you are willing to wear glasses.  My cataract repair eye ended up a little more nearsighted that the doctor intended, but it has not been a problem for me. I agree that doing what is necessary to feel that you have made the right decision is worth it.

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Mine was done the opposite way-my first eye for monovision was set for near distance. It was my non-dominant eye. It was the eye where the cataract was much worse.

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It is great that you have done a trial of monovision with the contact lenses (I also was lucky to have used monovision with contact lens for years before getting IOLs).

Thus, you can definitely use monovision. This makes the process of choosing the second lens  little easier. After you vision in the left eye settles down , you will be able to get good vision at 2 of the 3 distance ranges (far, intermediate at about 26 inches, and reading at about 16 inches). Although one can work with having good vision only at far and near (and not so good at intermediate) distances, usually it is better to have far / intermediate or intermediate / near combination of distances for good vision (and use glasses for the third one).

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Sue.An, both you and my hubby are having a blast with your Ferrari or is it Lamborghini, scuba diving and skiing. The price tag says it all ~ one focus point vs 10 focus points. I don't want to delve in to too technical stuff, beyond me. I bet those of you implanted with premium lenses (multifocals / trifocals / EDoF) do not get tired as easily as me (monofocals). I do not need glasses for near / intermediate distances. According to Dr Por, if you hate glasses, then EDof and trifocals are for you.

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Sue.An has a valid point here. My family doctor while taking my blood pressure, would leave me abruptly to rush to 2 separate rooms to check on the other 2 patients. Outside in the waiting area there are about a couple dozens patients waiting to get in to one of these 3 individual cubicles. And I am allowed only ONE question per consultation. Sigh!

Specialists with extensive training usually charge more than their less experienced colleagues. However, this is not the case of a universal healthcare system or Medicare, where the cataract surgery waitlist could be as high as 25,000 patients in one single metropolitan city. Private clinics are there for those who want a greater peace of mind and a higher likelihood of success; a small price to pay in exchange for an invaluable investment in your eyes.

Having said that, I would choose a highly qualified eye surgeon with a high number of IOL surgeries performed every year. If he/she has hospital privileges, this indicates that he or she adheres to proper safety and ethical protocol.

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Ha ha!!!!   Funnily enough never hated glasses but wasn’t yet into bifocals or progressive lenses - could read well without glasses before cataract surgery.  But I hear that is when glasses become a pain in the butt.  I wore contact lenses years ago for sports and up until I had my daughter almost 27 years ago.  Eyes became too dry for them and I switched to glasses.  Due to work and my age wasn’t too keen on monofocals (but I have more of an understanding now than decision time of ways they could work for me).   But no regrets for sure of my EDOF lenses and I am truly thinking it is individual choice here and more than one solution to bring good results.  No guarantees until the perfect lens comes out which for now - just isn’t there.

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Maryland 2018; just reading the word "explant" makes my eye hurt!eek

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Boy, I am so with you on this one, BellaD. I don't care how the surgery is paid, you deserve to be treated with respect. Yes, the docs are busy, but a little courtesy goes a long, long way. I was scared to death before my surgery because I just KNEW that I'd have problems (lots of problems), but the doc was great. I walked into the op room knowing that I was in the best hands possible. Even though she's extremely popular and always has clients waiting for her, she never once rushed me...and I have a terrible tendency to talk too much when I'm nervous. I wish you the very best and hope things go smoothly. As SueAn said, they're YOUR eyes.

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OK, I had to chime in wink You're absolutely right about being happy with the trifocals. I'm nearly a week out and cannot get over how good my vision is. I joked with my sister that I haven't had vision this good since I was in the womb. The sad thing is that it's probably true. Like you, the tech stuff was more than I wanted to get into, other than how it would affect me. I was so sick of glasses, but would have been happy if the iols had given me decent far vision. I was expecting so little that the actual results were amazing. More importantly, Claire needs to feel comfortable about what her doc is doing. She may be limited by her choice (mine aren't available in the US or the UK), but that doesn't mean the doc should rush her. This may (or may not) be her only bite at the apple and I think the doc sounds a bit callous and/or burned out.