Mono focus for distance or Mini Mono Vision
Posted , 4 users are following.
65 year old, last 18 years far sighted needing reading glasses. Last 1.5 years or so cataracts worsened to the point of being near sighted. Just had dominant RE corrected for mono focus set to distance 5 days ago.
The corrected RE vision is incredibly clear, sharp past arms length, and white. I didn't realize how bad my cataracts were. LE is worse with limited 20/150 and yellow sepia toned. I can now use my phone without glasses now but this mono vision is temporary and disorienting. For work sitting in front of 2 computer monitors I am using an old pair of progressive bifocals and looking through the top with corrected RE, monitor is sharp, LE is blurry but since RE is dominant it works well as temporary fix.
My question is for my LE, would a mono focus set to intermediate distance or less than full distance be beneficial over another matching fixed distance lens? How would it help? Is it worth considering.? Is it only near intermediate or far?
My current new lens is a Bausch & Lomb AO60 distance set to 18.5D? Not sure of the significance of that or how that plays into my options. Any thoughts and advice?
0 likes, 16 replies
Guest Pifutoast
Posted
Do you think it's the left unoperated eye that's letting you use the phone without glasses? You said the right operated eye doesn't get sharp until arms length. Anyway I do think it's worth considering a monovision offset but I would never do more than maybe a 1.25D offset at the most without trying it first with contacts to see how you handle it. And with your vision so poor in the left eye I'm not sure you'll be able to do a proper trial. Something to discus with your doctor for sure. But I think the safe bet is to stick with binocular distance.
Pifutoast Guest
Posted
yes, unoperated eye allowing for that, but near vision is at about 18 inches, closer or further it blurs out.
Like you mentioned, with sight so limited in LE, I can't "test drive" the option plus I can't stay like this for too long.
would a slight back from full distance give me any potential benefit?
RonAKA Pifutoast
Posted
My thoughts would be that micro monovision with an under correction of -0.75 to -1.0 D could give you decent computer screen reading ability, but would likely leave you short of comfortable reading 10 point text on paper, especially in dimmer light.
RonAKA Pifutoast
Edited
For some reason the right side of your second paragraph is chopped off, so I am guessing a bit on what you are asking. I think there are pros and cons to both options.
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Correct both eyes for distance: This will give you the best distance vision and down to perhaps 1/2 meter. Probably not ideal for computer screen, and readers will be needed for closer than that. I don't really like using readers because when you look up, everything is blurry beyond about 1/2 meter, and you end up putting your readers on, and taking them off all day long. There is the option of using progressive glasses and that eliminates the need to take them off. It could also give you the best distance vision as the residual error for spherical and cylinder can be corrected too. But, you have glasses on all day long.
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Mini Monovision - If done properly this can pretty much eliminate the need for glasses except perhaps for the very smallest of print. There is no need for the glasses on off routine. But, your distance vision will be somewhat compromised as it will be really good with one eye, but less so with the other. I would call it very functional convenient vision but not perfect vision. It can be attractive if you put value in not having to wear glasses at all.
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I currently have my right eye corrected with an AcrySof IQ monofocal set for distance. I get 20/20 vision and perhaps about half the next line. I can read down to about 1/2 meter, but it is not comfortable to use for computer use with a 24" monitor. Perhaps it would with a very large monitor further away. My left eye has a cataract but I still see pretty well with eyeglass/contact correction. To simulate monovision I am using a contact that under corrects to leave me at about -1.25 D. When it comes time to do my second eye, I am pretty sure I will ask to have it under corrected to the -1.25 to -1.5 D range using a similar monofocal lens as the one I have in my right eye. You can never be really sure what they will get, and I would hope it would be closer to -1.25 than to -1.5. I would not want to go under -1.25 D as I think that would leave me short of reading ability up close. I can read my iPhone 8+ fairly easily, but that is kind of getting down to the limit of what I can read easily.
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I think it pretty much comes down to what you want to be able to see with no glasses on. Will you compromise overall vision slightly to see at pretty much any distance without glasses, or are you OK with having to carry readers or progressives with you to see closer when needed. I do all my normal activities including driving with no glasses. Commonly I am on the computer with the TV on and a distance away. With monovision I and switch back and forth effortlessly with no need for glasses on and off. If I was going to drive at night at highway speeds out of the city I probably would wear my progressive glasses for best all around vision.
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Hope that helps some
rwbil Pifutoast
Posted
If you have not tried monovision with contacts to see how you adjust, I would recommend looking into the LAL. I am becoming more of a fan of that IOL for anyone thinking of monofocal monovision. I think it is worth the extra expense, after all you have to live with the results for the rest of your life or go through more surgery. The biggest issue might be finding someone that has the equipment and expertise to implant that lens.
Worse case if you hate monovision they can "hopefully" put you back to Plano or close to it.
It is something to at least look into.
Pifutoast
Edited
Not sure what happened to my original post, but half has gone missing?
Where is edit function?
Anyway, 5 days out and I work in front of 2 computer monitors. Since RE is dominant, I am able to see really well with an old pair of progressive bifocals by looking through the top. even though left eye vision alone is blurry. This is a temporary work around.
I am just lucky this worked out, since the surgeon never mentioned what I'm supposed to do until the 2nd eye is fixed.
Are you are saying I could be good for computer work at 2 feet out if do mini mono vision?
