Is Targeting the Dominant Eye for Distance Necessary for a MonoVision Strategy?

Hi Michael, I’m  so glad I came across your response to this post. I’m really struggling. I had cataract surgery on March 8/18 on my right (dominant) eye. It was to be set for distance but because of previous Lasik the outcome was not as I had hoped. My best vision is intermediate. So now the doctor wants to tweak things to set the non dominant eye to distance. I’m concerned because right now distance vision is blurry out of my dominant eye and I’m not sure that will work, to have the non dominant eye set to distance. 

Having had Lasik all those years ago I have decent distance vision out of my left eye but the cataract is what’s not giving me clarity. 

I guess what I’m saying is I have decent distance vision  in my left eye (still has cataract) and clear intermediate vision in my right eye ( dominant eye that had CS) and together my distance vision is terrible. 

Hi Diane - you are only 10 days out from surgery so things could still continue to improve.  Did you have a toric lens?  If so, it's possible it might have shifted a little.  I don't think I would do anything with your non-dominant eye until things settle down with your dominant eye and you know what you want to do.  How is your near vision with your dominant/operated eye?  Sometimes (at least for me) if the second eye gets done and it's not too different in diopters from the other eye, then both eyes can "help" each other see better at all distances.  Personally, I don't think I would go more than 1 dipoter difference for the second eye.  It's not so much a matter of which is dominant, but rather that most don't tolerate mono vision so well.  Also, if the eyes are closer together (ie: 0.5 - 0.75 diopters differences) then they can help each other see better at all ranges.

If your distance is good in your left eye but not good with both eyes, then perhaps your intermediate is more towards near than distance (In other words, you have a good deal of mono vision that you can't tolerate which is what I had after the first eye was done).  With that said, if that is the case, then it might make a lot of sense to wait for the eye to heal more and then when you do the second eye, don't go with full distance, but perhaps bring it in a little so that the eyes can work together.  Now, the other option would be to use the laser on the operated eye to bring it out more from intermediate and more towards distance (since it sounds like you prefer distance).  Then once you have that eye seeing where you want, consider doing the second eye then.

In the meantime, some have used glasses (between surgery - where they remove one lens from their glasses - the lens for the eye that was operated on is removed) where they have only one lens so that their eyes are more in sync.  That never worked so well for me but I've read it worked for some so as to not have mono vision between surgeries.

Perhaps others can offer their input as well.

Good luck to you.

 

Thank you Michael. It’s actually 20 days today since my surgery. My second eye was scheduled last week but we postponed it. I go see my surgeon again next Monday. Hoping for answers and options because right now the two eyes only work well together at intermediate distance. 

Thanks again.

The 17 years difference between the 2 cataract surgeries was for me.

Hi at201,   This is all that I have in terms of measurements:

Boots Opticians ( about 1 1/2 years ago ) 

Right:  -3.00    Cyl:  - 0.50    Axis: 110    Reading (Near) Add: +2.25

Left:    -2.50     Cyl: - 0.75     Axis: 115   Reading (Near) Add: +2.25

Tesco Opticians ( 4 or so months ago )

Right: -2.25  Cyl: -1.00      Axis: 105.0    Near Add: +2.25

Left:   -2.50  Cyl: -1.50     Axis : 50.0      Near Add: +2.25

Private Surgeon (3 weeks ago): 

Right:   -2.00   Cyl: -0.75  Axis:  105

Left:     -2.25   Cyl: -1.25  Axis:    54

My surgeon said that at present after he sets my left eye for distance, I'll probably be about 2+ diopters difference between the two eyes.  He did say it's on the extreme side of mono-vision.  He said he can't in fact tell which eye is dominant due to my cataract in my left eye.  However, I suspect my right eye is my dominant eye because it's the eye I use on, for example, a telescope or peering into a camera.  Again, my right eye has little to no cataract and is near-sighted.      I must admit I'm a bit confused by the variations in the measures above.  Boots seems to be the odd one out.  In any case, this is all the info I have at the moment.  Hope this helps. 

G

 

With the most recent refraction results for your right eye (-2D nearsighted) targetting your left eye for near 0D (best distance vision) after cataract surgery would indeed be extreme side of monovision.  If your right eye is actually a bit more nearsighted like in the previous refractions, it could really difficult to get used to and even with eyeglasses due to that much difference between the eyes.

