Glasses with monovision?
Posted , 3 users are following.
Hello,
I really appreciate this forum! I recently had cataract surgery and now have a distance monofocal lens in my non-dominant left eye. It's the AcrySof IQ IOL at +18.0 D. It works great.
I'm pretty sure that I would like the same done to my right eye, a distance monofocal lens, with the knowledge that I'll always need reading glasses. A cheap $10 pair of readers would suffice. This is so I can see distance with both eyes as well as near with both eyes using glasses. However, I'm intrigued about the idea of testing monovision and micro monovision with a contact lens. I'm not too keen about the side effects I've read about using multifocal IOLs, and I think it's too late since I already have a monofocal in one eye.
I know that with monovision, the idea is to be free from glasses or contacts, in theory, which would be awesome. Does anyone with monovision (near in one eye, far in the other) occasionally wear progressive glasses or contacts to give both eyes perfect vision at both near and far? Or would this undo the training required to get your brain adjusted to monovision?
Thanks for any comments.
0 likes, 7 replies
RonAKA Mark439
Edited
Yes, you could still do monovision. Ideally it is better to have your dominant eye as the distance eye, and non dominant as the closer eye. However, I am in the same situation as you and have a distance monofocal IOL in my non dominant eye. And, I am simulating monovision with a contact in my dominant eye that leaves me at about -1.25 D myopic. I can see distance really well with my IOL eye, and down to about 20". With my -1.25 eye I can see 10-12 point text on paper, my iPhone, and my computer screen. I don't seem to have any issue using the two eyes together. I frequently sit in front of a computer while having the TV on about 15 feet away. I can easily switch back and forth and see both very well. That is the issue with having both eyes corrected for distance. Yes you can see well at distance without glasses, and see well up close with reading glasses, but you are constantly putting them on and taking them off. I do not enjoy looking at distance or walking around with reading glasses on.
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My suggestion is to do a trial run of monovision by using a contact in your non operated eye if you can still see well enough with it. If for example your prescription is -4.0 D sphere you would use a contact of -2.5 D. That would leave you -1.50 myopic. That would give you some idea what a monovision world looks like. If you have astigmatism it is best to consider that in your simulation. For example if your prescription is -4.0 D sphere, -1.0 D cylinder then you can estimate the total power by adding 50% of the cylinder. This would be equivalent to -4.5 D. Then to get -1.5 D monovision you would use a -3.0 D contact. And if you like it and want to do it for real with an IOL you need to also consider what your residual astigmatism would be after cataract surgery. Your surgeon is the only one that can predict that with some accuracy.
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As far as wearing glasses with monovision, I do that as well. I have a pair of progressives that I wear without the contact. It corrects both the sphere and cylinder in both eyes. It does give me the overall best vision at distance, and for reading. But it does come with the disadvantage of progressives -- having to look up and down depending on the distance. With my simulated monovision, I almost never wear glasses. My long term plan is to only use progressives for difficult situations like driving at night outside the city. I currently drive in the city at night without glasses, just the monovision.
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Hope that helps some.
Edit: I just noticed that your IOL is an 18 power, so you probably have very little spherical error, so my -4.0 example is not going to match your vision, but the process and math is the same.
Mark439 RonAKA
Posted
Really appreciate your insight (again), RonAKA! Especially since your experience matches mine with the distance IOL in the non-dominant eye.
My dominant eye is -2.25 D sphere. So, I should request a contact of -0.75 D to get me to -1.50 myopic, is that right? What's concerning is that just 6 months prior, my dominant eye was at -1.50 D sphere, so I wonder if the change in prescription is due to cataract growth.
What you described, being able to read your iPhone, computer screen, and see the TV without glasses, is awesome. So, near, intermediate, and distance without glasses. At the intermediate distance, do you have blended vision where you can read the computer screen with both eyes comfortably?
Thanks for the feedback!
RonAKA Mark439
Posted
Yes, if you have no astigmatism and your sphere is -2.25, then a -0.75 D would give you -1.50 D of myopia or monovision.
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Yes it is likely the cataract that is making your vision change. The error in your cornea is likely very stable, but the lens changes shape as the cataract grows. You should base your contact trial on what your vision is currently.
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I see my computer screen comfortably with both eyes open, but it is my near eye that is doing the reading. I sit about 12-14" away. I don't think my far eye is contributing much to the computer screen reading as it does not start to get good until 18-20". I can see 12 point text with my far eye, and kind of read it, but it is not clear enough to be comfortable at my normal computer monitor distance. But, if you try the contact you will see what it is like. Most contact lens places have free trial packages of 5 contacts. Costco Optical is quite liberal with the trial contact packages. I am currently using a -0.75 D Kirkland Daily lens in my near eye. They are made by CooperVision.
Mark439 RonAKA
Posted
Just a follow-up question...
What far distance could I expect to see with a -0.75 D IOL? Is there a calculation? I'm just wondering how much worse my distance vision would be if I put this in my -2.25 sphere eye.
RonAKA Mark439
Posted
Are you asking what your distance will be like if you use a -0.75 D contact lens in your -2.25 D natural eye? If so, this will leave you at -1.5 D myopic. The best way to find out is to just get some sample -0.75 contacts to try. Another less direct way would be to buy some -1.50 D readers at the dollar store. Then what you see out of your distance IOL eye will be similar. It is not going to be great and I would guess in the 20/50 range.
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If you are asking about doing -0.75 D monovision with an IOL then of course distance vision will be better, but reading vision is not going to be very good.
Mark439 RonAKA
Edited
Thanks, RonAKA.
Yes, I do have some -2.00 D readers from the dollar store that I bought for the IOL eye. You're right, distance is not good at all. I'll try that with -1.50 D readers also. I'll also look into the contact lens trial at my appointment next week.
I'm asking because right now I can still read quite well with my natural eye when I hold documents around 8 - 10 inches from my eye. So, it feels like monovision already. Just wondered if a -0.75 D IOL in this eye would maintain distance vision as poor as it is or make it worse. Of course, the purpose of the IOL would be for reading. I may not be at a place where my dominant eye needs to be worked on yet. But it's good to learn these options early.
Very much appreciate your posts!
RonAKA Mark439
Posted
When you get a -0.75 contact then try it in your IOL eye. Contacts are not eye dependent. That should give you a really good idea what an IOL eye set for -0.75 D myopia is like. I suspect it is going to leave you short of good reading at 12-14". After much reading and experimenting I am convinced that the sweet spot for monovision myopia is -1.25 D to -1.50 D in the near vision eye.
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I can't remember if I gave you this link. It has some figures that if you click on them they will expand to give you the details. Figure 1 shows the Snellen vision quality at the various distances in meters. A -2.0 myopia yields about 20/150 at distance. A -1.0 is about 20/40. Figure 2 shows the two eye combined vision with the -1.0, -1.5, and -2.0 D. The conclusion of the article is that -1.5 D is optimal. I think viewing the graphs that -1.25 may also be ok, and that a range, since you cannot be exact with an IOL of -1.25 to -1.50 D is a reasonable target.
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Optimal amount of anisometropia for pseudophakic monovision Ken Hayashi, Motoaki Yoshida,