Mono lenses, what is your takeaway?
Posted , 7 users are following.
OK, I decided to just got with the insurance covered mono lens. And save the 7K to have my teeth fixed in Mexico 😃
Currently, I have good near vision which is fading. I spend a lot of my day on computers, crafts and reading (although Kindle will adjust font size. 😃
I used to have good far vision and needed readers for everything close. I have about a hundred around because I lost them all the time.
So my first question is....could I still use off the rack readers if I choose the far lenses? Because if I need RX reading glasses, I would probably spend a fortune replacing them every week.
On the other hand, I have to drive for my job and look for house numbers. I don't really mind wearing glasses for this, in fact I like my glasses for far, but which are now pretty ineffective.
So any experience, thoughts about this, or say mid range sight for either choice???
I thank you so much in advance for any insights! This is such a helpful group!
0 likes, 18 replies
RonAKA mary28814
Edited
There is nothing wrong with going for monofocal lenses. That will assure you of the very highest quality of vision, with the only drawback that you have to pick the distance you want that vision at. Most choose distance, and wear reading glasses for closer work or reading. Yes, you can use off the shelf readers. Since it sounds like you were far sighted and have used reading glasses this will be very familiar to you. It does have the hassle of always having to carry reading glasses to read the menus in restaurants in dimer light, or read the fine print on price tags or labels in the store.
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Considering your history the only other option I would suggest you could consider is mini-monovision. That is where you correct one eye for distance and the second non dominant eye for about -1.25 D or so less than full distance vision. It gives you very good intermediate vision, and some reading ability. However reading fine print or doing fine work still will require readers. The down side of this is that your quality of vision at all distances will degrade some without glasses. And if you do decide to add glasses for excellent vision at all distance they would likely have to be prescription progressives. Monovision just uses monofocal lenses and is no more expensive, but you do have the potential added cost of prescription glasses.
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I would suggest thinking about what you want to do without glasses, and when you are prepared to wear glasses. Keep in mind that with a monofocal with the correct power for distance still lets you see pretty close. I have no problem seeing my dash in the car. However, if I had to read a small map, that would be trouble...
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Hope that helps some,
dom54026 RonAKA
Posted
Hi Ron,
thanks for all your great info, I am now considering going for the Monofocal lens with Mini-Monovision, just wondering how much distance one would lose but gain in the intermediate, I guess that would be different for everyone. I can live with wearing glasses for near, but would love to have good distance and intermediate vision.
Would it be like, lose a few metres at distance to gain a few inches at intermediate ?
In Spain where I live they use the Zeiss monofocal lens as standard on the public health system.
Regards
RonAKA dom54026
Posted
First off, you don't lose any distance in the eye that is corrected for distance. You always take a bit of a chance they will miss a little on the correction power. The normal practice is to target for a slight under correction to leave you will an error of about -0.25 D. I have only had one eye done, but that is about where I came out. It is actually 0.0 D for spherical, and -0.75 cylinder (astigmatism). That is approximately equal to -0.25 D. I can fairly easily see 20/20 and perhaps half the next line with it.
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The issue is with two eyes fully corrected for distance you will pick up a bit extra vision which you will not with monovision. I have not had the second eye done, and am simulating monovision by using a contact that under corrects that eye by about -1.25 D. Using that eye only my vision is not real crisp at distance. However, together with the other eye I still see 20/20+ a bit.
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For nearer, I see my car dash instruments perfectly, but I do even when I use the distance corrected eye only. Closer at computer distance I also see very well. Under bright sunlight I can read the very smallest print on an eye chart used for reading. That drops off with lower light levels however. For the very best vision real close for small print I use a pair of reading glasses that I had lying around. I still need to get a pair that is better optimized for my vision. What I have is a bit too strong, and I would be better with a +1.25 or +1.5. The ones I have are +2.5. I only use them once a week or so, and have not bothered yet to get a better pair.
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Are there issues? Yes. I had my right eye implanted first and it was corrected for distance. However, my left eye is dominant, and that is the one I am correcting for closer up. My surgeon said that was not necessarily a problem. I did a bit of on line research and found that so called "crossed monovision" where the non dominant eye is correct for distance usually works as well, but not in every case. The issue I am having I think is related to my crossed monovision. Up close I see very well like right now when I am reading what I type. At distance it is very good, even at night. But at long intermediate ranges like about 6-7 meters I can have some issue getting a good clear image. I think the problem is that my brain has trouble deciding which image to use as the preferred one. It doesn't have that problem at distance as the distance corrected image eye is much clearer. Up close the dominant eye gets the best image and the brain has no trouble using that one. But, in between I think there is some indecision. I am only 2 months into this simulated monovision and it remains to be seen if my brain will learn over time which image to use. I have concluded however, if you have a choice I think it is better to correct the dominant eye for distance. That is the normal practice for monovision.
