Distance vision vs mini-monovision (intermediate/distance)

Thanks so much for the clarification! To be sure I understand, -1.5D would provide good reading vision at 1 foot with still good general vision from 2-3 feet whereas distance vision would not? Would I expect my best vision to be at the 1 foot point or is it more of a range? Is there a general range of vision for -1.5D? Does the range of vision improve if such a lens is placed in both eyes?

On a related note, I remember you said to wait until the first eye has settled (6 weeks) before proceeding with the second eye. Would that mean that what I see now at various distances with my operated eye will likely change at least a little over the next few weeks?

Many thanks! You are such a valuable resource!

A -1.5 D target on average will give good (20/32) vision down to just over a foot. Peak visual acuity will be at about 2 feet. Good vision should extend out to about 5 feet. However, individual results will vary. Subjectively I find I have useable vision from 8" to about 8 feet with my -1.60 D eye. Not sure if it is 20/32 or not over that range, but it is functional.

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Vision will improve very slightly if the same target is used in both eyes. The benefit is quite minor though compared to seeing a full range of vision potentially from 1 foot to infinity with the eyes set to mini-monovision targets.

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Vision after surgery will change as the eye heals. At three weeks most will have a good idea where things are going to settle. I had an eye exam at that point but the optometrist would not give me a written prescription as he said the eye could still change. The advice I was given was to wait until 5-6 weeks to be sure the outcome is stable. 6 weeks is a good time to get a full optometrist eye exam and prescription to see what you have really got. I would suggest scheduling the second eye for a date past 6 weeks. The surgeon should review the refraction results of the first eye to see if any adjustment is required in calculating the power for the second eye.

Hi Ron,

I tried to send you a copy of my IOL card but the message is being reviewed. Basically I was asking for clarification of the sentence,

The surgeon should review the refraction results of the first eye to see if any adjustment is required in calculating the power for the second eye.

I get easily confused between words like power, target, focus, setting...

For example is the power -1.50 D or -1.75 D? Is saying power of the lens the correct terminology? Other numbers on the IOL card include +16.5 D

and CYL 1.5 - do you know what these numbers mean?

I also wanted to ask you about driving safely. My unoperated eye has a cataract and higher myopia. The surgeon told me I would need some help in that regard but not what such help might be. My optomotrist is booked so my options are to go to another practice or another optomotrist in the same practice.

I just tried on my glasses. Probably better vision overall but my operated eye seems off with the old glasses lens.

I would consider going to an optomotrist go get a refraction (prescription).

What I would not do is to get the other eye operated on until you know more.

The +16.5 D is an internal number, that is of some interest, but is not something that you would normally be concerned with directly.

I just tried on my glasses. Probably better vision overall but my operated eye seems off with the old glasses lens.

That sounds right.

Yes, your old glasses should be "off" for the operated eye because your new vision is unlikely to be exactly the same as before the cataracts. And yes, driving can be a problem during the time period before the eye settles and you get new glasses made.

When I had my surgeries, I had a drawer full of old glasses from a lifetime of myopia. I found an old pair that worked okay.

Best to be careful and don't push driving with poor vision. If necessary, you could get a pair of cheap driving glasses made (distance only). Use taxis, get deliveries, ask friends. This period won't last forever.

Yes, the refraction is the power of the corrective lens required to give you the best possible distance vision. If your target was -1.5 D and your prescription is -1.5 D then they hit the target.

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The 16.5 D is the sphere power of the IOL. It would suggest you were moderately myopic prior to surgery. The Cylinder number is the correction for astigmatism and indicates you got a toric lens. Depending on the brand of lens you got that is either the lowest available cylinder or second lowest.

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The advice I got was to wear whatever glasses that you have around and work the best, but not to get a prescription filled until you get the refraction done at 5-6 weeks.

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I think in most jurisdictions you need 20/40 with both eyes open to be legal to drive. There are snellen eye test charts that you can download and print to see where you are at without spending the money on a optometrist. For the 6 week check I would get the optometrist to do the prescription though.

Thanks Ron!

When you say,

the refraction is the power of the corrective lens required to give you the best possible distance vision. If your target was -1.5 D and your prescription is -1.5 D then they hit the target,

are you referring to a prescription for new glasses once my vision has settled after the 6 week waiting period after cataract surgery?

Yes, I was moderately myopic before LE surgery. RE is still moderately myopic. I got the Alcon monofocal toric lenses.

I only have one pair of glasses but rimless!

Thanks Laurie! When you refer to cheap driving glasses, what does that mean? Would I ask for that from an optomotrist or optician?

Hi Laurie,

I'm interested in drivers glasses. Do these require a prescription? I don't think I've heard of these before!

Yes, it would be your eyeglass prescription for the eye at the 6 week mark.

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Alcon makes more than one monofocal type. The more common ones would be the AcrySof IQ, and the Clareon (newer). Your card should have a model number on it that I could tell you which lens you got.

