24 years old, cataract in both eyes , edof or monovision

Hi Chris - not sure I understand this statement. There is a small percentage of people who for some reason see a larger range of vision with monofocals both targeted for distance - but that isn't the norm. Most would need progressives for near and intermediate. Premium lenses can provide more range and as is for all IOLs hitting the target or within .25 of it is key. i copied and pasted part of your reply that I was confused with - my apologies if it is just my misunderstanding.

Mister84 - As for astigmatism it is worth getting toric lenses to correct (these come in monofocals and premium IOLs).

The best choice for your situation would seem to be monofocal IOLs in both eyes, adjusted for distance, and maybe combined with progressive glasses for excellent vision. You may be able to get away with just reading glasses if the implanted IOLs give you plano >

to clear the confusion, you belong to the small group of people who would see all distances with a monofocal just kidding. be safe.

Then that sucks soks cause had I known I would have saved the expense (although much cheaper in Canada for premium lenses) eliminated the concentric circles and gone with monofocals. LOL

Honestly more concerning is this new condition I am dealing with. With COVID19 it will be many months before I see a retina specialist.

Staying as safe as I can. Banks considered essential service so I am at work each day - although many changes and processes in place to protect both staff and customer. Still would be nice to isolate in safety of my home. But on the other hand I have a pay cheque. Unbelievable amount laid off. Glad our gov is helping but how long can that continue?

Stay safe soks. I am guessing all cataract surgeries worldwide are on hold.

i understand the frustration for having to wait. i too need to get my right eye fixed. all cataract surgeries are on hold and my surgeon is in NYC. thanks for being in essential service and its good that they have the added protection. my group is essential rail but i only have 2 people onsite per shift and rotate them. some have complained and there is no hazard pay. unfortunately worst is yet to come. hopefully there is a cure vaccine soon.

I think we are all hoping everyone works together for vaccine.thanks Soks - you too hope all turns out and this is over soon but human nature being shat it is and too many people still not self quaranting it likely get worse before better.

Hi Sue, it is my understanding that aspheric monofocal IOLs will allow good vision for distance & intermediate, or near & intermediate. Glasses would then be needed for the range not covered, e.g., reading glasses for near vision when monofocals for distance & intermediate were used. These reading glasses will not help with distance vision if there is residual astigmatism or if the IOLs were not plano.

Progressive glasses will correct for both these situations, if necessary, and also provide the correction required for near vision. Add in transition coating that automatically darkens in bright light will eliminate the need for separate dark glasses.

I think you'll find who gets a better range (even with aspheric monofocsls) will vary person to person. You will see well at one distance (unless another issue going on). If you see more - it is a bonus. Which is why mini or micro monovision is a very good option and many go that route. We all go in hoping for the best but prepared to have to deal with glasses etc.If you wear glasses regularly the adjustment is less.

The other difference is adjusting to light following surgery. With cataracts light was being blocked so for weeks after surgery everything brighter. I wore sunglasses for weeks inside my house.

Good news this is not life threatening and urgent so you have tome to look at all the options.

I think both you and Chris are correct. Distance IOL's in both eyes and reading glasses for up close may provide the overall best vision at all distances, providing you are willing to put on and take of the reading glasses as required. There are some progressive reading glasses (Foster Grant) that cover both the near and intermediate range, but most will still take them off for good distance. The monovision solution tries to solve this by using one eye for near and the other for distance. And the hope is that not so good intermediate vision from both eyes can be combined to provide somewhat reduced but perhaps acceptable intermediate vision- binocular effect. The graph below illustrates this effect in a perfect world. The hard part in this method is in selecting the right amount of under correction in the near eye. The range used is wide -- from -0.75 to -2.5. That is why contact lens trials are recommended.

Yes finding that right amount of under correction in non dominant eye is the tricky part - add into that the settling which can add an additional change either way. Even if you target both for plano you can have .50 diopter difference. I will leave that to the surgeons - they know ore about the measurements.

Yes, I think that is the advantage of doing one eye and waiting to see what you actually get for an outcome and residual error. Then the decision on the second eye can be made while knowing half the answer as to what you have to deal with.

