Near vs. intermediate setting for IOLs
Posted , 14 users are following.
I'm deciding now whether to go with near or intermediate toric monofocals. I have tentatively chosen Clareon over Eyhance due to less rotation and PCO risk. That said, Eyhance seems to have a slight edge in terms of near and intermediate vision. Leaving that aside, has anyone else struggled with the choice of near versus intermediate IOLs? I do not have much experience with monovision so may choose near or intermediate rather than both, with the understanding that monovision may choose me! As background, I have been near sighted since childhood and started wearing glasses full time at the age of 12. I also have astigmatism, hence the toric lenses. Many thanks for any shared experiences.
0 likes, 74 replies
maura04015 judith93585
Edited
I found and kept these recommendations by an ophalmalogist:
Mini monovision with near bias (give intermediate and near):
-1.00 for intermediate -2.50 for near
Mini monovision with distance bias (give distance and intermediate):
0.0 and -1.50
The different recommendation for intermediate makes me wonder a bit and there was no reason for that given. Maybe to fudge how much distance you'd lose in that configuration.
I'm another one who would rather have to wear glasses for distance (which would mean a couple hours once or twice a week because good distance really only matters to me for driving) and be glasses-free for near and intermediate. Bookwoman, the forum member who had her cataract surgery with good near vision the goal, ended up with one eye at -2.0 and the other at -2.5 (evidently -2.0 in both eyes was the goal). When I asked, she said she believes having the -2.5 eye really helps for comfortable reading. She sees well enough that way to function around the house and wears glasses when she needs more than near.
The people who all say mini mono with -1.5 in the near eye is enough for them to see well at near ranges also usually add that if they're going to sit down and read a book they use reading glasses. Their good near is good enough for the phone, which to isn't my standard. When I say I want good near, I mean the sitting down with a book kind. My difficulty deciding which way to go is part of my procrastination over the whole process.
soks maura04015
Edited
i would also like lenses that give 12 inches to 15 feet vision and will happilybwear glasses for anything beyond that.
Bookwoman soks
Edited
maura has summarized my situation well. I would add that I can see well beyond 15', it's just not crystal clear. Right now I'm sitting at my kitchen table and looking out at some trees which are about 20 yards away. I can see the branches and clumps of leaves, although individual leaves are blurry. If a bird landed on one of the branches, I could tell it was there, and if it was something striking like a bluejay, I'd be able to tell the kind of bird as well. So even with -2 and -2.5, I still have very usable (at least compared to my old myopic eyes) distance vision.
judith93585 soks
Posted
Hi Soks,
12" to 15' sounds wonderful! Is that possible with monofocals only and no mini-monovision?
soks judith93585
Edited
not possible with monofocals without monovosion.
-2.5 is very limited range. 12 inches to 20 inches and the rest is quite blurry when i wear a +2.5 reader on my plano symfony.
judith93585 Bookwoman
Posted
Thanks Bookwoman! Did you indicate to your surgeon prior to surgery that you wanted -2.0 in both eyes or just that you wanted good near vision?
Bookwoman judith93585
Edited
We discussed it at length and decided that -2 in both eyes would be best, as I know that what you put in isn't always what you get (viz. the -2.5 I wound up with in one eye.) I didn't want to risk too great a discrepancy between the two eyes, so wanted the same power IOL in both.
My surgeon is also my ophthalmologist of 30+ years, so he knows me and my eyes well and was always available for any questions. He's a gem. 😃
judith93585 Bookwoman
Posted
You are so fortunate to have that level of trust!
lucy24197 maura04015
Edited
Those sound like pretty good recommendations for near and far bias. I guess you could call mine mini monovision with intermediate bias. I went slightly myopic on the distance eye (-0.5) to get more near vision and still stay within 1.5D difference between the eyes (-1.75 in near eye.) My distance eye regularly measures 20/25, and on good days is 20/20. So I can drive without glasses if necessary, but prefer to wear them for best vision. For near vision looking at a Jaeger chart, I start losing crisp vision at about 17" in my near eye. At about 15", I'm losing the smaller text. So I can read the mail, grocery labels or most small text if I hold it out a bit and do almost everything without glasses. For reading a book or doing fine work like soldering or needlework, I've got cheap readers. I can crank up the font on my ereader a bit and comfortably read without glasses for short periods, like waiting in the doctor's office or using the exercise machine, but for just sitting and reading, I'd want my readers. I have ZCB00 lenses (Tecnis monofocals), and the doctor nailed the targets. No astigmatism. I'm pretty happy with the results, because I only need glasses when I'm going to be still for a while--no need to constantly whip them on and off, so I can just have a couple pairs of readers that live where I'm going to be reading, and my distance glasses live with my keys for driving . If my goal was to have really good reading vision without glasses, I wouldn't be happy.
soks maura04015
Posted
maura this is a very good post for the recommendations. especially the mini monovision with near bias.
if i still need glasses after -2.5 iol then that would be disappointing. i always wonder how the distance is with -2.5 iol. bookworm gives a good account of it. if i wear -2.5 readers on the iol eye the near range is very small and distance is significantly distorted. in my experience paper is easier to read than phone. with panoptix the phone is distorted at 21 inches but paper is very comfortable.
if i were to start over i would get a clareon monofocal set for between -0.5 and -0.75 (i have been a myope of -2.5 all my life) . then after a month when the eye heals i would put a +0.5, +0.75, +1, +1.25, +1.5, +1.75 and +2 contacts in the iol eye to see how much near i get with it and how much distance is distorted. my optometrist will give me free trials for each of these lens powers. i will get the monthly contacts so i can experiment for a month. if i think +1.5 is the sweet spot for nice near without much disturbance of distance i would set the other eye for -2 because my iol eye was already -0.5.
if i am unhappy with the near i would get clareon trifocal in the other eye. this way trifocal will give the reading range and the monofocal will balance out the light effects and contrast loss.
RonAKA lucy24197
Posted
That sounds like a good outcome. I'm a bit surprised that your near eye does not let you get a little closer than 15". Is that on a computer or on paper with dimmer light? I find the lighting level makes a big difference in how close I can see. How close can you go with your distance eye only and still read a computer monitor?
soks RonAKA
Posted
how is the vision in each eye in dim light? how close can you see?
RonAKA soks
Posted
I go from J1 in bright light to J3 in dimmer light with my near eye. With my distance eye I can start to read a computer monitor at about 18-20", and can easily see my car and motorcycle instruments.
Lynda111 judith93585
Edited
"Life begins at Intermediate." I read that a while back in a J & J article extolling the intermediate vision the Eyhance is supposed to provide. I know you prefer the Clareon, but I agreed with the article about the importance of intermediate vision. That's what I told my surgeon I wanted and I like it.
judith93585 Lynda111
Posted
In this case, did you ask your surgeon for intermediate or give a specific number?
On another note, I thought to ask my optomotrist recently who suggested intermediate for me. Prior to that I had only been thinking of near.