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Yes, those would be impossible to remove the lens and still have the glasses. I guess you could have a lens made for them, but would wonder if it would be worth it. You could get a balance lens with no prescription in it, and then that would simulate monovision.

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If it were me, I would be getting some contacts for the non operated eye. A optical dispenser should be able to do that as long as you have a prescription for the eye.

Thanks Ron! I'll be interested to see what that prescription turns out to be.

The lens should be the Alcon Clareon monofocal toric. The number on the card is #CCW0T3. Is there anyway to double check whether it is -1.47 or -1.50? I don't see either number on the card.

I ordered a plain lens (balance lens?) just to hold the glasses together. It was $80 with a discount! That said, I hope to use these glasses for 7 weeks before my next surgery so I'm OK with the splurge. It was easy to order from my optician as the records for my current glasses are still on file. If all goes well, I'll be using a progressive lens for my unoperated eye and the new -1.50D lense for the other.

Yes, that is a Clareon Toric. Should be a very good lens.

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The IOL lens power is what you said earlier; 16.5 D sphere, and 1.5 D Cylinder. The outcome of this lens depends on your eye, and the accuracy of the surgeon's calculation. Your predicted outcome numbers will be on the IOL Calculation sheet. The surgeon should give you a printed copy if you ask for it.

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Those glasses should work for you.

Thanks Ron. Would you assume that would be available for a long time or do I need to ask to it as soon as possible? The reason I ask is because I wouldn't know how to interpret at this point!

I would be quite sure it will be saved in your clinic's computer system. Normally both eyes are measured at the same time, and the calculation is run for both eyes. Your surgeon should be reviewing it with you before your second eye surgery to confirm what you target is for the second eye. That would be a good time to ask for a copy of it. The important part of it is the list of power options for each eye. For example on your first eye there should be a line that shows what outcome is predicted for the 16.5 D power, as well as the 16.0 D power and 17.0 D power. The same will be there for your second eye, and you will see the power options and predictions for the outcome for the powers in the range of your desired target (-0.25 D for example if you want distance vision).

Here is basically what the small section of the IOL Calculation sheet of interest looks like.

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In this example the target is for -1.25 D. The calculation sheet is showing what the predicted outcome will be for a range of IOL powers from +9.5 D to +11.5 D. The computer has recommended the +10.5 D IOL as the best one to achieve the desired -1.25 D outcome. The actual predicted outcome is -1.19 D.

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If the desired target had been -1.50, then the +11.0 D IOL would be the best choice with a predicted outcome of -1.52 D.

That very interesting and not nearly as complicated as I thought.

With my particular eye, the target was -1.50D or possibly -1.75D. Can you imagine why my IOL card says +16.5D?

Many thanks as usual!

I think the part you are missing is that your outcome is the result of your particular eye and cornea shape combined with the IOL lens power. The IOLs come in standard powers and the measurements with help from a computer program predict what those standard powers will end up at for a final refraction for your particular eye. It would appear with your eye a +16.5 power results in about a -1.50 D outcome. That predicted outcome will be on the IOL Calculation sheet like the example image I included above.

Thanks so much Ron! Of course things might change with my eye over the next 6+ weeks, but my thought is to play it safe (conservative) and target my second eye for either -1.0D or -1.25D (a difference of either .5D or .75D if I understand this correctly). From what I understand, a difference of .5D to .75D is within the range of a normal difference the eyes and would be extremely unlikely to be problematic to anyone even without a contact lens trial. What do you think? Would you have reasons to recommend or not recommend either -1.0D or -1.25D? Many thanks.

My recommendation would be to do a contact lens trial of those options for the second eye that you are considering. If you target -1.0 or -1.25, that will improve your reading vision but is likely to require eyeglasses to be legal to drive, as distance vision will be compromised. The normal target for the distance eye with mini-monovision is -0.25 D. That should give you 20/20 distance vision, and be able to drive without glasses.

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If I recall correctly you will have 6 weeks or so to do some contact lens trials in your non operated eye. Your eyeglass solution with the blank lens for the IOL eye will give you some idea what mini-monovision is like, but contacts in the non operated eye will be better.

I understand that would be best, but I would like to avoid a contact lens trial because my optometrist is against it and more importantly the condition of my eyes. I wore hard then gas permeable contacts from 14 until my 60's. My eyes were extremely dry with some surface irregularity and poorly functioning MGs. I've spent years trying to improve the situation with the hope that my cataract surgery would be as successful as possible. I wasn't able to handle soft contacts when I tried and would prefer not to go there and possibly undue the progress I've make with my right eye just before the surgery. There you have my story!

Yes, be careful that your eyes not get dry.

Thanks Lynda, I've been using PF lubricating drops 4-5 times a day.

Your eyeglass solution with a no correction balance lens for your operated eye will give you a good idea what full mini-monovision may be like. It won't be perfect because the image in your non operated eye will likely be smaller and could be a bit annoying.

