Monofocal or Mutlifocal Lens?
Posted , 5 users are following.
Hi All,
I used to frequent this forum a few years ago and revisiting now. Back in 2018 I had a mono-focal lens placed in one cataract affected (left) eye. I was quite happy with that result given I can see quite clearly from around 2 feet to "infinity". Reading with that eye is, of course, a non-starter. My right eye, a naturally near-sighted eye, covered my reading needs up to around 6 months ago when its cataract worsened over these intervening years. Desiring to remain glasses-free I'm now faced (I think) with a choice of chasing monovision (i.e. setting the right eye to near with a mono-focal lens) or placing a mutlifocal lense in my right eye to achieve reading ability.My questions are these:
- If I go with a mono-focal lens in my right eye set to near (reading) vision, how impaired would I be at middle and far distance in that eye? In other words, is distance sight only slightly affected with a near vision IOL, or is there a massive bokeh (blur) effect at far (or even mid) distances?
- Would a multi-focal lens be a better option for my right eye for near vision (and mid and distance)? Would this give me the best of all worlds so to speak? Granted, I might experience halos, flaring at night.. but it seems to me this might be minimal given the multi-focal lens would be in only one eye.
I think I could get away with option 1 above if the mono-focal lens placed in my right eye could just get my reading distance about 4-5 inches closer in that eye provided my distance vision isn't entirely blown out at the same time.
Does anyone have any experience or knowledge as to how option 2 would turn out? I'll be discussion with these things with my doctor in a few days but I just wanted to get the forum's thoughts. Thank you.
IG
0 likes, 11 replies
Sue.An2 indygeo
Edited
Sorry you are once again faced with this decision. I think I remember you from before.
Is your vision too poor to experiment with monovision using a contact lens? If you can you could frequent a place like Costco to experiment with this approach.
Something else you might want to consider is a Symfony IOL and target -1.25 diopter. That setup may eliminate Symfony's concentric circles that tend to appear around certain lights at night (ie red traffic lights) as the brain will choose better view - particularly if monofocal you have is in your dominant eye targeted for best distance.
Do wish you well.
indygeo Sue.An2
Edited
Sue.An!
Yes, I'm that guy. It's really great to see you again! I thought about you when I was making my post.. indeed when I came back to the site.Thanks for your response. You ask a good question.. My sight probably isn't quite bad enough to prevent me from experimenting with a contact lens. I should look into that first, although I do have an appointment tomorrow at the cataract clinic. I'm sure they'll tell me what's possible in this regards. I'll definitely ask them.
My situation a few years back was that, yes, my left eye was set to distance and my right was functioning rather well naturally for close up/ reading. I honestly don't know if my left eye is my dominant eye.. It may not be. I think I've read some literature, maybe even in this forum, that mono-vision can work in a "cross mono-vision" way where the dominant eye isn't actually set to distance. I guess it depends on the person(?). Maybe.In any case, my current mono-vision was a stretch as I think the diopter difference was at least 2.0. It took me a couple of months to get used to it but all was pretty good up until the past 6 months or so when I slowly noticed things getting cloudier and a bit frustrating.I was previously in the UK but now based in mainland Europe and trying a new clinic. I may still go back to the UK for the new procedure, but I'm not sure yet.I hope all is well with you!
Regards,
IG
Sue.An2 indygeo
Posted
A lot more options in Europe than here in Canada. It would be great if your vision allowed you to experiment with contact lenses - especially if going with a mini monovision approach with another monofocal lens.
Many may disagree with me but my own experience led me to believe dominant vs non dominant eye didn't really matter. I recall asking my surgeon about it and he mentioned most people can adapt either way. I thought I was Left eye dominant prior to my surgeries but after the cataract surgeries turns out I am Right eye dominant. The cataract was worse in my right eye so left eye took over. I have a condition right now (epiretinal membrane) where vision very skewed out if left eye (all lines appear curvy and hard to read out of it - lot of distortion) but with both eyes open I see perfectly fine. very glad I have a symfony IOL in my particular situation.
Nice to hear from you - back on these forums - wish you well as you investigate best option for you.
