Monofocal set for distance... what should be my expectations?

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For people who have had cataract surgery with a standard monofocal IOL lens how drastic has your near vision acuity been reduced? I am fully aware that reading glasses is pretty much the guarantee when opting for monofocals that are set for distance... I think I’m okay with that if I go that route but I also hear some people require different strengths to see close up and a bit further out like near-intermediate.... I really do not want to have to have multiple pairs to see for example computer and than a different set to see my smartphone. Is there anybody out there that just really just need one pair of reading glasses to see things in detail near.... and are fine without glasses for the rest of their visual spectrum. I know I do not want progressive or bifocal glasses nor do I want my eyes set for  monovision. My surgeon did hint of setting slightly near sighted with monofocals. I guess I might have to wear a different prescription for really good distance if that were the case?

Also with monofocal lens how are things like hiking, playing sports, mountain biking, etc..... is it difficult to find footing to see things close that would require me to have to use multifocals contact lens to get by?

Although i know things will be generally a lot clearer after my cataract surgery but just wondering how much does it affect your hand eye coordination with monofocals set for distance..... 

Most experiences I read about people’s results with cataract surgery is that distance is good 20/20 and they usually just need reading glasses to see close in detail... is it really that simple?? 

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  • Posted

    I am very pleased with my distance mono focal IOLs. I can read the information on my car’s display without any issues: text etc on the sat nav. I have a prescription for reading glasses. My optician seemed to think that I wanted to read text at about 3 inches from my face. He also suggested varifocals but in truth I do not need them. I took the prescription and ordered 2 pairs of prescription glasses for £35 from an online lab. One pair I use for reading: the other pair has had the prescription adjusted for using an iMac at about an 1 1/2 arm’s length in front of me. I find that I can also read quite happily with this pair as well.

    Having worn glasses for 35 years, I still find it slightly annoying when I sit down and find that I have left my reading glasses are in another room! I can see why some people elect to put them on a chain.

    I also have a cheap pair of ‘readers’ in my coat pocket in case I am out and about need to read a menu etc.

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  • Posted

    I'm one of the lucky ones.  I don't need glasses for anything, near or far.  I was pretty farsighted prior to the surgery so I don't know if that has something to do with my vision now.  I was told that I would likely need glasses for reading, but I don't.  As for physical activity - I was told, also, that I can resume any activity I choose.  I run, bike, and hike with no problems.  The only thing I was advised against doing for ever is rubbing my eyes too hard or too vigorously.  

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  • Posted

    If you want distance and intermediate vision without glasses, and OK for using glasses for near/reading the usual option is mini-monovision with monofocal IOLs.  That targets one eye for good distance vision and the other eye for slight nearsighted for intermediate vision (computer, smartphone screens, etc) thats usually about -1.0D or so difference between the eyes.  Another alternative is the Symfony IOL that gives a wider focus range of distance and intermediate to some near vision.

    I have one monofocal IOL in my right eye so far set for distance vision and I need to use about -1D glasses for computer and smartphone reading.  So I plan when my other eye  eventually needs cataract surgery to either set it for a little nearsighted with a monofocal IOL to get intermediate vision without glasses or possibly go for a Symfony IOL in that other eye to get both distance, intermediate, and even possibly some near vision.  I currently am using my old progressive eyeglasses with the right lens popped out - so that simulates that  and has been working well for me.

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  • Posted

    I almost never wear glasses for anything.  After my first surgery I was quite upset because I thought my near vision was gone.  But, we decided to go for "mini monovision" so my other eye was set for distance also but about 1/2 diopter set in for near.  I would never advise full mono vision because few can tolerate it.  But, most people already have mini mono vision anyways since their eyes are not exactly the same even before surgery.  So, my eyes are working together and I see great.  There is some advice I can suggest you consider and talk about with your doctor:

    1.  Be sure you find a really good doctor.

    2.  I believe there can be error factor of about 1/2 diopter which means if you set it to distance, the doctor could miss by 1/2 diopter and you could be a little far sighted making your near even worse (although it can be correct by a laser, but it's best to try and get it right the first time).  So you might want to consider going 1/2 diopter in when doing the first eye.  See how everything is after that and then decide about where you want the second eye set to.

    3.  Before I had my cataract surgery with an Alcon toric mono focal, I was used to looking at everything around 5 inches away and I could even read a 4 point font.  So, rather than run for the reading glasses for everything, I had to retrain my brain to hold things around 12" - 18" away and over time it just got easier and easier.  I also found that early on if I used my LED light from my iphone it was even easier to read  (harder to read in dim light which is normal).  It just continued to get easier to read everything over time.  But, I usually don't struggle and try to read things less than 8 point font.  If it's a medicine bottle around 6 point, I can read it in good lightlng but if it's a lot to read then sometimes I'll get lazy and just throw on a pair of reading glasses or use my credit card magnifier that I carry everywhere (it's in between my iphone and a nice but flimsy rubber protective case).

    Good luck to you.