Thanks, I'm looking forward to that! I was wondering about my current mini-monovision trial pre-balance lens (if it could be called that). I definitely wouldn't want to live with this view of the world! Of course, my vision is not currently ideal in either eye, except for my operated eye for near/intermediate. That's why I'm tending toward a conservative approach with no more than .5 to .75 difference between eyes. Even though I love being glasses free around the house, it wouldn't be that bad to wear glasses to bump up my visual acuity.

That brings to mind yet another question. If I'd like to improve my vision with the help of glasses, would progressive glasses work for me?

Absolutely! Bear in mind that some people have a hard time adjusting to progressives, but for those who don't they're wonderful: perfect vision at all distances.

Yes, progressives work well within the limitations of progressives. You have to look up to see distance and look down to see close. I have full mini-monovision and have progressives which correct both the near and far eye. I don't really like wearing them though, compared to being eyeglasses free. They basically sit unused in my eyeglass case. Except perhaps for driving in total darkness in the country I don't need or use them.

Agree. I thought I didn't mine glasses (progressives) but I've really enjoyed being glasses free this week (since surgery).

With regard to having an eye exam and refraction 6 weeks after cataract surgery for the purpose of new glasses and to have the data for use in selecting a target for the second eye, is that usually done on coordination with the surgeons office?

I've had no problem with progressives. I heard from one optician that the lens manufacturer can make a difference. She said if you're accustomed to Zeiss, it might be difficult to switch. Not sure if that's correct as those are the only progressive lenses I've worn.

My ophthalmologist said that highly myopic people tend to have an easier time adjusting to progressives than less nearsighted people. Anecdotally, I adjusted to them in a day, while my husband, who has a very mild prescription, had a much harder time.

Interesting!

I had my six week exam done by my regular optometrist. The surgeon recommended the timing of it, and I arranged it. I asked for a written prescription that I could take a copy of to my surgeon on the next visit.

What do you consider highly myopic? As well as less nearsighted?

I'm sure there are technical definitions, but I was -8 in both eyes before my surgery and my husband is around -2.

Here is a quote from a technical article on myopia.

"Refractive error is measured in dioptres (D), and myopia is designated with a minus sign. Mild myopia is 0 D to −1.5 D, moderate −1.5 D to −6.0 D, and high myopia −6.0 D or more."

Very helpful!

Thanks Ron!

I know your vision is -2.0D and -2.5D. I wonder how you look at your feet with your progressive glasses? Don't you see your feet better without progressives? I had progressives 35 years ago and could not adjust. My eyes are similar to your your husband's.

May I ask the brand of progressive you have as well as the model?

Can progressives be made that are clear at the bottom?

Thank you Bookwoman.

I can see my feet and everything else perfectly with my glasses. (Without them, my feet are just very slightly blurry.)

I don't know what brand the lenses are - they're made by a local optician who has his own lab. I've been getting my glasses from him for over 30 years (first regular, then progressive), and while they're expensive, I've never had an issue with any of them.

A good optician should be able to make glasses any way you want them. Try going to an independent shop rather than a chain.

25 years ago or so when I first got progressives I quickly learned the first rule of wearing progressives. DON'T LOOK AT YOUR FEET, ESPECIALLY ON STAIRS! I actually got used to them quite quickly and liked them for the last 23 years or so. Now, I like eyeglasses free mini-monovision much better - and I can look at my feet!

I think there is a big difference in progressives. With time I expect the technology to get better and better.

With regard to having an eye exam and refraction 6 weeks after cataract surgery for the purpose of new glasses and to have the data for use in selecting a target for the second eye, is that usually done on coordination with the surgeons office?

I think you would be better to get some opinions here before you settle on what to do with your second eye. Wisdom of the crowd, and we don't have a financial interest.

Can progressives be made that are clear at the bottom?

Yes. Suppose the prescription for an eye was sph -2.5D cyl 0D add +2.5D, then the bottom of the lens would essentially be clear in the corridor. If corridor does not mean anything to you in this context, try this search:

progressive lenses corridor

Yes, in that example the bottom ends up with no correction. However, that does not make it any easier to adjust to as the differential does not change from top to bottom of the lens. You still need the difference in power to see both distance and near.

Good idea!

Thank you!

If you are -2.0D without glasses and you look at your feet - you can see your feet without any magnification. So, if the bottom of progressive glasses are clear - wouldn't it be same as without glasses?

Yes, I guess in theory. But, most adds in progressives are +2.5 D. When going down stairs I don't think it is as much about clear vision as it is about the vision changing when you look down. At least that is my recollection. I essentially don't wear progressives any longer.

From the beginning I had no problem adjusting to Varilux progressive lenses. And I switched seamlessly to Shamir about ten years ago. Based on limited records (and ignoring astigmatism), my prescription went from -7.25 / -7.50 in 2007 to -6.00 / -7.75 in February 2023.