Mini-Monovision Range for Near and Intermediate

Thanks for responding, Steve. I've been wearing glasses for myopia for over 55 years and, like you, don't mind continuing to wear them. I currently have progressive lenses, but hope to need only distance lenses after the surgeries. One of the first questions my doctor asked was whether I take my glasses off to read (I do), so he wasn't phased by my asking for near/intermediate vision.

That's great that you can see clearly at 12" with right eye at 0 and left eye at -0.5. I saw in past threads that nina234/Lin 59/Andi77 also had good near vision when she was corrected for distance, although her Bausch & Lomb IOLs probably helped some with expanding her depth of field. If I could count on results like yours and hers, I might shift the numbers more to distance. But by most accounts, it appears that your results are outside the norm. I'm fine with continuing to wear glasses for distance, although expanding the range that glasses aren't needed is always good.

I think it's considered mini-monovision if the difference in diopters is up to 1.5 and regular monovision if the difference is greater than 1.5. I wonder though why this is gauged by diopters and not by distance since the focal point distance lessens as you get more myopic. For example, a 1 diopter difference with one eye set at -2.50 and the other at -1.50 produces 10 inches of blended vision, while the same 1 diopter difference with one eye set at -2.00 and the other at -1.00 produces 19 inches of blended vision. Your blended vision at 0 and -0.5 is a wider range than mine would be at either of the two targets in my example.

The cataracts are bad in both of my eyes, so I don't know if testing with a contact would work at this point, but I'll ask my doctor about it. Based on the current difference in my eyes, I don't think I'll have a problem with at least 1 diopter of mini-monovision. I'll have to see what my left eye ends up at before setting a target for my right eye due to the error factor.

That table posted a lot bigger than the original image.

Hi- don't know if you will see this. I may do same as you -2 but never did monovision trial lens-cataract too advanced so not sure if can tolerate -1. for 1 diopter difference. Naturally I am .50 between eyes. What happened and results of your surgery? Can -2 allow you to see small fonts What was your second target. I also want some more distance after arms length. I am only -2.50 & -3.25 so moderately near sighted.

I haven't visited this forum for a couple of years, but I received an email telling me that you left a comment to my old thread. I don't think my experience will help much to answer your questions. And I haven't been following IOL developments in the past couple of years to know if there is a better option now than monovision.

I ended up with my left eye at -1.00, cyl -0.50, and my right eye at +0.50. Because my left eye ended up where it did, I decided to go for better distance vision in my right eye, thinking that targeting (and maybe not reaching) -2.00 might not provide much benefit.

My distance vision is now pretty good, although there is a slight improvement with glasses correcting my left eye. I now drive and walk around without glasses.

(While it's great to have that distance vision, I do miss the near vision at times. I can read normal fonts best at arm's length, but it's never as clear as with my glasses. I can generally make out some small fonts if there is plenty of light (daylight is best) and contrast. If I'm going to read anything substantial like an article or book, I'll wear my (progressive-lens) glasses. I also take my glasses with me when going to the grocery store or other short trips just in case they are needed.

As far as the monovision goes, I think I tolerate it pretty well. I haven't noticed any eye strain or other bothersome effects from it.

Hi Bella. I couldn't find a copy of my latest prescription, but my vision has deteriorated since then due to the cataracts. In early 2017, my prescription was measured at -3.25 OD with -.25 astigmatism and -3.50 OS. In 2012, it was -2.00 OD with -.25 astigmatism and -2.50 OS. So you can see the effect the cataracts are having.

My doctor asked why I took so long to come in for surgery. The cataract in my left eye is particularly dense and my vision particularly poor, which is why he decided to do that one first. Laser surgery is apparently recommended for dense cataracts, so I'll need to pay the extra cost for that. I'll also be getting the Limbal Relaxing Incisions (LRIs) to correct my astigmatism.

It's interesting to hear the actual vision that you and others experience beyond the numbers. The numbers apparently represent best focus and there is a depth of field range beyond that. You probably also have some accommodation going on with your left eye.

I'll likely stay with the -2 and -1 mini-monovision recommended by the surgeon, but still wonder if the extra 4 inches of near vision gained by going with -2.5 instead of -2 would make much of a difference in adapting to the blended vision.

hi - just a quick comment about limbal relaxing incision. With .25 astigmatism (which is considered low) - a toric lens isn't recommended unless one has astigmatism greater than 1.0. if you are going with a monofocal lens this should be covered under insurance and the surgron cannot charge extra for using laser UNLESS used for some like limbal relaxation.

Just want to caution you to look into that as don't want yo see you pay more than necessary.

Thanks, Sue.An. It was my impression that insurance would cover monofocal implantation only if done by hand, and not the extra cost when the femto laser is used. I had planned to have the implantation done by hand, but my surgeon said that because the cataract is so dense, the laser should be used. I've since read a couple of online articles that also recommend using the laser for dense cataracts. I guess it's still considered optional, though recommended to reduce the possibility of problems.