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Last, if your vision allows think of this as a staged process. If you decide to go this route, I would try to simulate it with contacts first. And if you correct the distance eye first, then you can use a contact in the other eye to check again if you like it or not, and how much of an under correction you like. Then you have the option to go either way. Correct the second eye for monovision, or go for distance in both eyes. That is where I am at now. I think I will go for monovision, and I probably have up to 2 years to decide. The question I ask myself is "What do I want to see and do with no glasses on?" Right now this monovision arrangement lets me do just about everything. Yes, the vision in some situations is degraded slightly, but I can manage at least 95% of my activities. I drive, go shopping, watch TV, use the computer, all without glasses. I never take my reading glasses with me when I leave the house, but there were a couple of times I wish I had them when shopping.
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I have bought prescription progressives which correct my residual astigmatism in the IOL eye, and fully correct my left eye. Probably a full 20/15 with glasses. And, yes, watching TV is crisper with glasses, but not much. I may use the glasses for longer distance driving, especially at night. But I probably could do without them too.
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If you google this article you may find it interesting. It is a good one to see the gains and losses in going for more or less under correction (anisometropia) in the close eye. It gives you the visual acuity of the combination. I decided in the end based on trial contact lenses.
Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD
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Hope that helps some,
mary28814 RonAKA
Posted
Yes, very helpful, Ron, thanks!
dom54026 RonAKA
Posted
Hi Ron,
I am very short sighted -10 or there abouts (myopic) and will be having my right non-dominant eye, done first, and the left as soon as safely possible to do so after. I have to decide whether to have my right eye under corrected or fully corrected for distance, -50 or -1.0 or -1.25. At the public hospitals here, there isn't much time to speak with the ophthalmologist, as they have very limited time, so it's seems they normally just correct for plano for both eyes.
Amazed to read that with your distance corrected eye you can see the dashboard of your car.
Though you might like this video on YouTube from a Dr Cummings at Wellington Eye Clinic in Dublin, Ireland. "How to get the best from Monovision".
Thanks again !!
RonAKA dom54026
Posted
My experience was that -1.50 was too much. While it gave me the best quite close vision, it seemed to leave a hole at a little more distance -- right around what I need for a computer screen. It was not totally impossible to use though. Since we can't get an exact number, my current thoughts are that if I go with monovision to ask for a differential in the range of -1.25 to -1.50 and hopefully closer to -1.25. Based on my experience I think a monovision of -0.50 would be more of an annoyance that of value. -1.0 might be OK, but I think it would leave you quite dependent on readers.
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If it is at all possible I would have one eye done, and then wait to see what you get (8 weeks) before you jump into the second eye.
dom54026 RonAKA
Posted
Hi Ron,
yes, I will be having my right non-dominate eye done first, as that is the eye where my cataract is worse, so not sure whether to under correct or fully correct. Do people under correct both eyes to try and get more mid-range vision with Mono-focals, like -0.5 or 1.0 ?
Thanks !!
RonAKA dom54026
Posted
If you have time and vision, I would try to simulate what you are planning to do with contact lenses first. If you are committed to mono-vision I would go with the non dominant eye (which sounds like your right) about -1.25 to -1.50 under corrected. The other eye I would target to be -0.25 to 0.0 D.
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I can't see the logic in under correcting both eyes, unless you are prepared to wear glasses almost full time. My thoughts are that it is kind of a split the baby solution. Your are not going to read real well, and you are not going to see distance well without glasses.
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Just my thoughts on what I am "seeing" so far with my IOL in one eye, and simulated mono-vision with a contact in the other eye.
dom54026 RonAKA
Posted
I don't want to wear glasses for distance, I guess if I was having my dominate left eye done first, the choice would be easier, as I could correct for distance and see what that gives me and then later decide whether to under correction on my right eye for a little extra mid range.
I haven't decided 100% to go with the free public health monofocal lens, and at the moment all non-urgent operations have been cancelled due to Covid.
