Mini-monovision target?
Posted , 5 users are following.
Back on this site again after a detached retina repair (vitrectomy) derailed my plans for cataract surgery a couple of months back. Surgery was on the non-cataract eye, although that eye will now get cataract sooner due to the surgery. An unfortunate side effect, but I still have my vision so I'm thankful.
One other consequence of the surgery is that I am no longer a candidate for a Symfony or ReStor lens. As a result I am now strongly considering mini monovision and I'm looking for patient experiences to help guide my decision.
My cataract is in my Left eye, which is my dominant one. My plan is to correct to Plano, or close to it, and then wear a contact in my other eye to test out mini monovision. Ideally I was thinking I would go to -1.50 in the Right eye with contacts, but is that too much of a difference? Would I be better off targeting -1.00 with contacts?
Some other back on I would be curious if anyone has thoughts on. My measurements in my cataract eye are now -3.50 with -1.0 (180) astigmatism. This I has been -1.50 point five zero with-0.50 astigmatism for 10+ years. When I asked why the astigmatism changed, the Dr I met with said my cornea always had a -1.0 astigmatism, but essentially my natural lens was offsetting it by -0.50. Does that seem reasonable, or is that just talking around the issue? The reason I ask is that he was suggesting limbal relaxation incision (LRI) to help correct the astigmatism, but made no mention of a toric lens option. I am leaning towards getting the LRI, but welcome any feedback on the procedure or what I was told.
Let me start by saying I do really like this surgeon a lot, and have heard very good things about him. The one other thing that I heard that didn't make sense to me was that he does not use 0RA for last minute Lens calculations because he said he did for a while and found no difference in his own calculations prior to surgery. All it did was add time and cost, with no improvement in outcome. I had been pretty set on wanting ORA as part of my cataract surgery, but he does not do it unless I am going to pay for the laser surgery which he is not recommending at over $2000 additional cost. BTW, the LRI is $500 more.
Back to my original question - welcome real patient experiences with mini monovision and what the two eyes are in terms of refraction. I think it's safe to say we all would love to be free from glasses, but if I can limit them to just extensive reading with this approach, I would be thrilled. If I can read my phone, my tablet, and my computer screen most of the time without any glasses Plus have pretty good distance vision so that I don't need glasses for driving I don't think I could ask for anything more.
Thoughts?
0 likes, 5 replies
Night-Hawk Maryland2018
Posted
-1.00D difference for mini-monovision should be pretty easy to get used to, -1.50D may be a little tougher but if you can try it with contacts and its OK for you that would be nice.
-1.0D astigmatism is usually considered too little for a toric IOL, so LRI is a possibility - but be aware I've read and been told by doctors that the astigmatism reduction from LRI may only last for a couple years or so before it comes back...
at201 Maryland2018
Posted
Your overall plan looks good.
That is:
1. Get a plano lens in your left (dominant eye). Actually, I will suggest aiming for about -0.25D. Having a little bit of nearsightedness is much better than having any farsigtedness.
2. If you can't try out mini-monovision by wearing contact lenses, targeting for only -1.0D is a safe bet. Otherwise, -1.25D or -1.5D should also work out fine (although you will still need reading glasses for fine print). By the way, I have been very happy with a monovision with -2.25D difference for many years, first with contact lenses and then with the IOLs with no problem in adapting to them, but that may not work out for everyone.
3. Based on my wife's experience, I would suggest saving the money on LRI. Her astigmatism value of -0.75D was hardly changed (although the axis changed slightly) by an LRI done by a popular surgeon in our area.
4. Using a laser to make an incision in the cornea should not cost anything extra. (it did not in my case). That is just a function of what a surgeon prefers. Only a LASIK enhancement using laser or a YAG laser to remove the PCO should cost extra.
jantje32476 at201
Posted
In Canada, using a femtosecond laser will cost an out-of-pocket C$1600, but is worth it for those requiring it. It is suitable for some people with corneal disease or some with very hard cataracts or cataract patients with ICLs, not everyone needs it.
at201 jantje32476
Posted
Actually, this charge may depend more on the hospital, where the cataract surgery is performed, since the hospital has to buy a more expensive equipment, rather on the surgeon performing the cataract surgery
Maryland2018 at201
Posted
Thanks at201.
Very interesting on the astigmatism correction by LRI. Will think a little more about that.
As I wrote earlier, I really like the surgeon and have full confidence in him, but some of my questions were answered by someone on his team who came in after to talk though options after surgeon and i settled in on mini-monovision. The 'assistant' said surgeon targets -0.3 which is in line with what you wrote. He also said that surgeon typically uses Tecnis 3 piece silicone lens, but I will get a Tecnis 3 piece acrylic lenses (Z9003) since I've had the vitrectomy and silicone lens would increase complexity if I get a retinal tear in this eye now too. The Tecnis lenses only only come in -0.50 steps. Wish they came in 0.25 steps for more precise vision targeting. Also, not sure why 3 piece lens vs 1 piece lens so reading up now, but appreciate any thoughts or experiences others may have.
I was a long time rigid gas permeable (RGP) contact wearer and only moved to glasses when i found that I could read quite well if I just flipped up my glasses. Found my old RGPs and cleaned them up. Tried one in my non-cataract eye and it may just give me the -1.0 to -1.50 range I'm looking for to trial mini-monovision. I've scheduled an appointment with a great optometrist to get more precise refraction, but I did a trial of RGP in Right with a higher power soft in Left that is pretty close to Plano, and it looked pretty good to me. I was able to read computer and phone without difficulty and spent half the day that way. Only have 5 samples of the Left contact so will try for that period of time.