Mini- Monovision diopter questions! Please answer any question that you can.
Posted , 7 users are following.
Before I contact Doc again I wanted to clarify my understanding. In the context of Mini Monovision...
Q1- For the eye set to far, am I correct in understanding that in general it is better to be under corrected than over corrected. So for example -.2 is better than +.2?
Q2- If Plano in the far eye means perfect sharp vision to infinity. Like mountains and moon? What will -.2 or -.5 mean?
Your sharp point moves from infinity to bit closer? How much closer? Moon and mountains will appear slightly blurry, completely blurry? I can't wrap my head around this fully. I have +1 reading glasses that I rarely use, so if I look far wearing them then something like that is what my wife will see if it overshoots to +.5 (ok half that blurriness as my reader are +1 and not +.5)?
Q3- Dr Zeiss's recommendation of -.2 with -1.4 for example is superior to Dr Rockstars Plano and -1 recommendation, as it wins you more near and intermediated vision sacrificing really far vision. Correct?
Specially if Dr. Rockstar plano ends up overshooting in the + direction after healing. That is wasted range, correct? Let us say if it overshoots by .5 after healing, then in Dr Zeiss's case it will still end up being +.3! However in Dr Rockstar's case it will end up being +.5!!!!!!
Q4- What about if for far eye we aim for -.5 and it undershoots by .5, then it ends up being .-1 in the far eye!!!!! What does one see in distance if they have -1? Basically what I see with +1 readers?
Q5- If I remember correctly. Dr Zeiss said the Zeiss lense's come is steps of .5. I think Sok's mentioned in one thread IOLs' come in steps of .3? Dr Rockstar did not mention the steps but he said that he can use Zeiss or Hoya. He said though that the Hoya's steps brings it more closer to plano than Zeiss's one. I assume their starting number are different even if they are both in .5 or whatever increments.
Q6- If Dr Zeiss's recommendation of -.2 and -1.4 is taken (difference of 1.2 Diopter between the 2 eyes). Then if it overshoots .5 in opposite direction in each eye, then it could end up being a difference of 2.4 Diopter!!!!
Although that will be taken into account when operating on the 2nd eye. Although Dr Zeiss even wanted to operate on both eyes together! As Sue said that shows why never to operate on both eyes at the same time.
Jeez!!! 😃
0 likes, 33 replies
Sue.An2 W-H
Posted
Heading out for a walk but off top of my head:
Q1 in my opinion yes undershoot plano target better than overshoot (wasted distance vision and sacrificed intermediate near vision) IOLs come in .50 diopters (wush they came in .25 like glasses or contact lenses) so take that into account along with healing and settling of IOL which can put you +|- .25.
Ask Dr Rockstar what his def of targeting plano - many tell you that is the target but they take into account the above in their calculations (complicated calculations that are often above patient's understanding). Except patients like us who dig deeper before surgery - lol.
Q2 plano is seeing 20/20. Yes some may think seeing better than that is terrific but again it's not as useful in everyday life and with IOLs you sacrifice more useful intermediate/near vision depending on IOL chosen.
Off for my evening walk. Will check in later
soks Sue.An2
Posted
my #4=5
and
#5=6
On ur #4: for distance use the simulator and see how -1 will show for distance. how much near -1 will get you is difficult to predict. settings iol's for near is a bit tricky.
W-H Sue.An2
Posted
I think it has to do with current manufacturing limitations.
Guest W-H
Posted
I think surgeons do things a little bit different, because they learn what works for them.
Lenses works a little bit different, some will have higher risk of shooting to high, some have higher risk of shooting too low, some will tolerate a specific refractive error better than others, this is something the surgeon knows, and he will choose lens and targets according to this and his experience.
Also, different eyes will move the power slightly up or down with the surgery, it depends on different factors, one of them how deep the iol settles in the eye.
Again the surgeon will take this into account, and make his best estimation based on his experience.
So I really think when it comes to lens calculation, you need to tell the surgeon your wishes for the outcome, and let him decide the rest, he have done it thousands of times before.
Even the most experienced surgeons with the best equipment gets refractive surprises from time to time, but he will have the experience to minimize the risk accordingly, we amateurs would only be doing wild guessing based on help from google.
You can not compare the diopters and outcome of vision to your own vision with glasses.
Iol diopters and glasses diopters are not quite the same, and your eyes still have accommodation, maybe not as much as it have had before, but it still have a lot.
When you have lens implant, you will have 100% presbyopia as part of the surgery, there is no accommodation left in the eye at all.
But some have a more adaptive brains than others, so some have still a little bit accommodation in the brain, and they will have a wider vision range than others with the same lens, that is why the eye doctor can/will not tell you much about the outcome in advance.
Off course all this is only my opinion, I wish your wife the best of luck.
Sue.An2 Guest
Posted
Hi Danish - just wondering how you are doing and adjusting to the atLISA? Hoping things ate well with you.
