Posted , 10 users are following.
Interested in knowing what makes a good candidate for this option ( vs monofocals or multifocals.)
Professional suggested I consider this option. However was very light on details as to why I would make an appropriate candidate. Suggested I start by trying out contact lens.
Thanks
0 likes, 15 replies
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Guest Ichabody
Posted
Hi
Monofocals vs multifocals is a bit like religion, many people think their opinion is the right one, but nobody really knows 😃
Monofocals have least risk for side effects. Monovision is one lens for far, and one lens for intermediate/near vision, with somewhat reduced binocular summation compared to two lenses that are set at the same target.
Monovision have been used many years with good results in most cases.
The difference between the two lenses decides how much close vision you get, but it varies from person to person how much difference our brain can cope with. That is why it is recommended to try with contacts before surgery, so you know if your brain can adapt.
My surgeon told me only 60% get full advantage of monovision, he never does monovision without testing with contacts first. Other surgeons just do it without testing, surgeons don´t agree either.
Multifocals have the advantage that you can see the same things clear with both eyes at the same time, and therefore you can get a higher bonus from binocular summation, and people who can not adapt to monovision can have both far and near with multifocals.
In my own case it was not possible to test monovision with contacts because my vision was too bad.
Multifocals always have side effects such as halos around bright light in the dark.
The amount of side effects varies from person to person.
I have a mix with edof and trifocal, I am a big fan of these lenses, I enjoy being free of glasses on a daily basis, but these lenses are not for all, you have to have a mind that lets you adapt and forget about the side effects.
Ichabody Guest
Posted
Thank you for taking the time to reply. I appreciate it.
My understanding is that those who select monovision represent a relatively small proportion of cataract patients. (The vast majority opt for monofocal IOLs.)
My question was meant to determine why specialists would promote this option ** to me** and not to others. In other words, who are the best candidates for monovision.? What are the things the specialist looks for to actually promote this particular fitting.?
Thanks again
Chris53317 Ichabody
Posted
Only the specialist knows why he promoted this to you. Many ask you to complete a questionnaire before meeting with you. It is my opinion that the best candidate is someone who:
In addition, they should be prepared to use glasses if the resulting IOLs do not give perfect near and distance vision.
Guest Ichabody
Posted
Hi
I should have explained better 😃
Monovision means, that you get two monofocal lenses, and the monofocals are set to hit different targets.
So monovision is monofocals.
When the surgeon choose the lenses for your eyes, the surgeon can decide at which range your vision will be clear.
With monovision you will get one monofocal lens that covers far distance, this is from about 3-4 feet and into eternity.
And then the surgeon can move the target a little closer on the second eye, so it gives you clear vision at a closer range, so you can get clear vision from maybe 2 feet, but then this eye it will have slightly worse far vision.
Your brain will always take the best it can get, so when you look with both eyes, you will have good vision from 2 feet to eternity with this setup.
So monovision is monofocal lenses, that have slightly different powers to cover slightly different ranges.
Most people who gets monofocal lenses, also get monovision to some degree. It is rare that both lenses are set at the exactly the same target.
With contact lenses you can try if your brain can cope with a big difference, but most people will adapt to a small difference without testing.
So the majority who have cataracts surgery with monofocal lenses, do get some monovision to boost intermediate/near range, that means millions of people each year all over the world, it is a well tested approach , that work well for most people.
So the surgeon promote this option to you, because it is the normal way to do it, and have been for many years.
Ichabody Guest
Posted
Thank you for this information, I appreciate it very much.
Ichabody Chris53317
Posted
Thanks again.
pat80248 Ichabody
Edited
I have monovision since cataract surgery last May. Am less than thrilled. I had used a single lens for distance for 30 years, happily, as I am quite nearsighted. The single point I made to my surgeon was that I read constantly and always in bed at night and did not want glasses for night reading! Well now for comfortable vision I must wear a reading lens/ glasses to read any length of time, and distance glasses for perfect distance...like golf or driving! For this I paid a premium. yes I can go without glasses most of the time around the house and shopping....but you know that old distance contact lens gave me that and more! Make sure you get what you want. My doctor decided making me a bit less nearsighted was a better option, WRONG! You live with the results...you make the decision.
RonAKA Ichabody
Posted
I am in the same situation. I had pretty much discounted multifocal options, and the surgeon agreed. However he suggested I consider monovision after the first eye is corrected for distance. Once one eye is done you can evaluate how well that eye turned out. Then the second eye can either be done the same, and accept that reading glasses will be mandatory. Or the second eye can be corrected for near vision. This should give you good intermediate vision, and some modest smaller print reading. However for lower light and smaller print you will probably need reading glasses. The purpose of doing a contact lens test is to determine how much of an under correction you find best for the near vision eye. If you google the article below, it gives you some of the pros and cons.
