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

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Hi Everyone, 

New member here.   I've been advised by an eye surgeon in London, UK that I'm best off (for now) getting a mono-focal lens in my left (bad) eye.  He said that because my reading vision was quite good in my other (right) eye that by getting the mono-focal in the left the blended result would be quite good.  I guess this is known as "monovision".  

I was surprised by that recommendation as my right eye is quite bad anyway..not from cataracts but from nearsightedness.   I'm surprised he feels I could achieve a good outcome from having only the left eye done.   Have member here heard of good outcomes via a monovision strategy?  

Lastly, he said he wouldn't be using femtolaser method to cut the incision but rather a blade.  Is there much support to use the femtolaser in the case of monofocal lens? or is that overkill?

Regards and thank you in advance. 

G

 

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23 Replies

  • Posted

    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.

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    • Posted

      Hi NH,   Thank you very much for your thorough reply.   My Rx for my right eye (from testing about 4 months ago at an optician...I do not have the more recent test results from the opthalmologist/surgeon) was as follows: 

      R: -2.25  Cyl: -1.00  Axix: 105  Near Add: +2.25

      The surgeon I'm dealing with is fairly well known in the field and apparently does work for some high profile people and other eye doctors so I feel I'm in reasonable hands.  What I did like was he didn't over-sell me on getting both eyes done because, honestly, I was expecting to go in there and him sell me trifocal lenses for both eyes (just based on what I felt I might need from my own reading and research).   I was somewhat pleasantly surprised when he said he felt I'd be pretty happy with just one lower cost mono-focal.  He further said I'd likely be glasses-free for the vast majority of the time as a result.  My knee jerk reaction was of skepticism  because my right eye is indeed pretty bad for distance (but good for reading still) and I didn't expect that a nicely working left eye (with the monofocal lens for distance) would make up for that right eye.  But as I try and imagine it, I can see how it could work (provided my brain adapts to it).   

      Although he brought up the Symfony lens as an option (to do in both eyes), he soon led me gently away as I mentioned I do drive at night at times and that astronomy is a hobby of mine.  He felt the risk of halos may not suit me.  

      I hope the above helps. 

      G

       

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  • Posted

    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.

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    • Posted

      at201,  Thank you for your reply.  So if I understand you correctly, ,you're saying I should aim for the left (bad) eye to have vision that is 1D more positive/less negative (i.e. a move towards 0) to get good intermediate and reasonable long distance vision.  So if my right eye is -2.25, then aim for -1.25 in my left eye with the mono-focal lens right?  Interesting.    Yes, I think that could be a good thing to aim for.  Although I like looking at the stars (or used to before I had this cataract issue), I also do a lot of computer and intermediate work.    So intermediate is indeed important to me.  Gosh, I really can't wait to get this all done.  I want to see better. 

      And this leads me to another topic.. maybe another thread if necessary.. But it it common to find oneself in a depression or loss of confidence state when their vision is affected by cataracts?  I seem to have felt rather down the past couple of years as my vision issue has progressed.  I really couldn't put me finger on it, but I think my vision has a lot to do with my mood.  Dealing with not being able to see is frustrating and leads to an additional layer of stress I could do without.  

      G

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    • Posted

      Hi Indygeo

      Yes having cataracts - or rather loss of sharp vision can lead to depression.  My own developed very rapidly at a younger age (at 53).  My previous eye appointment had no hint of them .  But during that year I couldn’t read road signs and wTching my daughter’s soccer games couldn’t distinguish one player from the other - couldn’t make out their jersey numbers.  Went to my

      Optometrist before 2 years were up (requirement of insurance co to pay for the eye exams) and it was then I learned I had cataracts both eyes.  Vision couldn’t be corrected with glasses.  Right eye could see only 20/60 and left 20/50.  Optometrist gave me a referral to an opthamologist but it took 4 months to see one.   I didn’t like driving and going to the movies - even on big screen couldn’t read credits and faces were blurry.  It did make me feel like something was off and I wasn’t happy.  Even after seeing the specialist and knowing I would need surgery brought on a lot of anxiety as I considered my options.  From diagnosis to first surgery was 7 months.

      I am now 7 months post surgery on right eye and almost 6 months from 2nd.  Feeling much better now.  Starting to even enjoy things I hadn’t for years now that I don’t wear glasses.

      Yes very normal to feel the way you do.  It is a process but once through it - you’ll be happier.  Cataracts can be very debilitating.

      Best of luck to you.