Guest Sue.An2
Posted
Hi Sue
Well, you know all this is an emotional roller coaster, and one minute you feel something, next minute you feel something else.
I still can almost not believe how good my vision is, I see a lot of things I have never seen before.
It can be small things, like looking at the rain, I have never been able to see rain before, it is almost magic to look at.
The Lisa works brilliant, and it has almost given me a new "problem" because the Lisa works so well, that it almost makes the Lara look like a mistake, and this is the thoughts I am struggling a little with right now.
Far vision is the same with both lenses.
Intermediate vision, I would say Lara is a little more "thick" but not as sharp, Lisa is "finer" and sharper. If I had to choose between the two in intermediate vision, I would choose Lisa.
Near vision is fantastic with Lisa, I can read such small things, even in not the best lighting I can easily read normal text like receipts from stores and stuff like that. I have not been near reading glasses after I got the Lisa.
Visual side effects are about double up on the Lara compared to Lisa, and this is a little strange, it was supposed to be the other way around, but seeing with both eyes the Lisa actually makes the starbursts from Lara more fainted.
Lisa is slightly more white, and colors are slightly more colorful with Lisa.
Eyes works perfect together, blended vision is really good.
So I am very exited over my new vision, and until now I have had no complications, no floaters, no problems at all, just a very solid result.
But still I am finding myself thinking, what If I have had the Lisa near vision in both eyes and getting the binocular bonus, with half the side effects, that would be even more fantastic, I can´t help to feel a little cheated.
I think the reason that my surgeon was very decided about the Lara in the dominant eye, was because you never know what quality of vision you have behind the cataracts, when you have never had normal vision like me, and the Lara is more forgiving if there are other issues, so I think his approach was the safest and best way to do it, walking into unknown country, I fully understand why he took this route.
I don´t think I would ever want to risk a lens exchange, and I really would have no reason to do it, because my vision is really good with both eyes, I think it is just a mental thing I need to get over.
In 3 weeks I have a checkup, I will ask if they can see signs of pco in Lara eye, because I find it a little strange that Lisa also is better in midrange, so maybe I am not judging the Lara on a fair basis.
And then I think I need to take myself away from all this lens exchange stuff for a while, and enjoy what I have, instead of thinking what if...
Anyway, thanks for asking 😃
Sue.An2 Guest
Posted
So glad you are able to appreciate and enjoy things that most take for granted - like seeing the rain. Treasure those moments. Maybe keep a journal as it is good to loom hack in years to come and remember those times. I had a similar experience snorkeling first time after surgeries and seeing coral and fish in such detail. I would watch it back before on GoPro but seeing it in the moment was breathtaking! Almost now want to scuba dive!
I can't help but think maybe Lara's target being overshot might be a reason for that loss of clarity in that eye for intermediate vision. I have 2 Symfonys so it isn't something I can compare.
Might be something to discuss with your surgeon but I definitely can relate to your comment about an exchange and willing to risk what you enjoy but also get that pull in your heart to want more. What about laser option to bring Lara more on target? Less risky?
Thanks for the update. We all route for one another here and are thankful for the good stories that provide hope for others on their journeys. When is your next follow up appointment?
Guest Sue.An2
Posted
I agree, if Lara had hit the target better, or maybe a bit short instead, I think both vision and side effects would be a different story.
I am not sure I would want to go through laser to fix it, they would do it if I want it, it is a part of the package I have payed for.
But when it has hit over the target it can only be corrected by the old type Lasik laser treatment.
If it had hit short of the target, it could be fixed with the ReLEx Smile laser, where they only make a very small cut in the outer part of the eye, maintaining stability of the cornea, I would have been more willing to have the Smile type laser surgery.
I see them in 3 weeks, and I will talk it over with them. Right now I feel like I need to accept it as it is, also because you don´t know what happens the next 20-30 years, I would like to keep options open, if something else happens in the future.
Again, I really can´t complaint, I know I am very lucky compared to many others that are born with cataracts.
Many in my situation have a lazy eye, that never becomes useful. I also had one eye with very poor vision, which is the Lisa eye, that have become so strong now, it is really amazing 😃
Sue.An2 Guest
Posted
That is a very positive way of looking at the situation. So many live with either regrets or what ifs that they can't enjoy and be grateful for what is. And what is is a total miracle that someone 20 years ago could not even imagine. If results weren't good it is less to risk it but if you are enjoying life who cares if it's not perfection. Many aren't satisfied with perfection either. The better (or thought of it) always the enemy of the good.
I have never had lasik or surgery to correct vision so had no idea there are different ways to laser treatment. Thanks for that info.
Very pleased for you.
W-H Guest
Posted
Enjoy your vision Danish! Yeah I wouldn't risk it.
tamarinda Guest
Posted
So great to read your updates, Christian. Thanks tons for sharing so completely.
