Is Targeting the Dominant Eye for Distance Necessary for a MonoVision Strategy?
Posted , 12 users are following.
Hi Everyone,
Most, if not all, articles I've read on the subject of mono-vision say that the dominant eye is the one that should be targeted for distance and the non-dominant eye for reading. I've been informed by my consultant/surgeon that my cataract affected eye, which is also my non-dominant eye, is being targeted for distance whilst my near sighted non-cataract affected eye will stay natural. So I'm wondering... How necessary is it that the dominant eye be given the implant for distance in a mono-vision scenario? I'm scheduled to have the surgery in the next 10 days or so, so I'm trying to finalize all this knowledge. Thanks.
Regards,
G
0 likes, 21 replies
michael74313 indygeo
Edited
My right (non-dominant) eye had a really bad cataract so we did that first and targeted for distance. As it turns out, I didn't like having lost near vision but also I couldn't stand mono-vision. So, we then did my left (dominant) eye (with a cataract not nearly has bad) and targeted for distance also but set it in a little bit (1/2 diopter) so as to have mini-monovision. This worked out great for me as I now see well at all distances. But, it was important to me that both my eyes work together. Most don't tolerate mono vision well. My understanding is that they recommend the dominant eye be targeted for distance but I've also read that things can change over time and your other eye can become dominant. Maybe others can comment on this since given I had "mini-monovision" done, it just didn't seem to matter which eye was dominant.
diane48177 michael74313
Posted
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.
michael74313 diane48177
Edited
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.
diane48177 michael74313
Posted
Thanks again.
Night-Hawk indygeo
Posted
If possible, its best to try with contact lenses both ways to see how it feels before surgery.
I did that a few years back and dominant eye for distance was much more comfortable for me than the opposite.
at201 indygeo
Edited
1. Get the vision you want without worrying about which eye is dominant. The dominance of the eyes seems to change if one uses mini-monovision or monovision.
2. How near-sighted are you with the non-cataract eye? That is what is your prescription for that eye? Unless you expect have a cataract develop within the next year or so (which does not have to happen: there was a 17 years gap between the 2 eye cataract surgeries).
3. My suggestion will be to aim for about 1D difference between the 2 eyes. That is, if your non-cataract eye is -2.5D, aim for -1.5D for the cataract eye. Otherwise, you will struggle with having to find a pair of glasses which will work for you. If you are using a contact lens for the non-cataract eye, this recommendation will change.
Any way, if you can share more information about the vision in your non-cataract eye, we may be able to give you a more-focused recommendation.
at201
Posted
indygeo at201
Posted
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
Night-Hawk indygeo
Edited
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.
indygeo Night-Hawk
Posted
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
at201 indygeo
Posted
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.
betsy83524 at201
Posted
at201 betsy83524
Posted
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.
betsy83524 at201
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at201 betsy83524
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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.
betsy83524 at201
Posted