IOL Monovison Simulation with a Contact Lens

If you are talking about during the simulation before cataract surgery I just wore my progressive glasses. With the CooperVision MyDay contacts I could make it pretty much through the whole day with them in. But usually to give my eyes a break I would put the glasses on for the last hour or so before bed.

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During the period when one eye has had surgery and the other not, it becomes a little more tricky. I used a near vision contact in my non operated eye as my first eye IOL was for distance. And for the first while, without a contact, I used some progressive glasses with the lens removed from the operated eye side. This is not a great solution, due to the difference in correction between the eyes. Since I went a long time between eyes, I got a pair of Costco Kirkland progressive glasses that I did not break the bank on. Then when I got the second eye done, I had Costco replace the lenses for my updated prescription at the time. I almost never wear them however, with my IOL mini-monovision working well.

ron

couldnt i just get some glasses with the lens corrected to an approximation of the contacts (ie one lens set for plano and the other for -1.25 or whatever the conversion would be from contacts to glasses)? i have no progressives

thanx as always

dan

If you have no progressives what do you use for your vision now? It would seem you need a substantial correction to get good vision.

i use single vision because i hate bifocals and did not want progressives. (i take glasses off and bring book, ipad close to read or put readers over my single vision lens)

wouldnt the dominant eye (the one i would put plano contact in for far) be easy to match with an eyeglass lens and then the other eyeglass lens would just be under corrected to match the contact for times when my contacts are out?

am i missing or misunderstanding something?

also, is there any advantage to setting far eye for -.25 and undercorrected for -1.50 with the contacts? did u try this?

thx again

Ok, I see. Yes in theory it would work to get lenses which correct to plano in one eye and to be left at -1.50 in the other eye for reading. I have never done it or heard of anyone that has done that. It could be hard trying to get an optometrist to write a prescription that way, but they might do it. When you get your eye exam at Costco you could ask the optometrist if they would do it.

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With contacts there is no point of targeting -0.25 D in the distance eye. That is only done with the uncertainty of what the final outcome will be with IOLs. With contacts the normal practice is to target right on 0.00 D for distance.

well, i would still need to be able to see when i would not have contacts on ( say before bed, or if they happen to be irritating me). it does happen, as you commented on not being able to do full days on every brand. so it will be interesting to see if they will do it. the way i look at it, i should be able to experiment on my vision BEFORE surgery as there are no real risks or liabilities for an optometrist in doing that. and its my 150$ .

another question (i might have already asked). is there any reason i would not ask for toric samples?

thx again

dan

I think if it were me, I would just depend on your existing single vision glasses and reading glasses arrangement up until the time of the first cataract surgery. You will have lots of the time of each day with contacts monovision to decide if that arrangement is what you want for IOLs. I see no benefit in simulating that with eyeglasses.

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When you get to the point of having one eye done and the other not, that is when I would consider an eyeglass solution. If it is going to be for some time then solve it with a new pair of glasses. And if you do the distance eye cataract surgery first, which would be normal practice, then get a lens in that distance eye that corrects for any residual sphere and cylinder. In the other eye, do your under correction to leave you at -1.5 D. It will not be the best, but for most of the day you hopefully can use a contact in the non operated eye. Then when both eyes are done you can get what you want in that eye. Buy what you have been doing I guess it would be a single vision lens assisted with readers when necessary.

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The only reason to not ask for torics is probably cost. For sure you want to try torics when they are free samples. Then you can decide if you want to continue on with contacts or not. If you are going to go on for a longer period of time and want to keep the cost down, you could try non torics. I actually did that. I did that because I could not get the Kirkland (CooperVision MyDay) in a toric version and they were the most comfortable. It came down to a choice between a more expensive Acuvue Oasys Toric that gave better vision but was less comfortable and a more comfortable and less expensive Kirkland. Since I already knew I was going for monovison it came down to comfort and cost.

thanx ron. that makes sense.

let me ask

did you focus more on brand and material differences or with prescription differences with the multiple sets of test contacts you got?

Fairly early in the testing I decided that I liked monovision, and that was the main purpose of the test. After that I tried -1.25 and -1.50 D for under correction. Both were ok and I kind of preferred -1.25. Then a participant here suggested that I use +1.25 and +1.50 reading glasses with my operated eye which would simulate -1.25 and -1.50 D under correction with a non accommodating IOL. The operated eye has no accommodation as it already was an IOL. That basically confirmed for me that -1.25 was not quite enough for reading , and that I would ask for -1.50 D.

