Disappointed with Monovision IOL's
Posted , 5 users are following.
10 weeks out from cataracts surgery in 2nd eye.
14 weeks out from cataracts surgery in 1st eye.
I'm only 50 years old so this was a surprising turn of events when I was told that cataracts needed to be removed when I was 48. Still put it off until last fall.
Wore monovision contacts (rigid gas perms) for past few years with small difference between eyes. Left eye dominant. Cataract in right eye was bad and removed first. Doctor set that eye for distance. Can now see 20/20 far. 2nd surgery set the dominant eye (Left) for near and see 20/200 out of that eye. Together I can see 20/20 (according to eye charts).
I'm miserable. The doctor said that I would adjust to the switching from my usual set up in contacts. He doesn't understand when I tell him that my distance vision is 'fuzzy' because my left eye is so nearsighted now.
He gave me a contact lens to try out in the left eye to bring them together. The contact is a -2.5.
Does that seem like a BIG difference between the 2 eyes? Is that why I can't adjust to this setup in addition to the switching between dominant/non dominant?
I am going to an optometrist tomorrow about getting a contact and glasses to wear in my left eye permanently. I don't want to risk surgery again and being unhappy.
I feel 'trapped' if that makes any sense with vision that isn't easy or natural for any distance right now. I have to put my face right up into my monitor to work as well.
Any suggestions or similar experiences?
0 likes, 18 replies
RonAKA pamela35990
Edited
That is an unfortunate situation to be in. I can understand your frustration. I am in a somewhat similar situation, but have not had the second eye done yet. I am also left eye dominant, and my right eye had the more advanced cataract, so was done first. It was set for distance as well and I had a very good outcome with 0.0 D and some residual astigmatism. I can see 20/20 plus in that eye. At the time I had a preliminary discussion with the surgeon about monovision (as you have) and expressed my concern about having distance vision in the non dominant eye, and close vision in the dominant eye. He said that in his experience it was not a problem. I did a little research and found that while it is not ideal, it can work in most cases. It is called crossed monovision. The way I left it with him was that before the next eye was done, I would trial monovision using a contact in my left eye, and when I found a power that worked, he would determine what power I needed to achieve the same thing with a permanent IOL lens. I am well over a year into this trial period waiting for a the second eye to be done.
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My experience so far is that with my non operated eye, I like a residual of -1.25 D slightly better than -1.50 D, but either is OK. With no contact I am about -2.0 D. I can manage things like shaving, dressing etc. with that, but I much prefer the -1.25 to 01.5 D.
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I am not sure of the reasons but it seems you have ended up with a -2.50 D monovision. The is the old outdated way of doing monovision. I don't know if your your surgeon gave you that much on purpose or if they just missed with the power calculation. There are issues with getting the power right when targeting intentional myopia, plus there are eye measurement issues when you have a dense cataract. Perhaps some combination of that caused you to end up with an excessive amount of myopia.
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Unfortunately changing the lens power is not a real good option. I have heard of surgeons being able to insert a "piggyback" lens to make a correction to the power, without removing the lens already in there. But, I am not sure how often that is done. Your other option would be to use a contact to correct the vision back to a mini-monovision value of -1.25 to -1.50. You can do that by trial and error of course. I have found Costco to be very cooperative in giving out trial samples of 5 to try different powers. I am currently using their Kirkland (CooperVision daily) to achieve my simulated monovision. If you have an eyeglass prescription for your eyes that is a good starting point. If it is for example -2.5 D spherical then you would try a -1.25 and a -1.00 D lens to see if that works for you. If there is any residual astigmatism you could get a toric contact to negate that. Or, if it is small then just add 50% of the cylinder to the spherical to get an estimated starting point. I have found some Costco technicians understand that, and others do not, so you kind of have to tell them what you want.
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So, it is unfortunate that you have ended up without an eyeglass and contact free solution, but probably using the required contact power to achieve a true mini-monovision is the best way out.
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Hope that helps some,
pamela35990 RonAKA
Posted
Thank you! You 100% understand my situation.
Ironically enough we did a trial with contact lenses before my surgeon did the 2nd eye and I loved it. Took a couple of tries but I thought that we had found the perfect amount of correction on my non dominant eye to achieve no contacts or glasses....it clearly didn't translate over into the IOL though. I know that the surgery is not a 100% guarantee of no glasses or contacts but I really thought that we had a good combo!
