About Mini-Monovision
Posted , 10 users are following.
Hi,
I have a general idea about mini-monovision. It seems to work well for most patients, but obviously there are some patients who just never adapt to it. What happens then? Can eyeglasses restore you back to binocular vision? And is it possible to have have something less than mini-monovision. like mini-mini-monovision so that maybe it would be easier to adapt to? I have dense cataracts and 2D of astigmatism. I am keeping it simple and just going with a monofocal lens. I have always worn eyeglasses and will keep wearing them. I am going for intermediate vision. My cataract surgeon suggested mini-monovision when we do my other eye a few weeks later. I wanted to go into detail about that with her, but like most doctors, she was in a hurry. As she left, I told her I would think about it. So, again, if I can't adapt to mini-monovsion, will eyeglasses restore me back to binocular vision? And is there something less than mini-monovison that would be easier to adapt to.. My thanks to you all.
0 likes, 28 replies
john20510 harry333
Edited
What type of Lens are you going with. lm getting vivity next week with mini monovision of -.05 in the left eye and plano in the right eye , my surgeon said with such a small difference of -0.5 either wont or hardly notice it and will adapt to it right away. l think it depends of what lens you get and the amount of monovision you go with
Night-Hawk harry333
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Yes glasses or contacts could compensate for the difference due to monovision, if the difference is under 2.0D
Mini-monovision is only around 0.5D difference and that can happen in any case since they can miss the target by that much - its never exact.
RonAKA harry333
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Yes, of course there is a plan B with monovision. If you get progressive glasses the differences between the eyes can be easily corrected. I have mini-monovision which is compromised somewhat with residual astigmatism. I go 95% of the time without glasses, but will use progressives for driving at night out of the city. I have a pair, but almost never wear them.
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There is a micro-monovision talked about. My thoughts are that it is a half pregnant solution. Once you start to go less than -1.0 to -1.25 in the near eye, your reading is going to suffer. The ideal is -1.50 in the near eye. And if the plan is to go eyeglass free you will also want to get the astigmatism corrected with a toric. If the plan is to always wear glasses then there is nothing wrong with correcting the astigmatism with eyeglasses and avoiding the extra cost of a toric lens.
harry333
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Ron I think you are the "go to" person here for mini-monovision. Yes, I have always worn eyeglasses and intend to keep wearing them. And I am getting a regular (Tecnis) monofocal and going for intermediate vision in my non-dominant eye. As I said, my cataract surgeon was in a hurry and said something about giving me near vision in my dominant eye on my next surgery but then left the room. So, I guess my options are to go intermediate vision in both eyes or trying for near vision in my other eye with mini-monovision. I really don't know what to do. Too bad cataract surgery isn't as simple as getting an appendix removed. The patient has nothing to decide about the operation. Any further thoughts you or anyone else has would be appreciated. Thanks
jimluck harry333
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Try putting your questions in writing to the doctor via email or a patient portal. I asked for an email discussion with mine and he has been great about it. We are gradually working through all my questions in what has become quite a long email chain. I consulted 2 doctors and chose the more responsive one.
gwa jimluck
Posted
I think online communication is a great idea. Realistically, there probably isn’t a lot of ROI for surgeons to spend lots of time discussing lens options with each patient. In hindsight, the quick 10-minute consultation I had with my surgeon was in between surgeries, so she didn’t have a lot of time to spend with me. I ended up getting referred to another person in their office whose responsibility was to answer patient questions… but that person had to take many of my questions to the surgeon for answers, which was time-consuming and inefficient. Much better if it’s possible to communicate online directly with the surgeon.
RonAKA gwa
Posted
I ended up in the same dilemma with my surgeon on the second eye, with him cutting short conversations by phone as he had drops in a patient's eyes. Way less than ideal. I think I ended up getting a non toric lens when I should have gotten a toric, and the power was off by 0.5 D as well. For this reason, I cannot recommend this surgeon to others.
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My experience with Lasik consults was a bit different. The first clinic did not even let me talk to the surgeon. The second one, the technicians took the readings, but the surgeon was prepared to spend lots of time with me explaining the situation, even when I was not a suitable candidate for Lasik. I think this surgeon was also an option for cataract surgery, and I now wish I had gotten in to him rather than the surgeon I got.
Guest harry333
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So there are different degrees of monovision. It depends on the IOL. If its a standard monofocal you will need a greater degree of monovision. If it's an IOL with an extended range like Vivity a very small amount of monovision like just a 0.5D difference is common. That amount is so small that there are no issues with imbalance or adaptation.
indygeo harry333
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Harry,
My understanding is that if you get the one eye at plano (or nearly so) successfully, then if you're not happy with the "near" eye provided with a monovision set up, you can either A) use glasses or contacts to correct for that eye or B) get a laser "touch up" to reduce the differences between the eyes thus making the situation tolerable.
I don't think there's much risk in starting out with a monovision or mini-monovision strategy, particularly with an EDOF lens these days, with the fall back from one of the strategies above.