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EyeWorld choosing between monovision and monofocals.
Ichabody RonAKA
Posted
Thank you. The attached link suggestion was also useful.
However, I was really looking to learn why I was told to consider monovision in the first place. In other words, why was I a good fit, seemingly? The specialist did not take the time to expound on this. I will raise it with her again but in the meantime, I want to learn more for myself, as these people have little time to spend on patients, I have learned.
RonAKA Ichabody
Posted
I can only really relate my own personal experience in trying to come to terms with this decision. Of course I would like to see perfectly right from up close out to infinity with no glasses. But, there is no technology to do that. EDOF and MultiFocal lenses promise it, but deliver it with some significant side effects, like halos and flaring of lights at night, and inability to read in lower light levels. However they do seem to work for those individuals that do not expect perfect vision or want to be without glasses so badly that they will live with the side effects. I fairly quickly decided I was too much of a perfectionist to put up with them. My surgeon basically confirmed my thoughts when he said that "There are multifocal lenses available, but I am not comfortable recommending them, because I would not put them in my own eyes." He is a university professor, and does consulting work for Alcon. So he obviously knows about and could use the PanOptix IOLs.
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Monofocal lenses are much more likely to deliver perfect, or in some cases better than 20/20 perfect vision, but only at one distance range. They are not a bad solution, if you are willing to live with needing glasses for the range they do not work well for. You can get lenses that correct only for distance and then you need reading glasses. Or, you can get lenses that are perfect for close up without glasses, but you need glasses for distance. It is kind of your preference as to when you are willing to wear glasses and when you are not. And the other advantage is that if you get prescription glasses, you have the easy option of having any residual spherical, cylindrical, or add error corrected with the glasses, instead of with further surgery.
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Monovision appeals to those that want the benefits of multifocal or EDOF lenses but without the higher risk of visual side effect issues. There can also be a significant cost savings as well. That said you have to accept the fact that there will be some loss of visual acuity because both eyes are not getting the most perfect image at all distances. That is why a contact lens trial is recommended to see how much anisometropia is optimum for your vision expectations, and how much you can put up with. However this is difficult if not impossible for someone with significant cataracts in both eyes already. My plan is to do the contact lens trial after my first eye is done for monofocal distance. The hope is my second eye is still good enough to evaluate what monofocal vision is best. I have done monovision some years ago with contacts in both eyes. My close eye was under corrected by -1.25 D. It worked sort of well, but I would like to revisit it before making a final decision on doing it with the much more permanent IOL solution. I read that monovision works better in older people with smaller pupil size, and I am making "progress" in that department! I am still about 50-50 on doing monovision with about -1.0-1.25, or just doing full distance in both eyes. Current plan either way to get the AcrySof IQ Aspheric Monofocal IOL. Toric version not needed for the first eye, but may be used in the second eye.
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Here are some more articles to have a look at:
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Optimal Amount of Anisometropia for Pseudophakic Monovision Ken Hayashi, MD; Motoaki Yoshida, MD; Shin-ichi Manabe, MD; Hideyuki Hayashi, MD
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Monovision Strategies: Our Experience and Approach on Pseudophakic Monovision Misae Ito CO* and Kimiya Shimizu
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Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost
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Hope that helps some,
Ichabody RonAKA
Posted
Thanks again.
I will read the articles suggested ,here
W-H Ichabody
Posted
My wife has mini monovision (-1.5 and -0.25) and has no problem working/reading/computer etc for 10+ hours a day. She has no glasses or contacts.
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Dry eyes from surgery + eye drop reaction post surgery has been the "only" problem.
Ichabody W-H
Posted
What prompted her to opt to get fitted for monovision as opposed to multifocal or monofocal?
Thank you for taking the time on this.
W-H Ichabody
Posted
I have tons of posts on this but here I go again lol We did lot of research and that was the most common sense conclusion for us based on what muliple surgeons said and what I read. I wanted the best quality and clearest vision possible in all lighting conditions. Monofocla IOL wins there clearly.
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Lot or many mulifocal IOL people end up using glasses anyway so glasses free was not the driving factor for us but it was still a factor due to wife being young and very active person, which is why we did mini-monovision. Kind of best of both worlds.
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Wife does not notice any loss of real world binocularity as there is some overlap between the eyes. If the diopter difference between the two eyes was greater then the loss of binocularity would have been more obvious.
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The idea of seeing rings, light issues or brain not adapting was too scary to risk.
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She has no soft spots either with the 1.25 diopter difference between the two eyes. She sees sharp from 35-40cm to very far ( mountains in the horizon) on good days.
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On bad days she see very sharp from 35-40cm to 5-10 meters....but bad days are due to her tear film issues so not mini-monovision related. If she did not have the tear film issues then life would be perfect.
Ichabody W-H
Posted
Thank you for sharing this info.