I really would not want to have another surgery on my eyes, if I can avoid it.
I have read everything that I can get my hands on in regard to monovison, IOL's, surgery etc... and have come to the same conclusion that you stated above.
I thank you for your response. Good luck with your 2nd surgery!
RonAKA pamela35990
Posted
The one complication of contact lens simulated monovision is that the natural eye will still have some accommodation or ability to chance shape to focus closer. I am 72 and it appears I still have some accommodation. You are 50 and certainly will have more. However, that effect tends to reduce the indicated amount of myopia you need for reading. My early tests indicted that -1.25 was enough for me. However when I did some further tests suggested by a contributor here, it looks like I would be better off with -1.50 myopia. I came to this by comparing what power of reading glasses worked with my right plano IOL eye. Some +1.5 D readers worked more closely to my simulated -1.25 monovision in the contact lens eye. But, regardless -2.50 D is way too much. If you surgeon understood what you achieved with simulated contact monovision you should have gotten better results. Kind of suggests that he/she simply missed the power. This is more common than people know about. Until you get an eyeglass prescription you don't really know what the surgery outcome was. My wife just had an eye check after surgery with a toric lens that targeted distance. The outcome was 0.0 D spherical and -0.5 D cylinder. So he perfectly nailed it on spherical power, but missed a bit on the astigmatism cylinder. But still she has 20/20 vision for distance, and needs reading glasses for close up.
RonAKA pamela35990
Posted
For more information try googling this article. We can't use external links here.
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CRST optimizing outcomes when the target is low myopia Andrew Turnbull Warren Hill Graham Barrett pdf
pamela35990 RonAKA
Posted
Thank you for the link.
Interesting......points once again to the difference of 2.5D being more than most patients can handle.
I was most concerned with the switching of dominant and non dominant but as you mentioned that could probably be overcome if there was more alignment between my eyes.
When wearing the -2.5 contact my distance is crisp but intermediate and near are awful. I do not mind wearing reading glasses for near tasks, but would like to be able to see what I'm eating on my plate without having to wear them.
I hope that I am able to explain all of this to the Optometrist tomorrow and end up with a plan that I can ultimately live with. Being disappointed in the surgery results is one thing but there are certain levels of sight that I need to function.
RonAKA pamela35990
Edited
What would be enlightening would be a refractive test (which is better, this one, or that one) by the optometrist. That would tell you where you ended up. You may be more than -2.5 D under corrected.
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This all said I would ask for lower power contacts like -1.25 or -1.0 D to try. That should restore closer vision without causing as much of a loss at distance.
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If I had it to do all over again I would go with distance vision in my dominant eye, and close in the non dominant. The crossed monovision basically works close and far, but I sometimes find vision is a little compromised in the 25 to 50 foot range. When I am at a big box store like Costco, I can have issues seeing clearly in that range. My suspicion is that brain is trying to decide which image to use. At that distance my IOL non dominant eye is crystal clear, but my brain seems slow in deciding to use it.
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In any case back when I was evaluating it, I found this article which you may find of interest.
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Healio November 16, 2016 Crossed monovision may be as effective as conventional monovision
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The key point here is that the degree of monovision was low. "anisometropia was 1.19 D in the conventional monovision eyes and 1.12 D in the crossed monovision eyes" This is almost at the micro-monovision level of -0.75 to -1.0 D level.
pamela35990 RonAKA
Posted
Just returned from the Optometrist and am going to try -1.75 contact in the near eye and obviously nothing in the distance eye (which is -.25) That will bring them closer together with 1.5D difference.
Also getting progressive glasses for when I don't want to wear the contacts. The Optometrist said that if I haven't adjusted to the level of monovision that I currently have after 10 weeks that the chances of my brain adjusting to this are not good.
I'm hopeful that I will someday have clear vision - even if it wasn't achieved solely with the cataracts surgery.
RonAKA pamela35990
Posted
Don't be afraid to try different powers of contacts to see which works best for you. If I follow your numbers correctly it sounds like you may have residual refraction of -3.5 D in your near eye, and a -1.75 D contact will reduce it to -1.75 D? If so being able to adjust to a -3.75 D in your near eye is going to be near impossible. Again if this math is correct, you may want to try a -2.0 D and -2.25 D contact to see if that works even better. That would give you the -1.5 D and -1.25 D that may be optimum. Keep in mind that it is not the differential between the two eyes that gives you the close vision. It is the absolute myopia in the near eye. You want the lowest amount of residual myopia that still lets you read comfortably. Less means better distance vision out of the close eye.
pamela35990 RonAKA
Edited
My distance eye is -.25 but no correction is needed.