To be safer, I'd recommend targetting your left eye for intermediate vision with perhaps -0.75D to -1.00D, that should (if astigmatism in that eye ends up not being too high) provide good vision for computer monitor viewing at 2-3 feet.   Your right eye would then provide good near vision for reading, and you could then just use a simple non-progressive pair of eyeglasses for distance/driving.

Night_Hawk... hmm, interesting.  What you've suggested is certainly reasonable.  I've not been stressing that side of the equation.  My surgeon has been discussing primarily the notion of achieving good unaided distance vision and, only if necessary, using readers (i.e. the other side of the coin so to speak).   Ideally, I'd love to achieve the outcome that Michael74313 has.   I also like the idea of seeing well at distance as I would like to enjoy the night sky, stars, etc.  It's just so frustrating because it always seems there's a tradeoff/compromise.  But then again, I guess almost anything is better than what I have now.  It's very frustrating to be so bad in one eye and rather clear in the other.   I just hope that when my left eye gets done in about 8 days, I'll be pleasantly surprised by the result.  

G 

Based on your prescription from 3 weeks ago for the right eye, the equivalent spherical correction for that eye is -2.375 (the actual no varies from -2.0 to -2.75 at different angles on the cornea).

Thus, my strong recommendation will be not to aim for plano or the best distance vision for the left eye. The resulting monovision difference of 2.375 D is not bad in itself (although it is a lot harder to adjust to than a mini-monovision), but while you will probably be able to see reasonably well from 14 inches to 21 inches or so (the same as you can see with the right eye by itself now and thus easy to double-check) and from about 6 ft and beyond (due to the new IOL in the left eye), your vision will not be good from 21 inches to 6 ft or so. That will be hard to deal with. You will then be trying to get glasses to see well at the intermediate distance, but will have a hard time in deaing with wearing the glasses because of the large difference in the prescription of the 2 eyes (due to difference in the size of the images caused by the glasses).

I think that you will find it much easier to live with the resulting vision if you aim for -1.5 D (or -1.25D). The difference in the 2 eyes of about 0.875 D will be much easier to deal with. You will be able to see reasonably well up from about 14 inches to about 40 inches and will need glasses only for far distance. This will be  much easier to live with. Also, you won't have any issue due to the difference in the images caused by the big difference in glasses prescription for the 2 eyes, when you choose to wear them for distance.

In a few years, when the time comes to have a cataract surgery in the right eye, at that time, you can aim for -0.25D in that eye. With that you will end up with good distance and intermediate vision, requiring glasses for reading. But there may be other options available at that time.

Just curious as to how you like the mix of monofical and symfony.  I may have missed a comment about this but have recently had a toric monofocal in my left eye and am disappointed with loss of near vision.  Am considering a Symfony Lens for right eye,  but after reading other comments, am still conflicted about the lens choice. I am delaying surgery for right eye for now as I am able to do ok with glasses and am hoping to get new Rx glasses to accommodate both eyes.  Thank you for any input.

I have had no issue due to mixing the Symfony lens in the right eye (set for distance) with the monofocal lens in the left eye (set for reading).

My day vision is very good at all distances. The only issue is the less-than-desirable night vision due to seeing the multiple circles around lights at night ( most visible from about 50 to 200 yards).

As I have mentioned in these forums before, I did not really have this choice (had a cataract surgery in my left eye about 19 years back), but if I were starting from scratch, I would probably have a monofocal lens set for distance and a Symfony lens set for the intermediate distance. Thus, if you have good far distance vision in the left eye, then getting a Symfony lens set for the best focus at intermediate distance (about -1.0D) will be a good choice for you. You should then have good intermediate and near vision also, with much reduced tendency to see the multiple circles around lights at night.

Thank you for your response.  This does make me feel better~ I think all of this has done a number on me psychologically.  Seeking wisdom and guidance to make final decision and this is most helpful.  Thinking I should have had the Symfony Lens implanted with first (left) eye so that both eyes would be same lens as I had read that is most recommended.  Do you feel this “mix” mimmics  monovision or mini monovision in any way?  Thank you again for your prompt reply~ feeling more relieved already~ prayers being answered and am thankful.

No. I don't think that mixing the monofocal and the Symfony lens mimics the monovision. Of course, I have that combination of lenses as well as monovision because the two lenses are set for the best focus at different distances.

 

Thank you~ this is most helpful.  I postponed my second surgery as I just need time to research and make the best decision.  Your comments are encouraging and appreciated.