I’m deciding now whether to go with near or intermediate toric monofocals. I have tentatively chosen Clareon over Eyhance due to less rotation and PCO risk. That said, Eyhance seems to have a slight edge in terms of near and intermediate vision. Leaving that aside, has anyone else struggled with the choice of near versus intermediate IOLs? I do not have much experience with monovision so may choose near or intermediate rather than both, with the understanding that monovision may choose me! As background, I have been near sighted since childhood and started wearing glasses full time at the age of 12. I also have astigmatism, hence the toric lenses. Many thanks for any shared experiences.
I would put more thought in to what degree of myopia you want than into which lens. The standard near vision you get with the add in prescription eyeglasses is -2.5 D. That will give very good reading vision even in dimer light. The standard near with mini-monovision is -1.5 D. That gives good vision in brighter light and is a good all around choice. But if you are resolved to wear glasses I would go with -2.5 D to get very good reading vision without glasses, and then depend on prescription glasses for distance and driving. Whether it is Eyhance or Clareon probably does not matter from a visual acuity point of view. A recent study found the difference was negligible.
I found and kept these recommendations by an ophalmalogist:
Mini monovision with near bias (give intermediate and near): -1.00 for intermediate -2.50 for near
Mini monovision with distance bias (give distance and intermediate): 0.0 and -1.50
The different recommendation for intermediate makes me wonder a bit and there was no reason for that given. Maybe to fudge how much distance you'd lose in that configuration.
I'm another one who would rather have to wear glasses for distance (which would mean a couple hours once or twice a week because good distance really only matters to me for driving) and be glasses-free for near and intermediate. Bookwoman, the forum member who had her cataract surgery with good near vision the goal, ended up with one eye at -2.0 and the other at -2.5 (evidently -2.0 in both eyes was the goal). When I asked, she said she believes having the -2.5 eye really helps for comfortable reading. She sees well enough that way to function around the house and wears glasses when she needs more than near.
The people who all say mini mono with -1.5 in the near eye is enough for them to see well at near ranges also usually add that if they're going to sit down and read a book they use reading glasses. Their good near is good enough for the phone, which to isn't my standard. When I say I want good near, I mean the sitting down with a book kind. My difficulty deciding which way to go is part of my procrastination over the whole process.
"Life begins at Intermediate." I read that a while back in a J & J article extolling the intermediate vision the Eyhance is supposed to provide. I know you prefer the Clareon, but I agreed with the article about the importance of intermediate vision. That's what I told my surgeon I wanted and I like it.
I just now Googled " Importance of intermediate vision" and turned up some good websites.
i would also like lenses that give 12 inches to 15 feet vision and will happilybwear glasses for anything beyond that.
I think what happens is that some people get drawn in by IOL company marketing. They promote the Vivity for example which gives an extra 0.5 D of nearer vision (into the intermediate range) and sell the lens at a substantial price premium. But, you can get an extra 0.75 D of intermediate by simply using a monofocal set to -0.75 D in your non dominant eye. It is called micro monovision. The extra cost is nothing, and there are no risks of the optical side effects of EDOF lenses. It is the same issue with the Eyhance. If you want the very minor gain which many not even be statistically significant, then just do the non dominant eye at -0.5 D instead of the usual -0.25 D. . The problem of course with doing these intermediate only improvements is that they still do not give you true reading vision. To do that you need mini-monovision at -1.50 D in the near eye.
maura has summarized my situation well. I would add that I can see well beyond 15', it's just not crystal clear. Right now I'm sitting at my kitchen table and looking out at some trees which are about 20 yards away. I can see the branches and clumps of leaves, although individual leaves are blurry. If a bird landed on one of the branches, I could tell it was there, and if it was something striking like a bluejay, I'd be able to tell the kind of bird as well. So even with -2 and -2.5, I still have very usable (at least compared to my old myopic eyes) distance vision.
Well, Ron, as you may remember, I told my surgeon I wanted the Tecnis 1 set for intermediate vision (computer distance) in both eyes and I ended up with excellent distance and intermediate vision and good/fair close near vision. My 2D of uncorrected astigmatism helped, the axis fell on the right spot and well, I got lucky. I was myopic all my life, and both my cataract surgeon and I fully expected I would still need to wear eyeglasses after surgery, but just not so high-powered. We were both pleasantly surprised by the outcome, which only goes to show that refractive outcomes are hard to predict and can vary from person to person.
If you are willing to wear glasses for the best distance vision then one option would be monofocal lenses targeted as follows: . Dominant eye: -1.00 D Non Dominant eye: -2.5 D . This would provide excellent near vision and intermediate vision (1 to 2 feet) with distance vision hitting the 20/32 limit of good vision at about 10 feet. So, for around the house that is sufficient for most activities, but it would be best to wear prescription glasses for driving, although you might squeak in under the 20/40 limit to get a driver's license.
