Experience after monovision with monofocus cataract surgery

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