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Experience after monovision with monofocus cataract surgery

Posted , 13 users are following.

marius19221
marius19221

Hi,

I just want to share my experience after undergoing cataract surgery five days ago.

After several rounds of uncertainty about what type of lens I should opt for, I decided to go for a "light" monovision solution, using monofocal IOL's.

The surgeon originally recommended Alcon Vivity, which is a new type of EDOF, which claims to improve, or completely eradicate many of the side-effects of earlier generation EDOF's. The lens was launched in November 2019 and my surgeon claims that it is the first EDOF that really delivers on the promise of near monofocal optical performance, coupled with glasses-free vision down to close, intermediate distance.

Unfortunately, Vivity was not available for my level of myopia, and the choice then fell between monofocals, or tri-focals. In my case, Alcon Panoptix was the tri-focal on offer.

After thinking quite hard about the choice, I decided that lack of visual artifacts and best possible low-light performance were more important to me than being completely glasses-free, and I opted for the monovision solution, with my left (non-dominant) eye focussed at +1 to +1.25, relative to the dominant eye, which was corrected for distance.

Five days on, I am generally extremely pleased with the result. I now have hawk-like long distance vision, already with very little aberration - no rings and almost no starburst or "fog". My right eye is crystal clear at distance, with just a slight softening of the image from the left.

The intention was that monovision should give me good focus at PC screen distance, with usable reading performance if I held the material a little away from my eyes, and on day one after the operation, it did indeed seem that this would be the case. However, as the slight post-operative swelling has reduced, focus has shifted further away for both eyes, so that I do now need +1 glasses for screen-work and slightly more for closer reading.

Even wearing the +1's, my distance vision is approaching my earlier experience from properly corrected (with glasses) myopia, so for many myopics, a slighly softer IOL correction may well be more than good enough, reducing the need for + glasses in every-day situations and offering good-enough distance vision, which can easily be corrected further with a pair of -1's in situations that demand perfect long-distance vision. This corresponds to advice from my surgeon, who told me that myopics generally prefer slight under-correction and that he aims for this when choosing IOL's for this patient group.

I believe that an exact measurement of the necessary strength of IOL's is difficult and that there will always be a margin of error, compared with prescriptions for glasses or contact lenses.

I am informed that, should I be dissatisfied with the result, I can opt for an additional, corrective tri-focal lens implant in a year, to completely correct my vision, and that the side effects of this, double solution will be comparable to an Alcon Panoptix, single IOL. This solution in both eyes would cost the same as the surcharge for tri-focal IOL's last week.

One option to minimise artefacts might be to opt for this in my left eye only. However, it is still very early days and I am certainly enjoying the overall clarity of my vision, which can only improve even further over the next couple of months. I do not feel that the need for work/reading glasses will pose any significant problems and will post occasional updates here as my post-op sight further develops.

2 likes, 17 replies

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  • Guest
    Guest marius19221

    Posted

    Hi Marius

    Most of your text have disappeared, but as I understand, you have got a good result, happy to hear it 😃

    • marius19221
      marius19221 Guest

      Posted

      Damn!

      That will teach me not to write long posts!

      Yes. generally very good experience. I cold have wished for slightly better intermediate vision on the non-dominant, but overall crystal clear and no artifacts. I have been offered a corrective op in a year if not satisfied.

      Recommended.

    • Emis_Moderator
      Emis_Moderator marius19221

      Posted

      Hi marius,

      The issue with the initial post was not length but a known bug where if there are spaces at the start of lines of text the format gets broken. I've edited the discussion and it is fine now so I have deleted your repeat post below.

      If this happens again use the "Report" link to draw it to our attention and we can edit until the fix gets deployed.

      Regards,

      Alan

    • jakub51385
      jakub51385 marius19221

      Posted

      Hi Marius, would you please tell me how you see on medium and close distance with only your dominant eye (corrected to the distance)? Are you able to read regular text on the length of your arm (PC monitor distance)? Are you able to recognize some text in close distance or this is not possible at all?

      Thank you,

      Jakub

  • mjcg
    mjcg marius19221

    Posted

    marius... - thank you for sharing your experience with cataract surgery. I'm sure it will prove helpful to readers who are trying to decide what lens will work best for them. It's not an easy decision! It's interesting, if I understand what you've written correctly, to know that you have the option of replacing a lens after a year. Is that correct? I always thought that once cataract surgery is completely, the lens can never be replaced again.

    • marius19221
      marius19221 mjcg

      Posted

      Hi mjcg and thanks for your feed-back,

      The option is actually to add a "piggy-back" lens behind (I believe) the original mono-focal.