My near eye is -2.5. When I wore the -2.5D contact in the near eye it was way too strong and while it made my distance perfect, it eliminated any near or intermediate sight.
Trying the -1.75 will bring the residual refraction to -.75. Hopefully I explained that correctly.
RonAKA pamela35990
Posted
I think I understand better now. A residual refraction or mild myopia of -0.75 would be a micro-monovision. In my experience that is not enough for reading of my computer, iPhone, and most text. I think I would try a -1.0 contact and a -1.25 contact to see if that works better. My test is to read my iPhone at a comfortable distance as well as read my computer screen at a comfortable distance. If I have too much myopia I can see the iPhone well, but I have to sit too close to the computer screen for comfort. If I have too little the computer is OK, but I have to hold my iPhone way too far away for comfort to read it. But, the good thing with contacts is that it is easy to experiment to see what works best for you.
pamela35990 RonAKA
Posted
So I have the -1.75 in and it's SO crisp for distance - what a relief. I think that you are correct that I want to try a tiny bit less. I'm wearing readers right now to work on my computer and see my iphone.
I have a follow up on the 31st and will ask about a -1.5 or -1.25 before I order for a year.
I'm finally hopeful though that I can have normal vision after the past few months, since my first surgery, that at some point I will have my life back. After the first surgery I wasn't given any instruction on how to handle the difference in vision between surgeries. Then after the second surgery and the monovision didn't turn out as planned I was turned loose until I "adjusted". The whole process has been fairly disappointing and actually depressing as I felt my world getting smaller as I couldn't see much.
RonAKA pamela35990
Posted
I wish you the best in getting things finally sorted out. Yes, it is good to be sure what power is best before buying big supply of contacts.
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Where I am at is that with my contact simulated mini-monovision I can see the TV across the room really well, my computer well, my phone well and most printed documents. Things only get difficult when I try to read the fine print on an OTC medication label. For really close or fine stuff I have some +1.25 readers that I put on very occasionally.
pamela35990 RonAKA
Posted
Sounds like you have a great plan then. Are you going to stick with the contact or have it replicated via surgery?
RonAKA pamela35990
Posted
Second eye has a milder cataract but I want to get it done. Had my first consult today and they took the measurements. I have a surgeon consult on Feb 3, and with fingers crossed I may get into the clinic for surgery by the end of February or so.
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I am down to two options. One is a Clareon monofocal which I will ask to get me to a residual of -1.25 to -1.50 D, and hopefully closer to -1.50. This part is always a bit of a risk as to what you will actually get. My surgeon predicted a -0.35 residual on my first distance eye, and I ended up with 0.0 D. Good, in what I got, but it was not what he expected....
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The other option is an EDOF Vivity lens. I will ask for that one to be also myopic but less so at -0.75 to -1.0 D. The Vivity provides about -0.5 D of extra depth of field with no monovision, but I don't believe that will meet my expectations for reading etc...
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Have to have a discussion with the surgeon to see what he thinks. The upside of the Vivity is that it will give me better distance vision, but it may have the halos and flare issues at night. If he thinks that is a low risk, I will seriously consider the Vivity.
john20510 pamela35990
Posted
They say 10 % of people cannot adapt to monovision , mybe if you find the right contact lens if will solve the probelm. l think will go with both eyes for disatance and glasses for close rather then risk mono vision or multifocal. l think 90% of the people in the world go both eyes for disatance
pamela35990 john20510
Posted
I had monovison contacts for years and loved it. I hope that with adding a little bit of vision in my near eye it will bring my eyes closer together to see both distances.
I had high hopes for not having to wear glasses or contacts again......in the end I have vision so I can adjust.
nancy03915 john20510
Posted
This is very interesting. I have had my dominant eye done for distance and next week will have my other eye under corrected. I've worn contacts like this for years and hope it turns out well. I actually can "feel" which eye is working when I need close vision.
pamela35990 nancy03915
Posted
I had contacts that way as well but my cataracts was done the opposite way and my dominant eye was set for distance.
You are used to monovision so I am guessing that you will be just fine! I hope that it works and you never have to worry about it again. 😃