OK let me add my 2 cents since most opt for distance thinking no big deal to use reading glasses for up close.. EVERY day Im thankful I chose monofocal for near vision. I do a lot of close up work and reading. I see people close up; I drive at night with glasses. I have little to no glare. Both eyes work together, I didnt opt for minimono. But No illusion- my near vision naturally was better before cataracts than now, but its 20/20 and I do need light to see small print when I never did. The blue sky is the most gorgeous color I can imagine (toric lenses removed the astigmatism). Both were set at 1.5. I wanted closer but he said I would lose more intermediate.

I am typing on computer without glasses; I watch TV without glasses. I use them for driving and walking an distance.

Call the facility and ask to speak to the RN or nurse. Ask your questions when she has your chart. I know you can get great advice here from people who either havent had surgery yet or had different surgery or different needs. They are all great but You need someone to listen to you and explain. If no one there can talk to you, go elsewhere. You have the right to understand exactly what is meant by anything the dr says. It really is written up in "Patients Rights" and must be posted somewhere.

I looked back over your initial post where you say that in discussion with your surgeon that you have dismissed multifocal IOLs, due to the potential issues with night time driving halos and glare. While it is not totally certain that you would experience those effects, I would agree the risk of it is significant. I have dismissed using a multifocal lens for those same reasons.

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This directed you to the monovision solution with monofocal lenses. However, you expressed some concerns about loss of binocular vision and being able to judge distance in driving and in sports like kick boxing. My unprofessional opinion based on doing monovision with contacts, is that loss of binocular vision is not that significant. In driving I found that I could see in the distance well, and when I glanced down there was no problem seeing the dash clearly too. The amount of binocular vision that you retain is based on how much the near vision eye is under corrected. In your post above you mention "monovision set on 1.5 D". This most likely is the amount that the near vision eye is under corrected by. It is a pretty standard monovision value. Think of it this way. If you had your near vision eye under corrected by that amount, you would then need an eyeglass lens of -1.5 D to get perfect distance vision. That is not a lot. Some people would not get eyeglasses to correct for that amount of distance loss. And keep in mind the target for the other eye will be set to get perfect vision at distance. Between the two eyes you should get pretty good distance vision. Short story is that with this 1.5 D monovision I would not worry about poor distance vision.

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The other issue is intermediate distance vision. That again, I would expect to be pretty good based on my experience with contact monovision.

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What may be more of an issue is very near vision. I found I could see the computer, and normal print on paper, but I had trouble with small print like the fine print on documents that they really do not want you to read. Or in trying to read the ingredients of an over the counter drug label.

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The number that you should talk to your surgeon about is the 1.5 D. While that is a pretty standard number, there is some movement to a slightly lower number, like 1.25 D. That improves your distance vision in the near eye, and increases the binocular vision even at intermediate distances, like seeing the ball hit your racket in tennis, or seeing the other guy's foot not hit your chin in kick boxing! And the reality is that there is always some uncertainly in what you will actually get after the lens is implanted. The typical accuracy is plus or minus 0.25 D. So a reasonable request of your surgeon is to ask for an under correction of your near eye of 1.0 to 1.5 D. If he gets it perfect, you will have 1.25 D, but it could be as low as 1.0 or as high as 1.5. At the end of the day any of these numbers is likely to work for all your needs except fine print text, which may require over the counter reading glasses.

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Hope that helps some. If it makes you feel any better if I do go with monovision I plan to ask for a 1.25 D under correction.

Ron , while 1,25 might be great for your needs, I think anyone engaging in sport where you need some kind of rapid response needs a bit more intermediate vision and that would be lost with your 1.25. Ofcourse we can postulate as much as we want and I know I would prefer very near vision like you say --although I can read small print labels , its a strain, but I have a further range of vision than I had previously. That is, if I play tennis I do see the ball a few feet ahead of me clearly. For kickboxing he does need some intermediate vision as well as most sports and going too near, loses that; as in it gets blurred a bit. My surgeon had said the .25 doesnt make a huge difference in close up but it makes enough difference in range that he didnt advise it. Having both eyes set the same does offer a depth perception needed for some activity. Its an individual choice and he needs to speak to someone who will explain all his choices. I hope he can get that. At minimum, monofocal will put less glare in front of him at night and with bright lights in indoor sports.

I think it kind of depends on what you define as intermediate. I think most define it as half a meter to 2 meters, or 1.5 feet to 6 feet. It seems to me that for kick boxing that range would be important, as are ranges further than that.