I totally feel that tug...like now that I have some better vision, I want it ALL! It's keeping me from being sure about my next step...which most say should be a monofocal in my dominant eye, but I still have this urge to just go for it and get a Symfony or something...but I think there is a certain amount of denial there. Just because I'm getting used to seeing 7 halos and ghost images all the time, doesn't mean I should accept them for the next 50 years.
I like what you said about staying flexible for future developments.
I bet ophthalmologists get a little weary of escorting patients through that emotional roller coaster we all have.
Sue An, I love the journal idea. As I adjust to the clearer vision, I lose the sense of awe about it, and that surprise was so delicious...I miss that feeling of it all being so spectacular. But of course, like new romance, that euphoria can't last, haha.
W-H tamarinda
Posted
I spoke with a guy who had monofocal IOL done last month. His surgeon does multifocals too but recommended monofocals as he said around 25% of his patients who had multis done could not handle it.
Btw he is very happy with his new monofocol IOLs
If I had to choose fir myself based on all my research, I would go for 2 x Monofocals or 2xTrifocals 😃
soks W-H
Posted
u r asking very good questions.
soks
Posted
soks
Posted
my #4=5
and
#5=6
On ur #4: for distance use the simulator and see how -1 will show for distance. how much near -1 will get you is difficult to predict. settings iol's for near is a bit tricky.
soks
Posted
more explanation: for my right eye for technis ZCB00 IOL:
1.
+16.5 IOL would give me -0.60D vision which mean I will need -0.6D glasses for distance. But my near will be a little better.
2.
+16 IOL would give me -0.25D vision which mean I will need -0.25D glasses for distance. The doctor will choose this for plano as my next reading is +0.09 which will waste diopter. At this reading with 0.25 overshoot or undershoot I will end up with 0 (plano) or -0.5D.
3.
+15.5 IOL would give me +0.09D vision which mean I will need no "sphere" glasses for distance. But my near will be worse than if I went with +16. I may still need distance glasses for any astigmatism (also called cylinder).
4.
See at the end in the picture that Emmetropia which means plano is +15.63 which means I need a +15.63 IOL to give me plano but there is no such IOL made by Technis so I go with the closest option.
W-H soks
Posted
Your IOL-
"360° square edge for uninterrupted contact at the haptic-optic junction
Frosted edge designed to minimize unwanted edge glare"
In your case, did not help though,correct?
soks W-H
Posted
my iol is symfony NON- toric which is zxr00. my exact iol in left eye is zxr00 16.5D. if you are using tecnis iols they will use the zeiss iol master readings for zcb00. but yes zxr00 is frosted edge and does not help with the glare.
soks
Posted
the iol comes with the card which is given to the patient by the doctor's office. if medical records were unavailable, you still know what went in.
soks
Posted
if that 6mm was 7mm, i would be a happy camper.
Sue.An2 soks
Posted
One would think this issue would have been addressed and 7mm ones would be available.
W-H Sue.An2
Posted
I got copy of all the readings from Dr Zeiss visit. Hard to understand all these numbers. Anyway I see...
Right pupil size- 5.94mm
Left pupil size- 6.26mm!!!!
soks W-H
Posted
my very first report says pupil size 5mm in dim light. it also says artificial pupil size 7mm. i dont know what artificial pupil size means. are your numbers from zeiss machines?
i went and checked after you mentioned this. second report has no mention of pupil size. i will check report 3 and 4 too.
soks Sue.An2
Posted
we may be a smaller population to invest in. i am shocked they wont do anything for the kids. this is what my surgeon said about 7mm iol.
"There is no large optic foldable IOL - that has always been my wish. I would use a different material IOL if we used monofocal - such as the B&L LI61A0 - this lens has the least edge or other glare for a monofocal - but not zero.."
so it seems inserting a foldable 7mm iol could be the deterrant. the BL LI61A0 is the one that Dr. Safran is prefering. also 3 doctors said just wait it out till pupil getting smaller.
janus did mention one iol that is 7mm though.
W-H soks
Posted
No, it says TOMEY CORPORATION on that particular sheet.
Sue.An2 W-H
Posted
So it is likely your wife's pupil will dilate beyond IOL? Has Dr addressed that possible scenario?
W-H Sue.An2
Posted
Dr Zeiss said young people have larger pupils and women larger than men. With age they get smaller.
Dr Rockstar said he likes Hoya IOL and it's size... something. Although it is standard 6mm lol
All good ones are 6mm so it is not like they or we can do anything about it?
Sue.An2 W-H
Posted
Let's hope it won't he an issue for her. I have no idea what my pupil size was (or is now) but don't have those visual disturbances of pupil dilating beyond IOL. My research prior to surgery didn't lead me to anything on IOL diameter being 6mm but as you say there really is not something anyone can do about it