Hi All, Will try to keep this short as possible. As some may know from my previous posts I had a left eye mono-focal lens set for distance successfully implanted several years ago. Now, my right eye is going. It "naturally" (cataract affected, really) has near vision with a slightly more than 2.0 diopter difference from my left eye. I've had two consultations with two clinics. My expressed goal is to be glasses free 99% of the time. First clinic (Barcelona) didn't seem to give me the time and attention I felt I required but in the end recommended a mono-focal lens set for -1.0 in my right eye for a mono-vision strategy. Second clinic consultation was yesterday (Girona, Spain..I'm actually from the US btw). The doctor seemed to listen to me more than the guy from Barcelona so that was good. He initially recommended a mono-focal lens of the same brand (Zeiss CT Lucia ) as my first eye and set to -2.0. He said ideally it's best to go with the same brand in both eyes. I told him I felt it was a bit on the extreme side of mono-vision and I felt that maybe -1.5 would be more suitable. He was okay with this. But then I asked him about the EDOF options, which in my own head I thought was a smart choice for my right eye because I was thinking I could still get reasonable distance whilst also getting the benefits of mid/near.I figured that an Eyhance set to -1.0 would maybe be perfect for me.But he wasn't very keen on this idea. He said he'd had two patients who had to have their lenses explanted when they did one mono-focal and one EDOF lens. I unfortunately didn't ask him exactly why the patients felt they needed the lenses taken out. So my questions are this: 1) Has anyone here had any experience with one mono-focal lens and one EDOF lens like the Eyhance or Vivity? I would have thought that mixing a mono-focal with an EDOF lens would be a fantastic idea. I can't understand why some people didn't have success with it? 2) And a few more actually ) Would -1.5 on the mono-focal get me to a reasonable reading distance? And what would my distance vision look like at -1.5. I think the doctor said my chart reading would be 20/60 at -1.5. Does that sound about right? Not sure about the reading distance though. I can read with my existing left (mono-focal eye at 20 inches or so, but not closer than that. Ideally, I'd like to get some reading at maybe 14 or 16 to 20 inches with the -1.5 eye but I'm not sure that's possible. 3)...oh and lastly, IF say I get the mono-focal implanted at -1.5 in the right eye and the doc doesn't hit the mark perfectly. I understand Lasik can "fine tune" the vision either direction (more close or more near)... Is this true? Apologies for the lengthy post. Kind Regards, IG
I have no experience with mixing a monofocal with an EDOF. I have read about it, and it seems to be a good idea. Try googling this for a paper that talks about using a hybrid monovision with an EDOF lens. If I read the paper properly they use a monofocal if the pupil size is 2.5 D or less, and the hybid monovision EDOF if it is higher.
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Monovision Strategies: Our Experience and Approach on Pseudophakic Monovision Misae Ito CO* and Kimiya Shimizu PDF
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I tried to discuss this option with my surgeon but it got bogged down with his poor experience with one patient who got a Vivity that was not up to the patient’s expectations. I got the feeling that he classed me as a “demanding” patient and I would not be happy either. It is unfortunate that he would not give me the time to discuss option in detail and in the end pushed me away from the Vivity and also away from a toric lens. I could have gotten a toric Vivity, which I still think would have worked well. If I was to do the Vivity I would target -1.0 D of myopia. But, at the end of the day, these surgeons are not going to go outside their comfort zone. Monovision is a good strategy, but it takes more planning and effort on behalf of the surgeon to do it right. It is worthwhile to seek out a surgeon who is willing to schedule the time to do it.
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With a monofocal, based on my experience with a simulated monovision with a contact, and now with a monofocal Clareon IOL, I would suggest a target of -1.5 D is ideal. That was my initial target, but the surgeon pushed me to -1.25 D as he was expecting a residual of -1.0 D cylinder (astigmatism) which would contribute to the effective sphere power. According to his measurements earlier this week the actual outcome was -1.25 D sphere, with no measurement of the astigmatism. I’m sure I have astigmatism, but I don’t know how much exactly. Will find that out at the 6 week check. I believe this gives me about 20/50 vision at distance. At about the 6 foot range where I watch TV my vision with each eyes is almost exactly the same. The close eye is slightly softer, but still very good. Like you I can read to about 20" with my distance eye, and now to about 12" with my close eye. I can easily read text on my computer monitor, and text on my iPhone 8+. In full sunlight I can read J1 on the Jaeger chart, and with indoor lighting about J3 easily, and J2 with some effort. I would say my experience is that it meets 99% of my needs. For really close work or extra small print I use some +1.25 readers. My thoughts are that with a monofocal a target of -1.0 D is not enough, and -2.0 D is too much.
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I have discussed correcting my residual astigmatism with my surgeon and he recommends Lasik. He says that with minor corrections Lasik is low risk and effective. I will wait and see what my final cylinder measurement is after 6 weeks and then consider it. I need to find out from the Lasik specialist how they will deal with irregular astigmatism before I make the final decision on whether to do it or not. There are some formulas for calculation of the required IOL power that are better than others, so there is no unintended miss of IOL power. Google this article for some more information. My read is that the Barrett Universal II and the Hill RBF-2 are the best when targeting mild myopia.
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OPTIMIZING OUTCOMES WHEN THE TARGET IS LOW MYOPIA ANDREW M.J. TURNBULL, BM, PGDIPCRS, FRCOPHTH; WARREN E. HILL, MD; AND GRAHAM D. BARRETT, MB BCH SAF, FRACO, FRACS PDF
Hi Ron,
Thanks so much for your informed reply. You are an invaluable member of this forum and please know I appreciate your contributions immensely.
As for YOUR outcome, I would say that you’ve done extremely well! If, as you say, 99% of the time your needs are met, if I were you I wouldn’t even consider Lasik to correct anything else… even if a Lasik procedure is low risk. But that’s just me.
I have a couple questions for you…
Okay, so you’ve said you can read clearly at 12’’ with your close eye (a great outcome I think). Does this mean you can also read clearly at 20’’ with that eye as well? In other words, what is your working range with that near eye? Am I correct in interpreting your statement above that the answer is essentially from 12’’ inches to 6’ feet? What I’m hoping for is that my yet-to-be-operated-on near eye will cover more near vision (simliar to your 12’’ distance) whilst also overlapping with my left (already operated) ‘far’ eye.Obviously, as we go out to infinity the distance vision with the near eye is going to decline and in your case, as you’ve said, you go to 20/50 with your -1.25.This seems about right because my Girona doc said that if I go -1.50 diopters with my near eye, I would expect around 20/60 distance.
Lastly, do you know if it’s true that Lasik can fine tune going in either direction? For example, say my doc doesn’t hit the -1.50 target and is off by 1/2 a diopter one way or the other. Can Lasik correction be done in either direction to correct it?
Again, congratulations with your outcome. I think all the research you’ve done has been worthwhile for you (and us on this forum).
Kind Regards,
IG
Yes, I can read normal size text such as this forum with my near eye out to about 3 feet on a computer monitor. Then it starts to get too small to read. There is no gap in vision between the two eyes. With both eyes open very good vision extends essentially from 1 foot to infinity. The dash instruments in my car are clear with either eye. As I said my TV vision at 6 feet is very good with the near eye. I am still seeing a shadow on the right edge of high contrast objects or text with my near eye, and not with the far eye. I’m sure that is the astigmatism causing it.
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Yes, Lasik can correct in both directions and for astigmatism also. There are some limits for extreme myopia or hyperopia. If I go ahead with the Lasik I will probably ask for a slight increase in the myopia, perhaps to -1.4 or so, to compensate for the loss of astigmatism which is probably helping me a bit with near vision.