Hi All, I need help trying to decide what refractive target to aim for on my dominant right eye for future cataract surgery. I’ve already settled on getting a monofocal IOL implanted in this eye. Additionally, my non-dominant left eye already has a multifocal from 2007. This eye actually has two effective focus points, one at -4.75D (around 8”) and another at -2.0D (around 19”). This gives me excellent ultra near/intermediate vision in the left eye. My dominant right eye has a refraction of -2.0 SPH which provides excellent near vision uncorrected. I’m also only 31 and my right eye still has good accommodative abilities (I can see near objects clearly through my distance glasses). Any recommendations on what refractive target I should aim for? I can’t decide between -2.0 or -1.75 as the baseline target. A little about me; I’m a perfectionist and do lots of reading & computer work for a living. To be honest, I probably should never have selected a multifocal for my left eye but that was a long time ago. I absolutely cannot handle another light-splitting lens on my dominant eye. The multifocal was originally set for distance but over time has shifted to a more myopic outcome. I like the idea of being able to read (like I currently do now) for hours without glasses. I worry if I aim for -2.0 that my dominant eye will not be set furthest as usually recommended (and computer work might be too blurry uncorrected). I would like the ability to work at a computer with no glasses and read my phone with no glasses (but not sacrifice image quality either). I’m okay moving my computer monitor a bit closer to help keep things in focus without glasses. -1.75 sounds great too because it would give me a little more reach and possibly reinforce the right eye being dominant (which might also help suppress halos & undesirable artifacts in the multifocal eye). However, the thought of -1.75 scares me for reading my phone for hours uncorrected and the balance between eyes becoming a little uncomfortable. Any thoughts? What would you do? My goal is to have a scenario where I only need glasses for driving/walking around outside and everything else is no glasses for ~20” and below. Maybe my expectations are unrealistic?
When your right eye is done with a monofocal IOL you will lose all your accommodation ability. If you target it for distance you should still be able to see clearly down to about 18-24", but under that it will be difficult. However with your multifocal in the other eye that should not be a problem. You should have good close and intermediate with that eye. If I were you I would target your second dominant eye for distance, which in IOL terms would mean somewhere between a residual of -0.25 to -0.50 D myopic. That would give you hybrid monovision with a MF in the near eye and a distance monofocal in the distance dominant eye.
Thanks for your comment Ron! My concern with choosing distance is that the difference in diopters would be kind of large between the two eyes (0 or -0.25 compared to -2.0). I’ve read online that having more than 1D of difference between the eyes can make it difficult for the brain to manage. One thing I do like about the option you recommended is potentially zero glasses but I wonder at what cost? Wouldn’t it be true that I’d be losing some depth perception when only one eye is used for each focal distance? I hesitate to move forward on an option like this since my top priority is achieving the highest quality vision (minimizing glasses use is secondary).
There used to be a good article on line called:
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Optimal amount of anisometropia for pseudophakic monovision
Ken Hayashi 1, Motoaki Yoshida, Shin-Ichi Manabe, Hideyuki Hayashi
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Now I can only find an abstract at Semantic Scholar. It does have the figures though. They compared 1.0, 1.5, and 2.0 D anisometropia for monovision. They concluded that 1.5 D was optimal, with minimal impact on stereoacuity. I am currently simulating 1.25 D using a contact lens and prefer it to 1.5 D, but I would accept a range of 1.25 to 1.5 D.
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It seems to me that if you don’t get full distance with your second eye, then you are into a glasses solution for sure. If you get full distance then you have a possibility of going glasses free, while still retaining the option of glasses for the best vision. I currently only have one eye done for distance with a monofocal IOL lens while the other eye is under corrected by -1.25 D and has not IOL yet. However, I still have progressive glasses when I want the best possible vision. Most days I never wear the glasses at all, or only for an hour or so before bedtime to give my eye a break from the contact.
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The only issue I can think of is that some find it is hard to get a good eyeglass solution for an eye with a MF IOL. A pure distance monofocal is easy for eyeglasses as it is just a standard progressive lens. But, either way you look at it, you are stuck with the MF IOL and will have to deal with it anyway.