Glasses only for close up reading? So the mini option will extend the glasses free range slightly inward?
rwbil Pifutoast
Edited
Not sure there is an exact breakdown, so these are rough estimates and I could be off:
I can tell you not everyone does well with monovision and the more the visual picture varies between the eyes the greater the risk. I tried monovision with contacts many many years ago and I personally would only consider micro monovision.
As for results everyone varies and the doctor can be off the mark and sometimes quite a bit such as over 1 D. With micro monovision you might gain about 1 line of vision improvement for close.
Just for a rough idea, see if you can get the defocus curve for your IOL and then shift that curve right by the amount of monovision. That will give you a general idea what your visual acuity will be , but that assumes there are no other eye issues, the lens is placed properly and the doctor hits the refractive mark exactly and your results are the average.
Pifutoast
Posted
Trying for clarity here(no pun intended) but micro mono vision and mono vision are not the same.
isn't mono vision usually the dominate eye set for distance and other eye set near? while mini mono has the non dominant eye backed off from full distance ?
how far off to have any benefit?
if both are set to distance does having them at different diopters achieve mini?
I really don't want to risk full mono, but I am willing make a less drastic adjustment to.improve closer vision, hence the mini
Pifutoast
Posted
rwbil,
I didn't see your post when I added my last comment, thank you for that information.
so micro is safest with some closer range improvement, maybe that's what I'll try for.
I have a follow up appointment coming up in a few days, need to have my questions prepared.
Micro mini mono fixed near intermediate far, bi focal tri focal and lal, oh my
RonAKA Pifutoast
Edited
Here is a quote from a decent article on the subject of monovision. It is basically when the dominant eye is corrected for distance and the non dominant eye is under corrected (slightly near sighted). The technical name for the difference between the two eyes is anisometropia. The full, mini, micro is just the degree of anisometropia. It is all monovision.
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Full monovision involves a high anisometropia of –2.00 to –2.75 D, while mini-monovision is set for an anisometropia of –1.00 to –1.5 D, and micro-monovision is set for less than or equal to 1.00 D.
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My opinion based on simulating this with contacts is that I would not like full monovision. I can simulate that now by simply not wearing glasses or contacts. My right IOL eye is 0.0 D, the same as your right eye seems to be now. My left eye when factoring in astigmatism is about -2.0 D for an eyeglass prescription. That is the lower end of full monovision, and I do not like it. It seems to leave a gap with poor vision pretty much at the distance I look at a computer monitor -- 14" or so. For me that is a no go.
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I have tried two different power of contacts in my left eye. One is a -0.5 D, so it reduced my anisometropia to -1.5 D. It is OK and is the best for reading smaller text on paper. The other power I have tried is a -0.75 D contact. This leaves me at about -1.25 D. While it is not a huge difference I find it more comfortable. Reading text on a computer like I am doing now is easy. But I do get into trouble reading the small print on say an over the counter medication bottle -- you know the fine print detailing all the side effects that they really don't want you to know about! In any case this is how I have narrowed down the amount of anisometropia I want when I get my left eye done. As I said earlier a range of -1.25 D to -1.5 D, but ideally closer to -1.25 D.
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A few things to keep in mind. First is that you now have excellent distance vision in your right eye, as I do. That means you are half way there. You know that no matter what the outcome is with the left eye you will have very good distance vision. That part is "in the bag". Now the issue is only what reading ability you will have, and how well you adapt to essentially switching eyes between close and distance. I have found it easy, but not everyone will be the same. The second thing to keep in mind is that if you go down this road and you do not like it, the vision is easily corrected with progressive glasses. You will just have one eye that is slightly near sighted, and that is an easy eyeglass correction.
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In any case here is an article about monovision that you may want to google. It explains it quite well. The author seems to favour micro-monovison, even though she talks about a study that found -1.5 D was best. I am not so sure about using less than -1.0 D. I would worry that it would leave you in no man's land with insufficient reading vision. But, if it did, it is easily solved with eyeglasses.
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EyeWorld Revisiting monovision with IOLs by Stefanie Petrou Binder, MD, EyeWorld Contributing Writer
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I think rwbil's suggestion to use a light adjustable lens (LAL) that uses UV light to adjust the power of it in the eye after it is implanted is a good idea. Similar to trying different contacts you could try different amount of anisometropia to see what you like. The only thing about the LAL, if it is actually available where you are located, is long term stability. It is pretty new and I wonder if the power of the lens may change with age. The concept is very good though. Standard monofocal lenses have been around a long time and are well proven.
Pifutoast
Posted
Thank you for that information, very helpful. I will report back after my one week follow up in few days.
it's interesting to note, the go to center in my area for cataract surgery never mentioned this as an option. I suspect it takes more time per patient thus reducing profit.
Guest Pifutoast
Edited
it takes no time. They just choose a different power for the IOL.
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Ron mentioned that this can be reversed after surgery with glasses or contacts. I might point out that the reverse is also true. You can create monovision after surgery by using a contact of glasses. In fact a lot of people that don't have cataracts do this. It's just that you have the opportunity to do it surgically.
Pifutoast Guest
Posted
I wonder why they wouldn't offer this option then.
I don't want to wear contacts and want to.limit reliance on glasses so I'm leaning towards some type of monovision light, hopefully I'll get the right balance. don't see much downside.
Guest Pifutoast
Posted
Honestly I think it just depends on the surgeon. They all have their own ideas about what the best solutions are.
RonAKA Pifutoast
Edited
Some clinics are more interested in using the expensive lenses like the PanOptix, Vivity, Symfony, and Synergy. The monofocal lenses have the same lowest basic cost even when used in a monovision configuration.