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After that it was just a matter of finding the most comfortable lens to use to get me through until the second eye was operated on. I liked monovision and no glasses so much that I did not want to go back to progressives. I sacrificed the astigmatism correction and went with the Kirland (CooperVision MyDay) as they were the most comfortable to me and also the least expensive. I had plans to test the Alcon Precision1 lens, but never got around to it. Based on the specifications for it, it could be a good lower cost choice. The proof is always in wearing it though... And each person could be different.

testing on iol would be very realistic. why didnt you use contacts on the iol eye insteadnof the readers? if you like 1.5 with glasses with contacts or iol is 1.25 going to be similar?

im confused. so do you wear readers for reading even though you have an eye set good enough (non dominant weaker near eye) for reading? if so, is that so reading will be less annoying by using both eyes?

It only cost me a couple of bucks at the dollar store to try +1.5 readers. And, I still have them around somewhere to use once in a while where a little extra close vision is required.

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I found the vision with an IOL eye and +1.5 readers to be similar to a natural eye being left 1.25 D under corrected. The difference is probably the contribution of my remaining accommodation with the natural eye. The IOL eye needs a little extra help.

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I think the reality is if one can get to the range of -1.25 to -1.50 with an IOL in the close eye reading vision should be pretty good. Sometimes people focus on the differential between the eyes. I think in monovision the important number is just the under correction in the near eye. That is where your reading vision comes from.

I don't use readers normally for reading. The only time I would reach for readers would be in dimmer light and very small print like you might find on an OTC medicine bottle. I also find readers helpful when I am doing some work in my shop with say very small screws and I need to see clearly to line things up. Phillips screws which I detest are always a bit of a pain to line up with the screwdriver if they are very small. And if you mess up and strip the head of the screw then you are in a real jam. But, for normal things like reading text on paper, text on a computer screen, or text on my iPhone, I don't need readers. I don't particularly like white text on a black background on my phone, but I can still read it.

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I don't bother to take readers with me when I leave home. Reading the menu in a restaurant is normally fine without readers, even if the lighting is dimmer.

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One has to be realistic about mini-monovsion. When you get a pair of progressive glasses they normally add +2.5 for reading. With mini-monovision you are only getting the equivalent of +1.5 and in one eye only.

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One thing I wondered about was how would readers work when, for example, I would technically need a +1.0 in my near eye and a +2.50 in my distance eye to bring them both up to the standard +2.50? What I have found is that a pair of +1.25 readers is just fine. They are not bringing both eyes up to the same value, but it works well.

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This is why doing a trial with contacts is a good thing to do. You get to evaluate these issues for yourself. I have a friend that got PanOptix MF lenses in both eyes. She is quite unhappy with them because she needs reading glasses to read books comfortably even in outdoors light. She, I recall, uses some +1.75 readers. There is no perfect solution to dealing with cataracts, but for me mini-monovision seems to be one of the best ways.

yeah, the one thing i realize reading so many messages about others post cataract experiences are that disappointment about the results is either not having had enough info ahead of time to set expectations realistically.

that is why i will hesitate to get iols that soon. i suspect 90% of the folks who have had them done were at a point where ANYTHING would be an improvement. when i read about their color contrast coming back, i realize i have no color issues. the 10% or so are like me who notice something has changed (like glare for me) and just want it banished, not doing the research on possible complications, on the inevitable compromises etc. this group is the one with all the regrets i think. this is what i struggle with. and this is also why i may cancel my eye exam tomorrow and push it back a week as you are helping me amass lots of knowledge. much appreciated!

It is an important decision as to when is the time right to do the surgery. Cataracts tend to sneak up on us. And, while you feel you have no issues with contrast sensitivity and colour you may be surprised when you get the first eye done and you have something to compare to.

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I am not so sure that there is any benefit in postponing a contact lens trial. You may find that wearing contacts to be eyeglasses free with monovision is superior to your eyeglasss solution that you are using now. But, in any case the learning you get from a trial has no shelf life. It can be used in a few months or in a couple of years.

I am not so sure that there is any benefit in postponing a contact lens trial.

Not to mention that once impairments from cataracts get very noticeable, you won't be able to tell what's working in the trial and what isn't. It's pretty amazing how quickly your vision can deteriorate, so best to figure things out before that happens.