Mildly Myopic non dominant eye only

Thanks yes she mentioned the accommodation factor and called me young which I gave me a good laugh. Right now uncorrected I see clearly from 8-28 inches. The little type in this thread on my iphone 12 looks great at 8". It would be an easier decision if I was getting both eyes done.

Thanks. I'm leaning toward a myopic monofocal in my left eye. As an engineer tried and true is the winner when risks are high and you've got one shot. We save the experimenting for lower risk times. Who knows if Vivity will even be available in 10+ years.

I could never wear contacts. They were uncomfortable but I haven't tried them in 30 years. They are a hassle but I might have to give them another try.

One comment my MD made about monovision is that for some unknown reason it magically fails at age 65. Not sure if that applies to minimonovision.

The failure of monovision at about 65 was true for me. My doctor warned me it was coming, and he was right. What he said and I didn't question was that the difference between my two eyes was becoming too great. I didn't question exactly what that meant or how it works but after 20 years happy with monovision it was true it no longer gave me vision I was satisfied with either distance or near.

The secret is to not try to use too much myopia in the near eye. -1.25 to -1.5 D is about right. Normal target in the distance eye is -0.25, so not much over 1.0 D differential.

I am also an engineer but retired for some time now. I started using contacts in about 1975 and have been on and off with them since. Over time supposedly the contacts were getting better, but I found it harder and harder to handle them. They simply would not come off my finger and stay in my eye. Recently I found some other contacts made with silicone hydrogel that are much better. The best three brands I found were the Alcon Total 1, J&J Acuvue Oasys, and best of all the Kirkland Signature ones at Costco.

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I used contacts for monovision on and off once I started to lose my near vision. I basically stopped using them due handling problems. More recently at age 72 I started doing it again, and now I have monovision with IOLs, and like it a lot. Years ago they tried to push full monovision with -2 to -2.5 D in the near eye. That has fallen out of favour, with mini-monovision now being more popular.

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I don't know of any reason why mini-monovision would fail at age 65. In fact the success improves as we age as the pupil size goes down with age and provides more depth of focus. It is the younger people with larger pupils that can have more issues. They can also have issues with seeing the edges of the IOL which has an effective diameter of 6 mm. Young people can have a maximum pupil size larger than that.

Sure, and it may give you "functional" near but not comfortable reading vision, like sitting down with a book for a couple hours. That's what I had before and what I want and less than that isn't good enough, so at that point monovision failed for me. I've been putting off surgery because I can't decide what to do target-wise. I really, really want to be able to read with naked eyes. I can still do that now, and even though readers make things crisper, I prefer no glasses.

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Glasses for distance are no problem. That's been the case all my life, and I don't have your feeling that anything less than 20/20 isn't good enough. I need to be able to drive and even drive at night, but that's all. Right now I spend most of my time with computer glasses on and even go out and walk the dog with them rather than switch for better distance vision. Reading and using the computer comfortably is paramount, and while I accept that I may have to, I don't want to use glasses for either of those.

Maura, you sound just like me. If you've read any of my posts you'll know that I opted for -2 monofocals in both eyes, with my left eye winding up at -2.5. I only put glasses on to watch TV or go outside, drive, etc. Since I spend much more time indoors reading books or on the computer than I do outside, this has worked out beautifully for me.

Once you lose your natural lenses and vision there is no perfect solution. What one might consider comfortable is very subjective. I find my -1.40 D near eye very comfortable for reading my computer monitory, iPhone, and paper documents. I would read a book with it, if there was decent light. The vision is not perfect as I have -0.75 D of astigmatism, and I'm sure it would be much better if I had a pure -1.5 D sphere and 0.0 cylinder. But, it works well for me, compared to the alternatives.

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What I dislike is putting glasses on and off, and fumbling around to find them when I need them (very fine print in dim light), and worst of all, I don't like readers when I have to look up and across the room. When I use readers they are off my face as soon as possible.

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I use my computer at 14" or so, and watch TV at the same time. I find it very comfortable to read the computer, and glance up to see the TV, and back down to the computer again.

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I wore progressives for decades and they certainly work, but having mini-monovision with no glasses is much more comfortable. I have progressives that do give me the ultimate best vision, but I never wear them. I prefer the comfort and convenience of glasses free. When driving I find the progressives limit my peripheral vision compared to no glasses.

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But, as I say there is no perfect solution for everyone. Each has to make their choice based on their personal priorities.

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My only regret with my choices is that I did not get a toric IOL to at least partly correct my astigmatism in my near eye. If I could take a mulligan that is the only thing I would change.

