A Few Questions: On the verge of getting a mono-focal lens

Monovision is a common method to get blended distance and near vision, but some people can't handle too much of a difference between the two eyes.

What is your current eyeglasses Rx for your right eye?  If its not more than about -2.0D that may work for monovision, but if its much higher it could be difficult. Of course you can always use eyeglasses to correct your right eye closer to where your left eye ends up after cataract surgery.

Femtolaser does not add much according to many eye doctors, at least not enough to warrant its high extra cost especially with a low cost monofocal lens.  I recently had cataract surgery only on my right eye with a monofocal toric lens and without femtolaser and it turned out well, saving me about $1500 compared to if I had gone with femtolaser.  My other eye probably won't need cataract surgery for years to come but it has significant astigmatism so I still need eyeglasses to correct that eye while my right eye has ended up near 20/20 distance vision and reduced its astigmatism down so small that it can be ignored.

The most important issue is going with an eye surgeon well experience with the blade incision method and the type of lens you go with.

1. Getting a monofocal lens will be a good decision. Other lenses offer certain benefits, but often have night vision issues associated with those. Thus, it becomes a question of what is more important to an individual.

2. I have used monovision for the last 30 years or so with contact lenses and then IOL's after cataract surgery. It was an easy adjustment for me, but some people have trouble adjusting to more than 1-1.5 D difference between the 2 eyes prescription.

Thus, if your right eye is at about -2.5D (which makes it good for reading), my suggestion is to aim for good intermediate distance vision (at about 26 inches), which will correspond to about -1.5D, thus with a difference of about 1D between the 2 eyes.

Also, you will have good vision in the whole range of about 13 to 40 inches and needing glasses only for far distance.

Try not to aim the left eye for the best vision at far distance. That may be a little harder to get used to. Also, while you may the have good vision at far and near distances, but will not have at the intermediate distances, which is sometimes harder to deal with.

Monofocal lens and "mono vision" are two different things.  I think of mono vision as having two mono focal lens with a difference of at least 2 diopters (or just a situation where your eyes are at least two diopters difference).  Anything within a diopter or less is considered more like "mini mono vision."  Mono vision is something to seriously consider against doing because a lot of people can't tolerate it.  Here's the other thing I considered and why I decided not to do full mono vision:

1.  As you age and your eyes weaken, you may wind up where you don't quite have good vision on "either side of the coin" distance or near.  Then you need glasses for both distance and reading.

2.  Because, mono vision compromises your depth perception, as you age, your chances of slip and falls are greater and your risk for injury increases.

3.  Your eyes work together when they are set within 1/2 to 1 diopter (although I think .75 is the upper limit for me as 1 diopter is pushing it).

So, depending on what lens the doctor puts in your left eye will determine whether you have mono vision or mini monovision.  For me, after I did my right eye, I did my left eye about three weeks later even though the cataract wasn't bad in my left eye (I couldn't stand the mono vision after my right eye was set for distance).  Most people do set the IOLs for distance or mid-range.  So, if you do get your left eye set to distance or just shy of 20/20, you might find yourself back at the doctor's to set the other eye out a bit because the mono vision might drive you crazy.  That's what happened to me - but I can still read up close (I just read things at least 14 inches away rather than 5 inches).

I have two mono focal lens in both my right and left eye.  They are set to 1/2 diopter apart.  I see great for distance as well as up close I can read my small iphone 5s.  Once in a while I might wear reading glasses for really small fine print.  It doesn't bother me at all.

Some who don't want to always use reading glasses for near vision have chosen to do one eye just shy of 20/20 (about 1/2 diopter short of 20/20) and the other eye about 1 to 1.25 diopter short of 20/20 and wind up with a good range of vision (0.75 diopters difference.  They go just shy of 20/20 when their near vision is more important.  Otherwise, if you don't mind reading glasses but want a good range, you might try setting one eye at 20/20 and the other eye about 1/2 diopter short then your distance will be better but you might need reading glasses.  I almost never do even at that setting.  But, everyone's outcome will be different.  Check with your doctor.  Another consideration when doing mini monovision is which eye you want to be more for distance and which one to set about 1/2 to 3/4 diopter set slightly in from distance to get better near vision.  My dominant eye was set for near although most will say to set the dominant eye for distance.  Because it's mini mono vision it hasn't made a difference and as it turns out my dominant eye sees better most of the time for both near and distance than my other eye.