Regards,
IG
RonAKA indygeo
Edited
I have seen comments here that correcting vision with eyeglasses can be more difficult when there is an EDOF or MF IOL in place. No personal experience. A monofocal IOL should be just as easy to correct with eyeglasses as a natural lens eye.
Guest indygeo
Edited
I think I recall reading once that very few people will have an issue with a 1.5D or less offset. It's the bigger offsets that you need to be more careful with. Although I would still try to trial 1.5D with contacts if that's what you're thinking.
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As for LASIK touch-ups I would say that's possible but of course the less surgery the better right? Even LASIK can have it's side effects and it's 100% accurate. Also bear in mind that I don't think LASIK works well (or at all in most cases) to make you more near-sighted. I think it works best to make you more far-sighted. So if you overshoot plano for instance in the dominant eye I don't think LASIK will help in most cases. Although you could use it to make a NEAR vision eye closer to plano.
indygeo Guest
Edited
David,
Yes, I agree a 1.50 offset shouldn't cause issues for the vast majority of people. And apologies, I may not have been clear in my post. What I meant was, yes, the adjustment as a result of any Lasik touch up would be on the "near" eye...i.e. to make it more farsighted in the event of a missed target refraction. I'm going on the assumption that the first, distance, eye surgery is successful. In my mind, it's a conditional probability situation. Once you have the distance eye set, the other "near" eye is low hanging fruit, so to speak, particularly with an EDOF lens due to its range of focus.
Seems to me with an EDOF lens in the near eye a surgeon could aim for (and achieve) anywhere from 0.50 to a 1.50 offset and have a reasonably happy patient. With a standard monofocal lens the tolerances are a bit narrower and there's not as much room for error.
To be clear, I'm not suggesting in any case that the Lasik touch up procedure is a strategy itself. I'm saying it's merely a fall back option in the unlikely chance the refractive result is wildly off to the near side for the near eye. In my mind, this is the safest bet offering the most optionality.
Cheers,
IG
harry333
Posted
harry333
Posted
I don't know what happened but my message got cut off when it was published. I was going to say that Dr Ben LaHood, a renowned Australian opthalmologist, told a friend of mine that an EDOF IOL might make it more difficult to correct astigmatism with eyeglasses
harry333
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Well, I am leaning towards not doing mini-monovision and going for intermediate in both eyes, But I am open to more feedback about mini-monovision. Thanks
RonAKA harry333
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I think it comes down to how much do you want to be eyeglasses free. I am essentially eyeglasses free with mini monovision except for a very occasional need for +1.25 readers on very small print in dimmer light. I got a pair of progressives for the best possible vision, but I never wear them.
harry333 RonAKA
Posted
Ron
I really don't care to be eyeglasses free. I just want the best vision possible. If eyeglasses alone can do it, then i would prefer that rather than mini-monovisson. But if mini-monovision could do it better, I would go that route. Thanks.
jimluck harry333
Posted
I have similar preferences and similar vision history. I just don't want different eyeglasses for different tasks and don't want progressives because of the tiny intermediate zone they have. My doctor said he consulted 4 colleagues and the consensus given my preferences and history was -0.75 for the dominant eye in a monofocal toric and -2.00 for the other, in an Eyhance toric. The hope is I will only need glasses for distance. I would prefer one pair that I wear for everything, but that means progressives and that means a tiny intermediate zone. If I have to have a second pair, let them be for intermediate. I really would like to retain the ability to take off or peer over my glasses for extreme close-up on tiny things. I don't want to go hunting for readers every time I encounter a need for that. And one eye is fine for that.
What do you think about needing multiple pairs of eyeglasses? Or progressives? An IOL, unless it has extended depth of focus or is multifocal, has very limited depth of focus, I fear. Even old eyes have a diopter or so of accommodation. An IOL doesn't.
RonAKA harry333
Posted
Eyeglasses will always give you the most accurate refraction correction. However, there are some issues with progressives which will be needed if you just do monofocals for distance or some other distance. It is a matter of whether or not you want to deal with the issues of reading glasses, progressive glasses, or the necessary compromises with monovison.
Bookwoman jimluck
Posted
If you have your glasses made by an independent optometrist, you can have the zones made to your specifications.
harry333 RonAKA
Posted
Ron, yes, there are issues with both mini-monovision and eyeglasses. But even with mini-monovision, I will still need eyeglasses to correct my 2D of astigmatism since I will use a monofocal., not a toric. Four years ago, before I had cataracts ( I was a -4.50 and a -5.00) I wore single vision eyeglasses. Never had progressives or bi-focals. Sometimes I could read with my glasses on and sometimes I took them off. I had no problem seeing my computer screen or driving or anything else. Even now with my dense cataracts, I still wear single vision glasses. I know surgery and an IOL will change all that.
harry333 Bookwoman
Posted
Thanks for that Bookwoman. Also, I have talked to some people who say that for them wearing bifocals was easier than wearing progressives.
jimluck Bookwoman
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You can have the zones of a progressive made to your specifications, but only within the limits of the technology. The intermediate zone must lie within a narrow corridor, and the bigger is the reading diopter add, the narrower will be the corridor. Also, you can make the intermediate zone bigger vertically only by taking away vertical real estate from one or both of the other zones. Or you can get a big intermediate zone by totally giving up distance, in the sense of making the intermediate the "distance" zone -- so called "office progressives." But if you want full functionality for distance and reading, the technology can only give you a tiny intermediate zone, I believe. If I am wrong, please tell me the magic words to say to the optician that will give me driving vision, reading vision, and a big intermediate zone too.