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It also seems to me that having both eyes at -1.5 D is an option that probably gives good computer distance vision, and good book reading, but is starting to get weak at 4 feet and beyond. In other words good for the close half of intermediate, but not so good for the beyond 1 meter distances as vision is rapidly falling off. See this graph for a measure of that.

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With monovision however, that drop off can be compensated for with the other eye which is corrected for distance. The question then become what under correction should be used to give good intermediate vision. That is a trade off decision. From the graph below which gives the combined eye vision with different under corrections in the near eye it can be easily see that a -2.0 D is a poor choice for good intermediate vision. It is weakest in the 0.7 meter or two foot range, which may be critical for something like kick boxing. It does give good vision for reading, but that may be of lessor interest. A -1.5 D is better in the short intermediate range, but weaker in the more distant intermediate range. A -1.0 D under correction is clearly the best in the more distant intermediate range, but a bit weaker in close intermediate. That is what leads me to think that -1.25 D is a good compromise. It is not shown on the graph but should be between the 1.0 and 1.5 curves.

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And what needs to be kept in mind is that the surgeon only has IOLs in his drawer in 0.5 D increments. In the worst case he may have to decide on an outcome of -1.0 D or -1.5 D, as there is no in between choice. So it seems to me that one needs a theoretical target, which may be achievable, or it may not. I think a discussion needs to take place between the patient and the surgeon as to what the preference is. If it comes down to the extreme of a choice between -1.0 or -1.5, what is your preference... Once the doctor has done the cornea topography he probably has a pretty good idea what the options are for the specific patient. My plan is to have that discussion with him before the final selection of power is made.

A few other random thoughts for the OP.

How important is kick boxing to you in the grand scheme of life? There are lots of other sports and physical activities that you could find enjoyable. This is extreme, but if you had lost an arm or a leg (rather than your perfect vision) would you be thinking about finding an alternate.

So have the discussion with the doctor/nurse/consultant and follow their guidance, and use our lay opinions to help you understand what may be possible.

There is another question that should be asked. Is LASIC vision an option after you have healed from the cataract surgery? This could fine tune each eye to achieve the desired refractive outcome. It will be an additional expense, and it may have its own set of disadvantages.

Hope this helps in your research of all the options and consequences.

Hi Ron, Since this is what I actually had done I am speaking only from my experience not what you read. I know everyone is different but setting too close takes away any oppty for seeing more than up close. I can see 4 or more feet away and read road signs. Everyone is different ofcourse. You are coming from a theoretical point and I am coming from my experience. The other point is 2 eyes working together give more close up and more distant than if we took each apart except for extremes. Then a close up eye and a distant eye (mini mono) may give more of the spectrum. I daren't say which is better for him.

Im a huge proponent of anyone taking time to discuss with their provider as I work in medicine myself (not opth) . Thats why the OP needs to find someone to talk to him with his chart in hand especially considering his age.

Im excited for you when you finally have this done. You've done an excellent job of preparing.

the IOL diopters of 0.5D translates to 0.35D on the actual vision. please check that in your iol master measurements.

My personal experience with monovision is with contacts using a -1.25 under correction in my near eye. I had the opportunity of trying varying amounts of under correction and deciding how much I liked. Then I ordered toric contacts with the -1.25 under correction for my near eye. I don't see why it would be much different with IOL's. Contacts of course give you the chance to compare and change your mind, and is the ideal way to get into monovision.

Your correction of -1.5 in both eyes is not monovision. It is simply intentional modest myopia, equal in both eyes. It may be the best solution for your needs but I don't think you can use it to predict what true monovision is like.

That is interesting. That means the IOL increments are not as gross as they appear to be, and are closer to the available 0.25 steps with normal eyeglasses.

I used the wrong term- monofocal. I was thinking of the OP.

yes they are 0.35. for example 16.5D iol gives me plano. but a 17D iol will make me require -0.35D glasses.

noone is really plano. they use the iol closest to 0. so for me 16.5D was -0.19. 17D was -0.54 and 16D was +0.16D for me.

if i wanted -1.5 i would need 20.5D iol whoxh would make me -0.19-0.35-0.35-0.35-0.35= -1.59D near sighted

That is very helpful. I now know better what the surgeon can achieve. I have never worried much about what power IOL lens they use, and have only focused on the outcome residual in eyeglass power terms. That is something I can relate to.

sorry i would need 18.5D and not 20.5D for -1.59D. they do the calculations for you on the iol master automatically and we can request it