      The mono-focal would stay and provide most of the correction, while the additional lens would be a mild tri-focal, to provide fine adjustment. My surgeon told me that they are the only clinic in Norway offering this option and that the result should not be worse than having tri-focals as the original implants, so this is clearly not an option that is universally available.

      It's good to have it as a fall-back option if I can't live with the glasses and it delays the cost of the fully glasses-free option, as the original lens replacement cataract treatment was covered by insurance / or state (where we're lucky enough to have state health-care), but opthalmic surgery is not.

  • Guest
    Guest marius19221

    Posted

    Hi Marius

    It sounds like your lenses have shot a bit over the target, you should have more intermediate vision, but this can change a lot within the next couple of month.

    It takes 6 weeks before the eyes are healed, and during this period the power can change back and forth, you maybe even feel it some days, that vision is better or worse than previous day.

    But main thing is you have had no complications 😃

    • marius19221
      marius19221 Guest

      Posted

      Thanks for that information. It will be interesting to see where the power ends up. I assumed that it would only move one way as the edema reduced.

      Day one after the op was perfect for intermediate vision, but my right (distance) eye wasn't performing optimally. Now both are already clearer than I can ever remember seeing, but certainly long range is better than intermediate.

      It's not that far off, so I should probably practice working through mono-vision, rather than always putting on the specs to do screen work.

  • ara21947
    ara21947 marius19221

    Edited

    Mine were also monofocal both set to near at 1.5 with correction for astigmatism. Right eye is 3 months out and left is 1 month. My computer and iphone near reading is excellent; book reading needs light along with that same search for where to place the book to focus and eyes tire quickly. I had originally asked for closer but surgeon felt I would lose too much distance and that the astigmatism would help the correction. Outdoors is extremely bright especially on sunny days. Night driving is fine. ( Im curious if anyone else notes more light dispersion from newer headlights than those on older models?)

    I havent gotten my new prescription yet for distance and am toying with reading glasses at lowest strength for book reading in lower light It is what it is. I wouldnt want to go through this again unless I had to.

    • Guest
      Guest ara21947

      Posted

      Hi Ara

      Happy to hear you have made peace with the situation, even though you were hoping for more close up vision initially.

      Newer headlights (the LED type) is for sure "worse" for us with iols, no question about it.

    • marius19221
      marius19221 ara21947

      Posted

      Hi Ara,

      Thanks for sharing your experience! I'm sure that learning to cope with whatever compromise it is that we have chosen, will take a while for all of us. It is interesting to hear that even with a +1.5 correction in both eyes, that you still find reading a challenge. It's also encouraging that even with that degree of correction, you still find night driving okay.

      My correction is aimed quite a bit lower than yours and on only one eye, so it is no surprise that I'm finding that anything closer than middle-intermediate needs glasses. It's clear that our visual priorities are quite personal and that reading without glasses will be the priority for some of us, while low-light, long distance will be more important for others. It's important to think hard about our individual preferences before choosing a type of IOL and prescription.

      I'm still a bit unsure in which situations I should try to force my brain to compensate and where I should just give up and use reading glasses. As you say, our eyes tire quickly when pushing the boundary of our focus. For me. Large fonts on PC are just about okay without, but a working day needs +1's. Anything closer or smaller is impossible without specs.

      My experience with LED headlights is quite a pleasant surprise. While very bright, I found the dazzle much worse before. I can see the shape of the light source quite clearly now and can even read licence plates, between the headlights (if illuminated by my own lights). All-in-all very pleased and eager to see where my eyes settle down.

      While not exactly wishing to go through the op again, I found it more uncomfortable than painful and would do it if I thought I could further improve my sight.

    • ara21947
      ara21947 Guest

      Posted

      Im wondering about those newer headlights still. Could it be the fact that they, like our new IOL, are clearer and cleaner so they shine to us "sensitive" eyes, brighter?

      Im only pondering the readers. I can still read close but not magnificently close, if that makes sense? I miss that but count my blessings.

    • ara21947
      ara21947 marius19221

      Edited

      for sure the lights are better now than pre cataract surgery. That was an other wordly experience -- all those wild and scattered lights coming and going. Alien abduction.

      I read my book last night without glasses or problems. Mind over matter?

    • Nelu_Goia
      Nelu_Goia Guest

      Edited

      The newer headlights are way worse even for me and I had no eye surgery done.

      I think they should be banned because they're a hazard to the traffic safety.

  • RonAKA
    RonAKA marius19221

    Posted

    Thanks for the detailed report. I have a couple of questions

    1. Perhaps I missed it, but what monofocal lens did you go with?
    2. You mention you still need reading glasses in some situations. With a +1.25 or so in your non dominant eye, what kind of reading glasses do you use? It seems to me that you will potentially need double that in your other distance corrected eye? Or do you just essentially use your non dominant under corrected eye for reading?
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