RonAKA indygeo
Posted
Yes, crossed monovision can work. I am currently simulating it with a contact in my non operated eye. If I had the choice however, I would do near vision in the non dominant eye and distance eye in the dominant. You can determine dominance by just point a something across the room with both eyes open. Cover one eye. If you are still pointing at it then this is your dominant eye. See this article:
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Helio November 16, 2016 Crossed monovision may be as effective as conventional monovision
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With no contact I have about -2.0 D of monovision. That is too much. I currently simulate -1.25 with my natural lens eye, but will go for -1.5 with an IOL.
indygeo Sue.An2
Edited
Hi Sue.An,
Yes, that's a good idea (to experiment with a contact lens). I think my vision is still good enough where I can at least get some idea of how things might look with, say, a -1.00 to -1.50 diopter. I don't actually know how the diopter thing works.. All I know is I'm a 2 diopter (+ or - I don't know) difference between the my distance lens eye and my near-sighted eye. And that's about borderline for mono-vision I believe.
As for the dominant vs non-dominant eye getting whichever lens, yes, I've been doing a bit of reading on that and some doctors say patients can adjust either way.I'm not even sure which is my dominant eye as one day I'll test it and it comes out as the left eye, and another day the right. The doc I saw yesterday (which is another story unto itself), said I was left eye dominant.
Lastly, I'm so glad you're happy with your Symphony lens!
Kind Regards,
IG
indygeo RonAKA
Edited
HI RonAKA,
Thank you for your thorough reply! Indeed, it sounds like your situation is nearly exactly like mine. I, too, am -2 diopter monovision with my natural eye. As both you and SueAn mentioned, it does sound like a very good idea to try a contact lens at -1.25 to maybe -1.50 to see how that performs.Hopefully I can look into this any day and get back.
Cheers!
IG
RonAKA indygeo
Edited
I have one eye with a monofocal IOL that is giving me 20/20+ distance vision and reading vision on a monitor down to about 20", and hopefully will soon get an IOL in the second eye. This is a somewhat similar situation as yours. My cataract in my second eye is not real bad, and I have been simulating monovision by using a contact that under corrects that eye by about -1.25 D. I can read my monitor easily, and also my iPhone. This is giving me excellent all around eyeglasses free vision. Yes, the distance vision is not crisp in the myopic -1.25 D eye. However my IOL eye makes up for that with very crisp vision. I do not have any gap of missing intermediate range vision. As a result of this I have reduced my options for the second eye down to those similar to yours.
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Of the two options I think #1 Clareon monofocal would give me with better contrast sensitivity across the whole range of vision, while the #2 Vivity EDOF would give better distance vision than the monofocal. It does induce a risk of night time flare and halos which gives me some pause for concern. The other option for the close vision eye would be the Symfony, PanOptix, and Synergy. The Symfony would still need some myopic under correction, while the PanOptix and Synergy should not. However, Symfony, PanOptix, and Synergy each introduce increasing steps up of flare and halos at night. I am not willing to risk that. I do not know if distance vision at night is good in one eye without halos and flare if that effect will be ignored when it is present in the other eye.
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In any case I see the surgeon later this week to discuss the two options I have narrowed it down to. I know he does not like the PanOptix, so we will see what he has to say about the Vivity.
nancy03915 RonAKA
Posted
Hi Ron--can you tell me what your vision presently is in your contact lens eye with the Snellen eye chart? I had the under correction mono focal last week in my non dominant eye and read quite well now. I'll find out what my vision actually is in that eye tomorrow but I'm thinking probably 20/40.
This was the best decision ever for me. I think my dominant eye is now 20/15. Never in my life has my vision been this good (-10 in both eyes with contact lens and still couldn't see worth a darn).
RonAKA nancy03915
Posted
I am not exactly sure what my vision is with the contact as I have not been tested that way. It is certainly not crisp. I would not be happy if both eyes were at -1.25 D as I could not even see TV clearly at 8-10 feet away. I suspect it is something like 20/40 to 20/50. But then I have some uncorrected astigmatism and a cataract going on at the same time. I am hoping my astigmatism comes down with an IOL, although I am not suitable for a toric.
nancy03915 RonAKA
Posted
Thank you so much. My doc said my astigmatism wasn't enough to bother with correcting and it apparently doesn't affect me. I will report back as to what my vision is tomorrow.
Pascal111 RonAKA
Edited
Hi Ron, nice to read you! 😃
Indygeo, I have the Vivity implanted unilateral for plano.
A successful implantation of the Vivity for emmotropy, ensures safely for 20/20 intermediate, so on 66cm (25 inches), with good eyes and lighting conditions also on 20 inches good vision. Halos and glare are as common or rare as monofocals. I don't have any halos or glares.