choice of lenses after cataract surgery

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My ophthalmologist has suggested that I get monovision lenses after cataract surgery (one eye with distance and the other one with mild nearsighted).  However, I am unsure about this.  If I choose distance for both eyes, what activities will I be able to do without glasses and what activities will I need glasses?

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  • Posted

    I think that your ophthalmologist is giving you good advice. People vision with monofocal lenses varies, but the suggested combination will probably be the easiest one to live with (you will need glasses only for reading).
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  • Posted

    There are basically 3 focus ranges: distance (beyond about 5feet, measured at 20feet), intermediate(2-3 feet), near(<20"wink.

    With monofocal lenses, each eye can be targeted for one of the three focus ranges.  If you set both eyes for distance, you might need glasses for both intermediate (computer/smartphone) use and another set for near (reading closer and for finer print).

    Some get monovision - one eye set for distance and the other for near, but that misses the intermediate range for computer/smartphone use, etc.  So glasses would be needed for some intermediate uses like computer monitors.

    Others get mini-monovision - one eye set for distance and the other for intermediate, or one eye set for intermediate and the other for near.  Again glasses would be needed for one of the three focus ranges, either for distance (driving,etc) or for near (reading and fine print).

    The best choice for you would depend on your individual focus range needs, pick the two focus ranges you use the most and the third (the least used) would probably require glasses.

    Of course some are able to get all three focus ranges by using lenses like the Symfony, perhaps with one eye set slightly nearsighted to cover a wider range.  But the tradeoff there is night vision artifacts vs better daytime focus range.

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  • Posted

    Barbara:

    Is your vision currently usable enough to test the desired outcome with contact lenses (glasses wouldn't work as well)? If so, I'd highly advise you to do so before you have the surgery. A small amount of monovision will be tolerated by a high percentage of people but as the the targets are separated further, more people won't be able to tolerate it.

    I have one IOL (set for distance) and the cataract in my other eye doesn't yet require surgery but it's natural best focus point is about 10" to 12" (pretty near). I only remove my contact lens at night when I'm ready to go to bed because I cannot tolerate the difference in vision for more than a few minutes. To me it's just horrible as I have a fuzzy, out of focus image from my nearsighted eye overlapping the clear focus from my farsighted eye. Glasses (with one lens) aren't really an option either as the image sizes are too different.

    However, if I wear a contact lens targeted for slight nearsightedness (+0.5D) I can tolerate the difference without any problems. 

    If you have never tried monovision and are unable to do so now, I would advise you to keep the focus difference between the two IOL's on the low side you that your rage of clear vision in one eye overlaps the other. If you can separate your surgeries, you can determine your range of acceptable vision in the first eye and then set the second one to overlap the bottom of that range.

    For example, let's say you set your first eye for distance and you end up seeing clearly from infinity to 10 ft with decent vision to 6 ft. Then maybe you can target your second eye at the 6 ft point so that will give you clear vision from 10 ft to maybe 3ft. You probably wouldn't notice much of an issue with this since both eyes would be working together. 

    Just my suggestion. Everyone is different. Some people would love the super-near and distance that I have when I'm not wearing a contact.

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    • Posted

      Thanks for your info.  I really think that I am going to go for the distance in both eyes, rather than take the chance of not being able to tolerate the difference.  My doctor did not mention testing the outcome with contacts.  Actually, he assured me that there is nothing to adjust to, which concerns me since I have read that only about 85 percent of people are able to adjust.  I am hoping that I will not need two pairs of glasses after surgery (one for intermediate activities and another for close up activities).  
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    • Posted

      With both eyes set for distance, you most likely will need glasses for intermediate and near(reading).

      I'd suggest mini-monovision (less than 1D difference between the eyes) since thats pretty easy to get used to and should give you good distance and intermediate vision, leaving only close up reading for glasses.

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  • Posted

    Hi Barbarasmile

    Most surgeons in USA recommend some sort of mini--monovision or even "micro-monovision" to be achieved via the Intra Ocular Lens implanted DURING the surgery. Not sure why your surgeon would recommend "after" surgery. Maybe misunderstood.

    The micro-monovision option would mean an even smaller difference between the target distance for the IOL's, (.5 diopter, I think). There is little difficulty for most people adjusting to this difference, yet it could make the difference between needing glasses or not.

    The adjustment is in your mind/brain, which is actually where "vision" occurs. The brain interprets the signals captured by the "camera" of the eyes. The mind (habitual thought patterns & emotional predisposition) is where the patience comes in - to wait and allow the brain to comfortably interpret the different signals. It can happen instantaneously for some, or take a little longer for others. This is why experimenting with contact lenses before surgery can be valuable, to measure your own tolerance. Most optometrists would have trial lenses you could use for this purpose.

    Some people have a greater natural depth of field, meaning they can see easily at all distances, even better than predicted/expected by their doctor.

    In the end, you have to take stock of your daily activities and decide whether near-intermediate or intermediate-distance vision is most important for you, and ask your surgeon to plan accordingly. If you're lucky you may get all three distances with little or no need for glasses. But you should be able to get at least 2 out of 3.smile

     

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    • Posted

      PS - I should say the most experienced/confident surgeons (i.e., over 10, 000 surgeries) recommend the mini or micro monovision option. The old school surgeons still tend to recommend just setting monofocal IOLs for distance and having to wear glasses for near and/or intermediate vision. But as the newer lenses and options take over the market, those recommendations are fading.

      Best wishes for a peaceful decision-making process.smile

       

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