The Vivity lens by Alcon, is still in the back of my mind, even though there seems to be very little info, apart from Alcon themselves and the Italian doctor you mentioned on another thread.
Here where I live the price for Vivity is 6.500 euros. and I have no idea how much more mid range I would get for that price, of course there is the convenience of going private and getting it done when I want it done.
Thanks for your time !!!
rwbil dom54026
Posted
From the IQ Vivity defocus curve you should get pretty good (20/25) vision from 2' and beyond. So about arm's length. You could also do some micro vision with IQ Vivity, let's say -0.75D to gain a more functional close vision.
rwbil
Edited
Want to add one other note. As someone with a Tecnis MF there is a big difference in what I call functional close vision and actually "Great" close vision. I have functional close up vision. And when I see a video of a doctor handing someone the close up card with J1, J2 and so forth and the person finds the sweet spot and reads it and the doctor says you have 20/20 closeup vision; I shiver in anger as it is a bit misleading or at the least an incomplete assessment.
RonAKA dom54026
Posted
One thing to keep in mind is a plan on how to deal with your vision after the first eye is done and the second is not. With your -10 D myopia that may be a little more difficult to deal with. When I had my first eye done, I got Costco to take the IOL eye lens out of my old glasses and I kind of managed with that. However I felt the sensation of wearing one lens and none in the other eye somewhat annoying. It kind of made me feel dizzy. Others here have reported that when there is high myopia. I am only about -2 D when including the astigmatism. What I have found most comfortable is wearing a contact in my non IOL eye. I somehow think that image presented to the brain with an eyeglass lens correction is not the same size as the image presented by the IOL lens, and this effect is reduced by wearing a contact which is closer to the natural lens location. Something to consider if you can tolerate contact lenses. It also gives you a chance to simulate monovision.
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I have the Vivity lens on my radar for the second eye, but I am starting to cool off on the idea. I somehow think that if one can adapt to monovision the overall quality of vision may be better.
rwbil mary28814
Edited
There is absolutely nothing wrong with going with a monofocal as this is the most commonly implanted IOL, probably because insurance pays for it. And then you could look at doing monovision.
There are a lot of problems associated with defractive IOLs such as dysphotopsias, but you did not mention that as the issue.
You only stated the cost. To me your eyesight is the the most or one of the most important things there is. And I watch people just waste money all the time. There are certainly people in situation where they absolutely can not afford a premium lens, but if you can I would not let the cost be a factor. There are payment plans and so forth. Personally I rather give up eating out or taking an expensive vacation to get the best vision I can.
So if the cost is the only factor and not all the other known issues, I would look into all the payment options and so forth. Just my 2 cents worth.
mary28814 rwbil
Posted
Thanks. At first I decided I would do the 7K route with multi focals. The clinic told me that visions with these is not as clear. And there is glare at night. And then there are many brands and new lenses now, not even sure what my clinic has.
But many people seem happy with their monos and only need glasses sometimes.
Bookwoman mary28814
Edited
I spend a lot of my day on computers, crafts and reading
How important is it for you to be able to do this without glasses? Or to be able to see clearly to, say, put on makeup or file your nails? Would you mind putting on glasses every time you need to do these things?
In my case, the answer to that was easy. I opted for near-distance monofocal lenses which I'm delighted with. They're the same power, but I wound up with what is essentially micro-monovision, with one lens at -2 and the other at -2.5. This works extremely well for me. I spend most of my day reading or on the computer, have excellent near and very good intermediate vision (i.e. I don't have to wear glasses at home except when watching TV), and wear glasses (progressives) when I go out, drive, etc. Having been nearsighted my whole life I knew I didn't want to give up my near vision.
Good luck with whatever you decide!
soks Bookwoman
Posted
how much close are you able to see with -2.5. clarity starts at what distance?
mary28814 Bookwoman
Posted
Thanks, Bookwoman! (I also am an avid reader, I just finished The Woman in the Window.)
I know! I have enjoyed my relatively newish nearsight for a while. And I sort of actually enjoy wearing my "stylish" glasses for far. But they better be damn far from now on.
I am waiting for my optomotrist to call me back so I can discuss with him the RX's he prescribes after lens implants. I feel under pressure because there is so much to learn, so much experience here to tap into.
Bookwoman soks
Posted
I've never measured, but I estimate I have perfect clarity starting about 12" when reading a book with both eyes, and probably 8" if I'm just using my -2.5 eye.