Mixing a Monofocal lens with a Multifocal lens
Posted , 4 users are following.
I can't find a discussion where someone has actually had the combination of a fixed lens in one eye and a multi-focal in the other eye. I am hoping someone out there has had this done and can share their experience. I've seen recommendations for it, but not anyone who has actually done it.
My doctor is recommending this for me.
I have an Acrysof IQ ReStor +2.5 D Multifocal (toric) in my right eye which I got 4 years ago.
I had some issues with it - some residual astigmatism, night starbursts. I also had a long streak of light which was horrible initially but was getting better. Nonetheless, the surgeon said he could fix that with Yag, so I stupidly had that procedure and resulted in not one, but 5 huge streaks of light. That was so horrifying, I never went back to get the second eye done. It has taken 4 years for me to neuro-adapt to those streaks. They don't bother me any more. But over the 4 years, the astigmatism has come back to almost what is was before the surgery.
Now I have to get the second eye done because my vision has deteriorated in that eye.
That is why I am wondering if anyone has had a fixed lens with a multi-focal. I am also debating whether to get a second opinion or just go with what my local doctor recommends. He also says they can fix the astigmatism with lasik.
This is not the doctor who did the surgery on the first eye. I would never go back there. He should have warned my about the Yag procedure. My Retinologist said removing the rear of the capsule let too much light in and that is why I have all those streaks. Ugh.
0 likes, 13 replies
RonAKA charly338
Edited
You may have seen this article that says they do it in certain cases.
.
Clinics in Surgery 2018 | Volume 3 | Article 2027 Monovision Strategies: Our Experience and Approach on Pseudophakic Monovision Misae Ito CO* and Kimiya Shimizu
.
I really don't think there is anything wrong with the approach. I am kind of the reverse of your situation where my first eye was done for distance with a monofocal. My surgeon offered to do a PanOptix in my second eye to give me hybrid monovision (as it is described in the article above). This came as a bit of a shock as two years earlier he told me he would not put a PanOptix in his own eyes. However, I had also concluded that I was not prepared for the risk of a MF lens, so I declined. For some reason he had changed his tune over time -- perhaps the money to be made with the so called "Premium" lenses got to him...
.
In your case I think it would be a good idea to do a straight monofocal for distance in the second eye. I presume you are keeping the Acrysof IQ ReStor +2.5 D Multifocal in the other eye. I would suggest the Clareon, or Clareon toric (if necessary and if it is available now) for the second eye monofocal.
.
I agree with your surgeon that Lasik may be an option to correct your astigmatism depending on the specifics of your first eye. I ended up with -0.75 D residual irregular astigmatism in my second eye and my surgeon suggested Lasik. I went to two specialists he recommended. I wanted to correct the astigmatism and increase my myopia by about 0.5 D. The first clinic said they could correct the astigmatism but could not increase my myopia. This is my close eye in a monovision configuration, and they said I would lose my reading vision, as the astigmatism was helping me read. The second clinic said kind of the same thing, but also said I had keratoconus and it was causing the irregular astigmatism. They said the thinning of the cornea made it too risky to do Lasik, so that turned out to be a dead end for me. But from what I learned if your cornea is healthy and all you want to correct is astigmatism it may be a good option. Look for a clinic that does custom or topography guided Lasik to get the best results. The SCHWIND AMARIS® 750S or 1050RS are top notch instruments to look for.
charly338 RonAKA
Posted
Thank you. I can't seem to pull up that article. I am thinking the Clareon set for distance.
I just am not sure what the brain will do but for 4 years my brain has been dealing with one artificial lens and on natural so maybe I shouldn't worry about that. My reading was really good in my right eye until he astigmatism gradually increased. Now it's a lot harder to read the small print.
I had a consultation with a top doctor after the disaster with my right eye. He has rave reviews and teaches cataract surgery to other doctors.
He told me that because I had laser surgery on my first eye, the other eye would require laser surgery as well. He generally doesn't do laser surgery but said he would do it for me. That worries me a bit because he doesn't do it everyday. Probably one of the reasons I've waited. I don't know who to go to. My first eye was done at UCLA Jules Stein Institute by a top surgeon there and still it got all botched up.
RonAKA charly338
Posted
There is not much in the article. You could try adding PDF to the search to find it. In any case this is about all there is:
.
"Hybrid monovision
In this strategy, we implant a monofocal IOL in the dominant
eye and a diffractive multifocal IOL in the non dominant eye. With
this type of binocular vision, patients do not complain of discomfort,
and more than 85% are satisfied with their results. We have noticed
a relative decrease in stereopsis; however, the normal range was
maintained in 63% of patients. No serious complaints have been
reported after hybrid monovision [5]."