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    • Posted

      Thank you so much Sue.An.   You mentioned you were 53 at the onset of your cataract. Well, that's about the the age I am now.   And cataracts  definitely IS debilitating.  Being relatively young is why I think I was so ignorant to what was going on.  It didn't occur to me that I could have such a problem.  I had thought that it was just my eyes needing a new prescription of glasses.  And so I just went on and on just putting it off.  But when it was finally pointed out to me how bad things were, and especially seeing how bad it was after getting a new prescription (mainly for my good eye as it turned out), I realized feeling the way I've been feeling made sense.  Needless to say, I'm looking forward to getting this problem sorted out and getting my confidence back. 

      Thanks again. 

      G

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    • Posted

      Your story seems so familiar to mine.  My parents are in their mid 70s and still don’t have cataracts.  We have no family history of early cataracts so I was totally blindsided.  I have had eczema my whole life.  When I started searching online I did see a link between that and cataracts - something my opthamologist also suggested but no one could conclusively say the reason for mine.  I was told if you start to develop them younger they do tend to grow fast which mine did.

      My research led me to these forums which were helpful with info and support.  Hope you find the same.

      Wishing you the best outcome.

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    • Posted

      I'd say thats a good plan to get one eye set for intermediate (computer distance) vision around -1 to -1.25D and use your other eye with its exisiting near vision for closer reading.  Then you can a couple months after surgery get a new optometrist refraction for distance eyeglasses.

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  • Posted

    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

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    • Posted

      Hi Mike, Thanks so much for your reply.  Much appreciated.  As I'm reading these posts, I'm starting to "get" how it all works.   I can see how mini mono-vision strategy can be an advantage over the pure mono vision, for example.     

      What's interesting, and unexpected to me, is that I've been seeing a number of posts in the forums in my research that actually rave about the reading ability achieved with the mono-focal lenses.  I mean, maybe it doesn't work out EVERY time, but  the reading ability as a result of mono-focal implants seems pretty acceptable to many people.    Is this in fact the case?  Have you found the same to be true from your reading and/or in person reports of people's experiences?

      G

       

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  • Posted

    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.

     

     

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    • Posted

      Keep in mind I was quite disillusioned at first after my first eye was completed which is what lead me to these forums.  But after my second eye was done, I was surprised at how well both eyes working together were.

      The results were like "two eyes working together" were better than any one eye alone at any or all distances.  Every day my eyes are slightly different whether due to allergies or just day to day. Sometimes, one eye just sees slightly better than than the other.  But for some reason, both eyes working together definitely see better at all ranges than any one eye alone.  I do not believe that is possible with full mono vision.

      Best of luck to you.

       

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  • Posted

    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.

     

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  • Posted

    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!

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    • Posted

      Glad your surgeries both went well.  Yes everything will be bright for awhile.  I even had to wear sunglasses in my house for awhile.  Likely our eyes were used to seeing everything through a brown tint due to cataracts.  Congrats - sounds like your vision is good with the monovision.  
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    • Posted

      Congratulations on two very successful surgeries. Also, it is great that monovision is working out well for you.
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    • Posted

      Caro, That's really fantastic.  So great to hear that your mono vision strategy is working this well so far.  It looks to only improve over time as well.   Thanks for sharing your experience on this thread. 

      G

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    • Posted

      CaroZim - I have two mono focal lens set for distance with "mini mono vision."  I too noticed a big improvement in the IOL vs. a test contact lens.  After I had my first eye set for distance, I tried a few contact lens for mono vision but it seemed like it was going to be a struggle so I opted for mini mono vision.  The test contact I had I think was around -1.5 and yet I see better at all ranges with my iol at only -.5.  I strongly believe the reason is because the cataract is gone and therefore, one would see better at all ranges.  In other words, when you have a test contact lens, it might not be a good indicator of how "clear" your going to see depending on the severity of the cataract.  But, it could also be due to both my eyes working together with mini mono vision or it might also have something to do with the IOL as well.

      Also, the sensitivity to brightness should settle down over the next few weeks.

      Mike

       

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    • Posted

      My sunglasses are getting a lot of use at the moment both in and out of my apartment!  Singapore  suddenly seems a lot brighter than it used to be!
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    • Posted

      Thanks - let's hope the final result stays the same as what I have now as I know that it could change over the next month or two.  I'll probably need computer glasses as I spend a lot of time on the computer at work but for everything else I should be glasses free.  So much better than before when I needed glasses for pretty much everything (except very close up - 20cm from my nose!).

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    • Posted

      That makes sense - everything is definitely brighter and clearer (except intermediate - about 50-70cm away which is a bit blurred (but manageable without glasses for now)).
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    • Posted

      It’s amazing how bright everything is.   It will take several weeks to get used to it.  I now don’t wear them in the house - although it is now winter here in Canada.   But I need sunglasses to drive or when outside - even cloudy days.  I have always been sensitive to sunlight and keep a pair of sunglasses in the car.  Nice to be able to get non prescription ones now.  Easier on the budget!
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