Bookworm, where does your near vision begin and end? 90% of the time I where my old old progressive glasses that allow vision from 8 inches to about 12 feet. If I leave the house or watch TV I put on my "real" glasses.

I can see perfectly clearly from about 8-24". And then well enough beyond that to not need glasses for most things I do around the house. I also have progressive glasses, which work for all distances.

If you google this you will find some figures from an article which is no longer up, but if you click on each figure you will get most of the useful data. Figure 1 gives the Snellen visual acuity vs distance for 0.0, -1, -1.5, -2 D lenses. If you scan across the 20/32 (limit of good vision) horizontal line you will find the distance limits for each of these choices. Figure 2 gives the combined visual acuity for each of the myopic choices with the distance choice in the other eye. The conclusion of the article was that -1.5 D was the optimum choice for monovision.

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semantic scholar Optimal amount of anisometropia for pseudophakic monovision. Ken Hayashi, Motoaki Yoshida, +1 author H. Hayashi Published 1 May 2011 Medicine Journal of refractive surgery

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Individual results will vary of course.

@RonAKA how long have you had your IOLs and if you don't mind me asking how old are you? Also I don't have any issue wearing glasses for distance. I just prefer not to have to fumble for glasses to read up close like waking and checking my phone or reading engineering prints when I'm in a meeting. It's always been so easy to take off my glasses to engage superpower. I do wear progressives but really don't need them or like their peripheral artifacts.

I got my first IOL in my distance eye in October 2020 when I was 71. My near eye was done in February 2022. There is no time when I like wearing glasses. Winter is particularly annoying when glasses fog up. Even working inside when sweating I find glasses fog up.

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With my vision now I never take my glasses when I leave home, neither reading or prescription. There are very few situations where I really need them. I remember in days past when I was doing distance correction with contacts, but not monovision I would get caught in a dimly lit restaurant not being able to read the menu. Was I ordering steak or fish, and how much was I paying for it? No idea! I would have to ask others like my wife to bail me out. Now the tables are reversed. She has a distance set IOL and can't read the menu. I can read it just fine. She refuses to wear readers and just cranks the font size up on her tablet. I can read it from the far side of the room as well as up close...

Yes, I've read your posts and am really considering, trying to decide. So far I've decided that multi-focals and even an EDOF such as Vivity are out even though if I really wanted them I could probably scrape up the extra cost. I'm too risk averse and not willing to risk halos, glare, and degraded contrast that could make night driving impossible. I try to avoid driving at night, but there are times when it's necessary. Not being able to drive at all would mean major, negative life changes.

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Wondering if a mini-mono with one eye set for as much near as you have and the other a little less extreme would do it for me. The statistics on how often doctors miss their targets are what worry me most, but the cost of LAL is a real stopper. I am pretty much decided that if a doctor screws up my first eye with a refractive surprise at the level some have described here, I'll manage the cost of LAL for the second.

Do you really need that -2.5 eye for comfortable reading or would the -2.0 do it?

I also hate eyeglass fogging. COVID mask wearing, especially as much as I fly, was greasy/foggy eyeglass purgatory.

I like perfectly crisp vision for reading, so I could manage with -2, but with -2.5 I'm able to hold books a bit closer, which is more comfortable. So I wouldn't say -2.5 is strictly necessary, but I do prefer it. And of course everyone's eyes are different.

Is your .75 diopters against the rule? This would theoretically improve your near vision without affecting distance until above 1 diopter. With the rule astigmatism wont work though.

My latest prescription is:

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OD: Sphere 0.0 D, Cylinder -0.5 D @ 83 deg (SE -0.25 D)

OS: Sphere -1.0 D, Cylinder -0.75 D @ 67 deg (SE -1.40 D)

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Is that with the rule or against the rule? Those with and against terms make no sense to me.

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The formula I have seen is to convert to spherical equivalent (SE) to compensate for astigmatism which is sphere plus 50% of the cylinder in negative cylinder format. That is what the IOL Power calculation formulas use, and makes some sense to me.

You can tell by the angle. wtr = minus cylinder x 180 degrees; atr = minus cylinder x 90 degrees; 0blique = minus x 45 degrees or 135 degrees ( 31-59 or 121-149). So yours both look like against the rule to me. I got the little chart off a study on residual astigmatism.

I find the whole subject confusing due to arbitrary conventions used for astigmatism. Optometrists express cylinder in minus D values, and Ophthalmologists express cylinder in Positive D values. I find it hard to retain things when they do not make sense other than to apply some arbitrary rule.