RonAKA jimluck
Posted
A few years ago there was a trend in eyeglasses to really wide but vertically narrow lenses. Some were so narrow that they would not even do progressives with that style of frame. If you want the best out of progressives you need to choose a frame that has deep lenses where there is physical room for the range of optical zones.
jimluck RonAKA
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I let my optician choose the frames. My only instruction is "Choose what will work best for my vision." They are pretty tall and not especially wide.
Today I am feeling particularly anti-progressive-lenses. My doctor is trying to steer me away from IC-8s, but without giving any scientific reason. So I suspect it's just because they are new in the US and he has no experience with them. But I'm willing to wait a year, or to go to once of the doctors in another city who participated in the clinical trial. I don't care if I have to wear glasses over them for residual astigmatism and/or diplopia. I just want the glasses I wear to not be progressives and for one pair to meet all needs!
Nothing rivals the IC-8 for smoothness and breadth of the defocus curve. I want that. High patient satisfaction. No dependence on hitting and maintaining a particular axis of orientation. Very forgiving of refractive surprise. Few reports of halos, starbursts, or other junk. Good contrast sensitivity. No restriction of field of view. What's not to love?
It's not really mini-monovision, even though the lens part is targeted to -0.75, because there is no loss of distance vision that results for that eye. The small aperture still gives good distance vision. There isn't a distance eye and a near eye. If paired with a monofocal targeted to distance (the on-label use in this country) then there is one distance eye and one near-plus-intermediate- plus-distance eye (the IC-8 eye).
People shooting from the hip say you won't be able to see at night because of the small aperture. The clinical experience contradicts this:
"CLINICAL EXPERIENCE
In the current population of patients, we have up to 9-month
follow-up. In the bilateral cases, no patient has complained
about reduced visual acuity at night or loss of visual field, and
significantly less ghosting with reading has been reported. In
general, these patients are happy.
In the unilateral cases, responses have been similar: Patients
have better vision in the IC-8 IOL eye compared with the
untreated eye, and they feel that the increase in the depth of
focus is rewarding. In all cases, UDVA is [at] least 20/40. Not only is
UDVA better and optical side effects of corneal aberrations are
reduced, but these patients even report that UNVA is significantly improved in the IC-8 IOL eye. " This was in a group of keratoconus patients. https://acufocusuniversity.com/wp-content/uploads/2020/08/0917CRSTEuro_AcuFocus_IC-8_Supplement.pdf page 16
In another study, the actual measurement of loss of contrast sensitivity relative to a monofocal was only 0.2 log units (mean) and they could not reject the null hypothesis at the 5% level (in other words, there's at least a 5% chance the true difference was zero).
https://journals.healio.com/doi/10.3928/1081597X-20191114-01
"Under mesopic conditions ..., the mean log contrast sensitivity was on average approximately 0.2 log units lower in the IC-8 IOL eyes compared to monofocal eyes, although none of the differences was statistically significant at any spatial frequency with or without glare conditions (P > .05)."
RonAKA jimluck
Posted
The IC-8 seems like a good idea, and I recall being interested, but dropped it from consideration. I believe that may have mainly been because it was not available in Canada. It strikes me as being like the old Kodak box cameras that had a fixed aperture set at F16. No focus was needed for distance to longer intermediate distances, but they jammed out when you got up close. And, in a camera of course there is the light issue. You essentially needed daylight for a good exposure at the standard 1/60 of a second. The eye must be more forgiving on the light levels, but I would think it must have some impact. In my time here at this site I do not recall anyone reporting on actually having these lenses implanted. In fact I think you are the first that has shown any significant interest. Way back, I may have posted about them being developed, but that was about it.
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There is an old saying something like "Be not the first to try out the new, nor the last to throw out the old!". I default to that thinking when in doubt...
jimluck RonAKA
Posted
Yeah. I wouldn't go near it if it was really new. But it has a long track record in other countries.
I found only one mention of it on this site -- someone in Europe who had it implanted as a lens replacement for a multifocal (Symfony?), and loved it.
Today I reached out to two of the 21 U.S. practices that implanted it as part of the clinical trial to get FDA approval. We'll see what they say.
US distribution is cranking up and there is an upcoming ophthalmologist convention where my doctor predicts the company will have a big presence, in light of the recent approval. So, we'll probably start seeing some mentions of it on this site as that activity trickles down into patients actually considering it or getting it.