For the LRI's, I'm curious about whether they are even recommended for astigmatism as low as .25 or whether there is much value in having them done at that level. That being said, I think the surgeon's measurements may have shown a larger astigmatism number. I'll probably be speaking to the surgical coordinator tomorrow, so hopefully can get a few questions answered.

Do look into it. Trying to recall person's name here on these forums who came seeking advice for her mom. Her story is interesting as she learned that the surgeon could only charge for laser used on her mom's dense cataracts if additional LRI was done. But surgeon never disclosed that and she ended up having to pay thousands to this doctor. What she found out after the fact is the laser surgery should have been covered with choice of monofocal lens. She said her mom was in her 80s and would have worn glasses for the astigmatism if needed but none of this was discussed at consultation. I will see if I can recall her name. Maybe Mary?My own astigmatism is .25 in RE and .50 in LE. Considered minor and no correction was needed. Sometimes these doctors want extra money to cover the surgery anyways so they suggest LRI. But if you are opting for monofocals cost should be covered (including laser) under health insurance. If I remember by (Mary's) comments they too went to a top surgeon but felt he misled them into paying for something never discussed.

That's interesting. I didn't get the feeling that my doctor was suggesting LRIs for financial reasons. After all, he could have recommended the Symfony or a multifocal, but said early in our first meeting that he thought monofocals were the best IOLs for me.

The call I will be making to the surgical coordinator later today is actually in response to a phone message I received from her last week when I was away from home. In her message, she said she wanted to discuss my astigmatism and whether I wanted it corrected during the surgery. I'll get some more information from her, but I think my answer will be no. I've also read that the surgery could induce some astigmatism, so maybe it's better to wait anyway.

I just talked to the surgical coordinator, but she didn't have the answers to my questions. I'll need to wait until I see the doctor before my surgery on Friday.

i will be curious about their responses. If going with monofocals and the amount of astigmatism you have is low (lower than mine for my left eye) I wouldn't opt for astigmatism correction. I was told it is only corrected if it is 1.0 or above. Given you will be wearing glasses anyways for one distance you can gave it corrected if you want with glasses.

Save yourself the money.

If you search benefit of laser surgery vs regular surgery there are many surgeons that say there is none. What it may come down to is method your surgeon of choice is most comfortable with. I have 2 symfony lenses (ORA nor laser was available in my province) and I have great results.

My thinking right now is that I won't have the astigmatism corrected unless the doctor convinces me that it will benefit me in a large way. I only hope that I won't anger the guy who will shortly be poking around in my eye.

I've read that the potential for complications with dense cataracts is less with laser surgery; otherwise, I would have no problem going with regular surgery.

LOL can certainly understand that line of thought. Hopefully he is a decent individual who won't mind a bit of discussion. Wish I could recall thread with person whose mom was in this situation. A number of us weighed in to tell her it made no sense why she wad being charged so much. Discovered after surgeries charge went up due to LRI which wad never discussed to their knowledge.

BobDob found the thread I was looking for. Look up Shae280 - it may be of help to you.

Thanks, Sue. I found it and read it. Seems like there is an incentive for doctors to push for femto LRIs even when they are not needed. Not very ethical.

well at least you are forearmed with the info and hopefully not blindsided (pardon the pun).

I should reach out to shae to see if she was ever able to file a complaint. Seems all the more unethical considering charging an 80 year old this much money.

I found my most recent prescription and unfortunately it shows that my astigmatism has gotten worse. As of February 2018, it was -1.25 in the left eye and -0.25 in the right eye. I guess that means I'll be getting the LRIs in the left eye, but probably not the right.

My left eye had worsened to -4.75 and my left eye to -4.50. I can tell that my vision has further deteriorated since then.

Correction - right eye worsened to -4.50.

my cataracts deteriorated my vision too - couldn't correct vision to 20/20 anymore with glasses. Will you be considering a toric lens for that eye?

No, I'll be going with the LRI as recommended by my doctor. I think torics are recommended for -1.50 astigmatism or worse. And they are more expensive.

I'm not sure if my left eye could be corrected by glasses. Even if so, not much after I got my last pair of glasses, my left eye worsened. It seems like I would have to keep getting new prescriptions and glasses to keep up with the deteriorating vision. In addition, my night vision is pretty poor at this point. I can't safely drive at night.

Yes there comes a point with cataracts that glasses won't correct vision. I was seeing double and glare was extremely bothersome prior to cataract surgery. There was a considerable wait here for surgery. In those months I dreaded night driving. Thankfully saw my surgeon in March with first surgery in July do at least night came later vs now in Nov it is dark going to work and driving home!

I retired a few months ago, but I remember some dark mornings driving to work where headlight glare was getting more bothersome than usual. I probably should have had my cataract surgery earlier, but haven't driven at night much since I retired. I saw my surgeon in late September and the first surgery is scheduled for November 30.

Not long now to wait. Hoping all goes very well for you and you'll be amazed at the new vision you'll soon have.

Thanks, Sue. Any improvement will be welcome, so I'm sure I'll be happy (provided there are no complications).