Mike

I can only speak for myself but I have read of several cases.  The most important thing of all I think is to find a great doctor and it sounds like from your post that you have found someone well known.  For me, I was extremely nearsighted  (about 3.5 diopters prior to surgery).  After I had my right eye done, everything was "flipped around" and all of the sudden my distance vision was great but I no longer had good near vision at all in my right eye. This was a big psychological adjustment and I wasn't sure I was going to be able to adapt to this.  My right eye saw just fine in the distance as well as mid-range.  But up close was awful.  We did the second eye and set that one 1/2 diopter in from distance.  With both eyes working together, I was able to see a wide range and as time went on it only got better.  I didn't want to revert to reading glasses so I "retrained my brain" to hold the phone around 14 inches away from my eyes rather than 5".

I can't emphasize how important that was for me to "retrain" my brain to find a new "sweet spot" if I didn't want to use reading glasses.  I used to just naturally hold things around 5" from my eyes to read.  I didn't even think about it.  Now, I hold the phone and or magazines, books, etc anywhere from 14" to 18" away.

I also found that I could read a lot easier in bright light rather than dim light so I turned the brightness up slightly on my phone.  As time went on, things just got easier to read small print.  Once in a while, for really small print (around 6 point) if it's a lot of pages, I'll get lazy and just use reading glasses - no big deal.

Other than that, I'll tell you as a very nearsighted person in the 3.5 diopter range, I used to struggle to read my computer which I'm in front of all day long.  The problem was glasses could only correct to 20/50 in my right eye which is when I decided to have the surgery done.  It was almost a year ago and it's hard to believe how easy it is now to see the computer and I almost never wear glasses for any range at all.

At my last check up I was 20/20 for distance and around 20/25 for near on the charts - all with a mono focal lens in both eyes.  I don't think that would have been possible without retraining my brain to find the "sweet spot." I've read online that one can get as much as 2 diopters improvement in vision for near from various eye exercises, etc.  I don't know, maybe what I have been doing has naturally improved my near vision.  Most important of all to me has been my mid range because I'm on the computer all the time.  Mid range and distance were just fine after surgery.  It was the near vision / reading the iphone, etc. that I had to work on to not need reading glasses.

We should also clarify "reading ability with a mono focal lens" that we are referring to reading ability with a mono focal lens set for distance since a mono focal lens can be set at any range.  However, most do set them for distance or almost distance with a slight biased in a little.  Another very important factor is the skill of the doctor especially when using a toric mono focal which is what I have.  I had an astigmatism, so I needed a toric mono focal although some might do a correction before or after surgery.  However, toric mono focals need to be placed in a very precise way and shifting or incorrect placement will lead to a decrease in clarity at all ranges.

Hi indygeo

I have just had my eyes done (right on 26 Jan and left yesterday 9 Feb).  I have monovision using Tecnis toric monofocals.  As of this morning my left eye was at 0 and my right eye at -2.25.  I can see 20/20 or 6/6 vision in the distance and can also see perfectly up close (about 25-30cm away). 

Amazingly intermediate isn't too bad either - as I type my screen is a bit blurred but that may be because I only had the left eye operated on yesterday! I'm sitting about 70cm away from my screen.  I have a nice 23" screen at home which obviously helps - my work MacBook Air may be a bit of a challenge for me as the screen is tiny!

I'm not 100% adapted to the monovision yet - I was wearing a contact lens set for distance in my left eye during the two week gap between my eyes being done so I was already using monovision.  Having said that I walked home from my doctor's appointment this morning and I really didn't notice the monovision much at all.  The IOL monovision seems better than the contact lens monovision I had for the past two weeks - the blurriness from the right eye isn't so obvious now.

I will need to turn down the brightness of my computer (and my iPhone and iPad) as they are now too bright!  It's hurting my eyes a bit.

Hope this helps!