     

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  • Posted

    You seem to understand the vision options well.  My answer is it depends.  IE how much myopia you had prior to surgery.  If you were corrected with glasses to say R -1.5 and L -1.25 then your mid will be ok, and close up you'll need readers.  However If you wer R -5.0 and L -6.0, your replacement lenses will put your mid/near in a poor situation.  Which is what I have.  So solution is progressive lenses that work close and mid range nicely.

    Note that when they remove your natural lenses the tiny muscles that shape the lens for different distances are cut.  So new lenses are fixed.  When younger this muscle allowed for far and near focus.  Older not so much, seems to get stiff.  Remember your child eyes?  Anyway the little focusing you had with natural lenses are gone after surgery. 

     

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  • Posted

    Good luck to you Miguel - guess you must be getting close to having your surgery.  I wish you success.

    As you know I have Symfony lenses which I am happy with.  Have good near vision from 11 inches to distance.  I think after cataract surgery good lighting is important for reading.

    I do contend with the concentric circles around some light sources (outside).  I have adapted to these and still drive comfortably at night but the circles likely won’t magically disappear.

    I think you could even consider mix and match a monofocal set for distance and a Symfony set for .75 diopter in and get a better all round experience.  And setting the Symfony Lens nearer should eliminate the concentric circles somewhat and whatever those are the monofocal would compensate.

    It’s a matter of deciding which trade-off you can live with as there will be a compromise to make.   But as mentioned in previous posts the lens power comes in increments of .50 diopters so that combined with how the IOL settles could account for why the target is missed by .50 diopter either way and why some with monofocals say they can’t see intermediate vision very well and others do.  The suggestion to target first surgery at .50 nearer and not plano is a good one to consider as I think there are better options being slightly near sighted than left slightly far sighted.

    Do wish you well Miguel and will look forward to hearing how it all turns out.

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  • Posted

    I'm still healing, but mono was not a good choice for me. My near vision was great before, now even with reader it's blurry. But you might not better judge your decision on me because of the central blur I'm experiencing. If I could redo...would go for clear near vision & glasses for distance. If seeing up close is dear to you, better reconsider mono.

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    • Posted

      Ann - there's no reason to reconsider mono for that.  Mono focal lens can be set to any distance (near, mid range or far).  Some prefer to set one mono focal to near and another to mid range and then just have glasses for distance.  With regards to your situation, do you have a toric lens?  There is no reason your vision should be blurred with the right reading glasses unless you had a toric lens that shifted and thus your vision is slightly blurred at all ranges.  The other possibility is that you might have gotten a minor astigmatism from the cataract surgery.  This can be fixed with a laser tweek.

       

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    • Posted

      Hi Michael, no, specialist found edema&bleeding near macula. On drops& waiting for it to subside., I pray! As far as laser.. I will be hard pressed to allow that Dr. to do anything except examine the eye!  Finding  a new ophthalmologist !

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  • Posted

    As some of the other people have alrady mentioned:

    1.The best choice will be to aim for about -0.25D for the first eye (preferably dominant eye), as your surgeon has suggested.

    2. Don't make any decision for the second eye for at least 2 weeks after the first surgery, to know exactly the prescription you end up with the first eye.

    3. If you do end up close to the target of -0.25D in th first eye, then aim for about -1.25D for the second eye. That combination with mini-monovision should provide you good far and intermediate distance vision (without the night bision issues of multifocal lenses or Symfony), needing only reading glasses.

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    • Posted

      AT201 - do you think 0.5 - 0.75D might be a better target to aim for since the error factor could be as high as 0.5D?  In other words if the first eye turns out to be measured as planned at -0.25D, aiming for -1.25D could end up at -.1.75D which is a difference of 1.5D between eyes.  That's starting to approach full monovision.  But, on the other hand, I suppose all of it is correctable with a laser.  1D difference might be pushing it for me.  I'm about 1/2D difference and probably would not notice 0.75D but I think I would notice a 1D difference.  I find for me that with only 1/2D difference my eyes tend to work together a lot better at all ranges.

       

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    • Posted

      The fact that there may be an errot of up to +- 0.5D beween the target and the actual "best" focus point makes the target selection harder. You will probably be the happiest if you end up beween -0.5D and 0D. Even though it is not good to have any farsighteness, you may find easier to live with +0.25D (no glasses for far distance) versus -0.75D (may need to use glasses for the better vision at far distance). Hence, my preference for aiming for -0.25D.

      The surgeon should be able to learn a little more about your eyes from the first eye results. After you have the first eye results in hand, I thin that you will be the happiest if the second eye is at -1.0D more than the first eye. If you want  to play it safe and aim for -0.75D more than the first eye, that is fine. Again, you don't have to make that decision for a while.

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    • Posted

      That -0.25D target for good distance vision is also what my eye surgeon told me he always uses for the same reason - to help avoid ending up too farsighted.

      That was my right eye's target and refractions at the eye doctor over the past few months indicate its very close to plano so that target worked pretty well.

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    • Posted

      Yes - you are correct - I meant  to write -0.5 to -0.75D to bring it in a little so that one has less chance of being farsighted.
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