Mini-monovision with Eyahnce and RayOne EMV

I am afraid I do not know what the term "late-in-bag dislocation" is about.

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I doubt that there is a significant difference in the distance visual acuity of the enVista compared to the Eyhance. Neither are going to be quite as sharp as the Tecnis 1 or Clareon. For that reason a good combination for mini-monovision is likely to be the Tecnis 1 in the distance eye, and Eyhance in the near eye.

My brother has had his first eye done with an enVista monofocal. He had his 6 week optometrist exam today, with the following outcome:

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Sphere +0.25 D, Cylinder -0.5 D Snellen 20/15.

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So he was pretty happy with that. Hard to do better than 20/15, but I think I would have chosen the next higher power lens. He got a +15.0 and I think a +15.5 would have been a bit better. It would have reduced the sphere to -0.10 D theoretically. Probably would have tested out at 0.0 D Sphere. His surgeon likes to target 0.0 D spherical equivalent, and I tried to convince my brother that a -0.25 D target is safer. In any case, even with the +15.5 D he would have still tested at 20/15. The slight difference might be in the closer vision. The more negative you end up the better the close vision. But, he is going to do mini-monovision anyway, so should get lots of close vision from that eye.

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In any case this is just one eye, but it does show that the enVista can give good distance visual acuity.

I had a 2 week follow up with my doctor yesterday. I was told the vision in my operated right (dominant) eye is 20/20. I told my overall vision is not that great since the imbalance is high b/w the two eyes.

I am scheduled for the second (left) eye on 12/20 for now. My doctor is suggesting to go with same lense with 0.75D offset to get the near vision and says most people will adopt to this offset. Based on what I read in this thread/forum, I can see few options for my left eye (non-dominant):

1. Eyhance lens with 0.75D offset (mini-monovision)
2. Eyhance lens with no offset and use readers for near vision
3. Tecnis 1 or Clareon with no offset and use readers for near vision (this is based on Ron suggestion earlier to get more distance visual acuity, assuming dominant eye switching is not a concern)

I am not sure how much distance visual acuity I lose with option 1 or 2, compare to option 3. The last thing I want is to go with any option, but wear glasses for distant vision.

Appreciate any expert suggestions for my options.

BTW, I live in Massachusetts (US), I asked about Rayner EMV in my doctor office (not the doctor), it seems they don't know anything about it. So, I am not considering that option for now.

My thoughts would be to go with an Eyhance with a target offset of -1.0 D. Based on all the information I have seen on the Eyhance it provides about 0.35 D extra depth of focus over a monofocal. If you offset it by -1.0 D you will end up with a total depth of focus over a monofocal of -1.35 D. That should be pretty good for reading, and it also should not affect your distance vision if you already have 20/20 in your other eye. Yes, of course an offset of -0.75 D will work too, but it will put your ability to read finer print especially in dimmer light more at risk.

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Going with a monocular lens or even an Eyhance with no offset is going to lock you into needing readers.

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My first choice in your situation would be to go with the Eyhance at -1.0 D, and if your surgeon objects, then the Eyhance at -0.75 D would be the second choice. If cost is any consideration, then a Tecnis 1 at -1.5 D is also an option. It will give the same reading ability as the Eyhance at -1.0 D, but will be a little weaker in the intermediate range.

I can't put myself out there as an "expert" but I think it's reasonable to ask how near your vision begins to degrade with your distance eye. Can you see well at arm's length with your 20/20 distance eye? Are you able to see even nearer than that? I think ideally you'll want some overlap in the intermediate range between the distance and near eyes in a monovision setup if possible. Of course that depends on your goals, but as for me I would not want to have an intermediate blurred zone at computer or dashboard distance. It's something to consider.

Regards,

Indy G

Thanks Indy and Ron for the responses.

Currently, I can see fine at arm's length - I don't know I can say it as 'well'.

Other problem I am having is I can't watch TV for long time with both eyes, I am closing my non-operated (left) eye for few secs in between. I believe this is b/c my left eye is so blurry for all three visions and imbalance b/w the eyes high.

The question/concern is whether this issue still be there if I go with an offset of -1.0D. I am trying to test it my self, it seems it is not feasible since the cataract in other eye

Oscar,

I understand what you're saying. I, too, was a bit freaked out as to how my distance vision would turn out with just about any offset. What reassured me though was a video on YouTube where this guy illustrated what 1.0D, 2.0D looked like. Check out "Antonio the Optometrist" channel and the "Myopia (near sighted) vs Normal Vision" video. At 1. 0D things aren't that bad and I knew that the two eyes would work together in a mini-monovision scenario quite well particularly after neuroadaptation.

Indy G

All I can say is that I would expect you would do fine with a target of -1.0 to -1.25 D in the second eye with an Eyhance, based on my own personal experience with a -1.40 D close eye with a monofocal. It is unfortunate however to be in a situation where you cannot test it ahead of time with a contact.

Hi Oscar,

If you're worried, then take it easy and don't rush into the second operation.

What is your current vision in sphere in the operated eye? it could be that your doctor targeted or the operation resulted into a +ve sphere.

I would propose that you try -.25, -0.5, -0.75, and-1.0 contact lenses on your operated eye. it would make you understand the gains you get in the near vision and the extent of lost distance vision. If you 'well' intermediate vision and your distance vision is still 20/20 that means your operation resulted in a +ve sphere and your doctor must consider this into the next operation.

Good luck,

Will

It is a good point to check the refraction in the operated eye to see what the baseline is. I would use the sphere equivalent if there is any astigmatism involved. Using contacts and compensating for any SE from 0.0 D is a good idea, when you can't work with the unoperated eye due to the cataract. I did that just as a final check but used dollar store reading glasses instead of contacts for ease in switching the powers. This test convinced me to target -1.5 D in my second eye instead of the -1.25 D I was planning.

During my last visit. I was told I have perfect 20/20 vision in my operated eye, I didn't ask for sphere vision details, I can try asking now. When I tried with 0.5 D it was bit blurry with my operated eye. I don't have 0.5 D at home to test it again, but I have 1.0 & 1.5 readers, both are blurry with the operated eye. Does this mean the results are not resulted in any +ve sphere?

Did you get an eyeglass prescription? That will tell you the residual refraction for the eye.

Hi Oscar,

The +1.0D and +1.5D readers have +ve diapoters but to try the monovision you need to try negative diopteres till -1.5.

Which lens did you have in the operated eye, if I may ask?

Take care,

Will

Will, you meant negative diopters with operated eye, which is already set for distance? I am bit confused.

BTW, I am still waiting for my spherical numbers for the operated eye from doctors office. I will share as soon as I have it.

For now, I am leaning towards the offset of 1.0D, unless the spherical vison in the operated says something different.

Hey all,

My doctor is now suggesting to try contacts with -0.75D or -1.0D in my left (non-operated) eye and see how I feel. The cataract in so left so bad already, how this is going to help? Is it my doctor missed the fact that my left is already blurred in general with bad cataract? I am trying to reach out to my on this, but no luck yet (she busy plus the holidays season)

Any ideas how this testing help in my case? I already started wearing it since yesterday - I don't feel any difference (for near or distance vision). I feel like same imbalance exists with or without contact in my left eye.

Oscar,

Yes, Given that you have significant cataracts in the non- operated eye I don't see what a contact lens trial is going to achieve. If anything you should try it out on a good eye just to see what sort of near vision you get out of it. My two cents.

Indy G