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Advice needed on Monofocal Distance vs Monovision IOL Alternatives

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RonAKA
RonAKA

My thoughts are evolving on my upcoming decision on what to get for an IOL in my cataract surgery. Some background again:

  • 70 years old
  • Cataract in right non dominant eye only, double blurry vision, with yellow cast on whites
  • Vision with glasses excellent in dominant left eye, but cataract predicted within next 2 years or so
  • Myopic in both eyes with current +2.5 needed for reading
  • Mild astigmatism in both eyes
  • Have worn contacts, but currently using progressive eyeglasses, which I tolerate well

I have seriously considered a multifocal type IOL like the AcrySof IQ PanOptix. But, frankly the potential adverse effects are scaring me away from it. I am a bit of a perfectionist and I don't think I would be happy living with less than perfect vision, especially at night.

My current thinking is to go with the AcrySof IQ Toric. There seems to be no downside to a toric lens other than cost. Again, with my perfectionist tendencies, going with the toric lens seems like the easy choice providing it is suitable for my particular astigmatism.

Now for the difficult part. Do I ask for a full distance correction? Or should I compromise that correction to get some reasonable near vision with this non dominant eye? This is a technique I have used in the past with contacts. Here is the prescription I had for this eye before the cataract, for glasses and with a a contact for monovision.

Correction type, Spherical, Cylindrical, Axis

Eyeglasses, -2.0, -1.5, 114

Contacts, -0.75, -1.25, 110

I recall I tried a few different options and settled on this one which essentially gave me a -1.25 under correction of my right non dominant eye. I recall it was pretty good during the day, but less so at night. In retrospect, I don't know how much of that night issue was due to the monovision and how much was just due to using contacts which are not stable in the eye and do not correct as well as eyeglasses. I recall I could read with this configuration as long as it was not real fine print. And for anything close up seriously small I still needed reading glasses help.

I do some target and sport shooting with a scope and am right handed, so this is they eye I need to use. I guess to some degree I could compensate for this under correction with my scope focus. Or, I would have to get shooting glasses.

So, especially for those with monovision experience, what do you think? It is an all or nothing choice. My right eye is so seriously messed up now, there is no opportunity to experiment with this using contacts now. The other choice of course is to go with distance monofocal with this eye and both eventually, and resolve to use reading glasses. I don't find that outcome intolerable either. It would reduce my ongoing eyeglass costs to OTC readers.

0 likes, 3 replies

3 Replies

  • rusanna
    rusanna RonAKA

    Posted

    I just had a surgery done on my left eye 6 weeks ago. It is my non dominant eye so I chose to set it for near .Before the surgery it was - 13 with astigmatism. Toric monofocal was put in and I ended up at -2.25 and no astigmatism. I don't wear any contacts or glasses on that eye.My right eye has a contact lens for -8.5 , I see pretty well with both eyes with this arrangement ( basically monovision). My right eye has a cataract too which eventually will have to be fixed.

    • RonAKA
      RonAKA rusanna

      Posted

      Thanks for the response. With the -2.25 residual that sounds like full monovision. Do you find you need reading glasses at all? Can you read in dimmer light? And, I recall when I was doing the research before trying monovision with contacts the recommended undercorrection was to be under -1.5 difference between the eyes. I ended up -1.25 under corrected. I am presuming you find the -2.25 ok for distance?

  • RonAKA
    RonAKA

    Posted

    My doctor has proposed doing my first non dominant eye with a full distance monofocal lens. And, he has asked me to consider doing my second eye, which is an undetermined time away from needing an IOL, for close vision. In other words monovision but with the non dominant eye corrected for distance and my current dominant eye under corrected by 1-1.5 to enable reading.

    Has anyone had their non dominant eye corrected for distance, and the dominant eye for reading? Does it work? My doctor says it can...

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