I think we need to be more circumspect in saying what particular choices would provide. First, we don't know how close our surgeon will come to hitting the targets. Second, we don't know whether our individual visual acuity will be better or worse than the mean visual acuities reported in defocus curves. Third, although defocus curves provide information that we hope is more-or-less reliable, and the alternative would seem to be simply relying on our surgeon's judgment alone, we don't know how reliable they are in terms of methodology and implementation. Also, their sample sizes are often fairly small. So, we don't know how representative the results actually are. (That's why I have tried to gather and average together as many Eyhance defocus curves as possible.) . What we can say, for example, is that, with the Eyhance, if you end up with one IOL at -1.00 D and the other IOL at -2.50 D, and if your visual acuities correspond to the average of the mean results in the ten defocus Eyhance defocus curves I've so far found, then, absent any other factor degrading your vision and subject to the other caveats in the first paragraph, you would have 20/30 vision at -4.00 D defocus (9.85") and 20/25 at -3.50 D defocus (11.25"). You'd also have 20/32 vision at infinity. . And if these results could be guaranteed, I'd probably take them myself. Although because I can't be 100% sure that the favorable results of trying 1.50 D of monovision with contact lenses over a few weeks guarantees longterm success, I instead might take -1.25 D in my distance eye (20/35 at infinity, which still would make driving without glasses legal in a pinch). . But, of course, these results cannot be guaranteed. For myself, therefore, I think, for example, about IOL targets as ranges. If I were to tell my surgeon I want him to target -2.50 D in my near eye, then I'd think of it as accepting that the result most likely will end up somewhere between -2.00 D and -3.00 D, with the actual result constraining the range I could choose for my second (distance) eye. So for me, it's not the end result I'd like to achieve that's the problem. It's thinking through how happy I'd be with possible other end results.
Doing any form of monovision should be a process rather than a single decision up front. In the example I gave above the process I would suggest to do the further distance eye first at -1.0 D. If it comes out at -0.75 D, then the surgeon should learn something and not miss on the second eye. And instead of a target of -2.5 D on the near eye, one could reduce it to -2.25 D to maintain the 1.5 D of anisometropia. Or if it missed to -1.25 instead, then I would expect the surgeon to adjust the calculation and still target -2.5 D. I wouldn't think there would be much value in targeting -2.75 D but that could be done too. And last if the surgeon really misses, and hits -2.0 D instead of -1.0 D, then one could switch eyes and make the -2.0 D eye the close eye, and with a readjusted formula then target -1.0 in the other eye. There really is no big deal with switching from the more standard dominant eye being the distance eye to the reverse. Some believe it is better. My monovision is reversed. . This is the value of scheduling to have eyes done at least 6 weeks apart so you can get a final refraction on the first eye to help with the decision on the second eye refinement. It short it is a plan rather than a one time decision.
Thanks RonAKA, With regard to the possibility that I might see both near and intermediate with each IOL set to -2.50 and only have to wear glasses for distance and driving, could you describe the range for the intermediate vision? In other words, does that include my computer screen, TV, or throughout the house?
On a related note, is it customary to give a specific target to the surgeon or just something general such as near or intermediate vision?
Hi Soks, 12" to 15' sounds wonderful! Is that possible with monofocals only and no mini-monovision?
not possible with monofocals without monovosion.
-2.5 is very limited range. 12 inches to 20 inches and the rest is quite blurry when i wear a +2.5 reader on my plano symfony.
Thanks Bookwoman! Did you indicate to your surgeon prior to surgery that you wanted -2.0 in both eyes or just that you wanted good near vision?
In this case, did you ask your surgeon for intermediate or give a specific number?
On another note, I thought to ask my optomotrist recently who suggested intermediate for me. Prior to that I had only been thinking of near.
Hi Lynda111, Thanks! I've googled "Importance of intermediate vision" and do find many interesting titles. More homework prior to my next cataract surgery appointment!
We discussed it at length and decided that -2 in both eyes would be best, as I know that what you put in isn't always what you get (viz. the -2.5 I wound up with in one eye.) I didn't want to risk too great a discrepancy between the two eyes, so wanted the same power IOL in both.
My surgeon is also my ophthalmologist of 30+ years, so he knows me and my eyes well and was always available for any questions. He's a gem. :-)
This is very interesting! So when you and your surgeon discussed the IOL setting, you said intermediate for both eyes, and you both agreed to target -2.0? I had thought that -2.0 was for near but sounds like I was wrong!