.
This is reference [5]:
.
5. Iida Y, Shimizu K, Ito M. Pseudophakic monovision using monofocal and
multifocal intraocular lenses: hybrid monovision. J Cataract Refract Surg.
2011;37(11):2001-5.
.
On laser surgery you are correct. You want someone that is doing it all the time. An experienced Lasik surgeon will have tens of thousands of procedures under their belt... I can't think of any reason why having laser surgery on one eye would indicate the other eye needs it. Makes no sense.
charly338 RonAKA
Posted
I agree. It makes no sense to me. Maybe that was only if I were getting the same lens in the second eye.
rwbil charly338
Posted
First I recommend you use one of the top doctors in the nation to have your second eye done. You can Private message me for thoughts on that.
I have mix and match IOL, though they are both diffractive IOLs.
Is your concern regarding the 2 eyes providing different images to the brain.
I think your least risky bet is go with a monofocal set to plano or -.25 D. Also think an Eyhance IOL will work well and give you a little bit of extended vision.
charly338 rwbil
Posted
Thanks for your input. Yes, I do have some concern about the different images to the brain, although maybe it's not so different than having one artificial lens and one natural lens these past 4 years.
A retinologist said that I have the very beginnings of Macular degeneration so that is another reason they are recommending a monofocal lens. Apparently if you have Macular degeneration, you shouldn't get multifocal lenses.
rwbil charly338
Posted
Yes, if one has any underlying eye condition other than cataracts I would not recommend a diffractive IOL.
Having said that the Eyhance IOL I mentioned is not a diffractive IOL and is categorized as a monofocal IOL.
RonAKA charly338
Posted
If you have the beginnings of Macular Degeneration I would suggest getting an IOL with blue light filtering. Whether or not a blue light filter prevents further deterioration is controversial, but there is no harm in having that extra protection. In general J&J Tecnis lenses do not have blue light filtering but Alcon ones like the AcrySof IQ and Clareon do have it. Our natural lenses have blue light filtering, and if you replace a natural lens with a clear lens, you are actually increasing your retina's exposure to blue light.
.
A recent study has shown that harm from blue light increases with age. Google info below.
.
Oregon State University Harm from blue light exposure increases with age, Oregon State University research suggests July 27, 2022
Myope_PSC RonAKA
Posted
Some of the fruit flies from that study didn't even have eyes.
In "Blue-light filtering intraocular lenses (IOLs) for protecting macular health" the conclusion was:
In "Association between conventional or blue-light-filtering intraocular lenses and survival in bilateral cataract surgery patients" they point out that the level of blue light filtering is high:
That same study hypothesized that ones overall rate of survival ( all-cause mortality) might be better with a conventional IOL vs a blue light filtering IOL.
Do blue light filtering IOL's harm us or help us or neither? It seems that the answer is unknown.
It's something that should be discussed with an ophthalmologist though if there are concerns.
RonAKA Myope_PSC
Posted
What seems clear to me is that blue light filtering does not hurt. It can only help. And, it is a much better match to the natural lens than a clear artificial lens. Other advantages to a blue light filter is that it gives a more natural colour balance than a clear lens. And, one would have to check the model number to be sure but I would suspect the OP's Acrysof IQ ReStor +2.5 D Multifocal (toric) is most likely to be blue light filtering, so a new lens with blue light filtering would match. Blue light filtering also reduces chromatic aberration, which can improve vision in some lighting situations.
Myope_PSC RonAKA
Edited
I'd guess that there's an equal number of people that prefer the clear lens of a younger person as there are those that prefer the slight yellow tint of a blue light filter lens.
I can't say I like what I see through the blue light filter on glasses when comparing filter vs no filter now. The sky is more blue for example through my clear IOLs. Grass is more yellow through blue light filter on glasses. Reds look the same through either to me. Glasses might block more blue light than blue light filter IOLs. I haven't looked it up.
I prefer daylight color bulbs indoors also and not the warmer color lighting that's probably equally as popular.
Good point about matching the IOL filtering of the first eye when selecting a lens for the second eye. That seems like a good idea to me.
charly338 rwbil
Posted
Thank, I have read about that. I'd ask about it. It sounds like it doesn't give much of an extended range of vision. I'd have to get a surgeon's opinion.
charly338 RonAKA
Posted
I believe the Lens in my right eye has blue light filtering if I remember correctly, so the Clareon would probably be a good choice for me.