Need help to choose iol for second eye, choosing in one day from now

You could simulate monovision with contacts and see what you think. Also you can do less monovision than -1.5.

Whatever you do it comes with tradesoffs. The key is to understand those tradeoffs and choose which is best for you.

Below is my list of refractive IOL option in order of risk:

Non Premium Monofocals:

These are the most common IOLs implanted. They will have the best contrast and the least issues of any lens (unless you consider close vision an issue). They have been around and tested for a long time. A Monofocal lens should provide great distance. In general close vision is reading your cell phone or a book, maybe 33cm-40cm. Intermediate is about 2 feet or so. A perfect example might be the dashboard on your car.

A monofocal you should get pretty good vision down to about 3' or so (again it depends on many factors). As you get in closer; vision quality drops off rapidly.

Premium Monofocals:

LAL – If considering a monofocal I would recommend giving this IOL serious consideration. I have had Top Ophthalmologist highly recommend this lens. Having said that it has been around for a while now, but not as long as the standard monofocal so there is the test of time issue.

What makes this lens great is no matter what equipment Ophthalmologist use they don’t always hit the refractive mark and in a few cases can be way off by more than 1D. And let’s say you decide to do monovision. You want to hit those marks.

From what I understand you can adjust the LAL more than once. So you decide on monovision, but not 100% sure how much monovison. So set 1 eye to plano and then try various settings with the 2nd eye to see which one works best for you. I would only consider micro-monovision like -0.75D, but if I had the option to adjust it you could try a different setting and see if you end up with a lack of stereopsis or other problems.

IQ Vivity and Tecnis Enhance - The newest hottest IOLs on the block. A refractive IOL that provides some EDOF. I think IQ Vivity is around .5D and Eyhance a little less. So not a lot but combined with micro-monovision you should get decent intermediate and some close up vision.

Vivity can have contrast sensitivity loss.

I tried mono-vision with contacts and was not a fan. I need good distance vision. That is why I say if doing mono-vison go with micro-monovision (<-0.75D). If you do that with Vivity you will be getting -1.25D of mono-vision, preferable in the non-dominate eye.

Enyhance from what I read has no CS lost, but you don't gain much EDOF.

Diffractive IOLs

These IOL, which include Trifocal and EDOF IOLs, give you improved intermediate and close vision but they all come with tradeoffs (dysphotopsias & Contrast Sensitivity loss). This category is a paper in itself, so I will not go into details unless you are interested in a defractive IOL. I personally have a defractive len in each of my eyes. In the US the main defractive lens currently would be Panoptics, Symfony, and Synergy IOL.

I have mini-monovision and like it a lot. My target was to be -1.5 D in my second eye, but some astigmatism issues made it a bit more complicated. I am probably closer to about -1.25 D. I would prefer to be -1.50 and have no astigmatism.

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I would agree with your surgeon to go for -1.5 D in the second eye. It is enough to give you good reading vision, and not so much that you lose your depth perception. However at night outside of the city it is probably best to have some progressive glasses to wear. I had my second eye done in February and have not had progressives, but I only drive at night in the city where there is lots of lighting. For really small print I have some +1.25 OTC readers around. I may use them once a week or so. I don't bother to take them with me when I leave the house. I have no trouble putting eye drops in my eyes.

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If your doctor predicts you will have -0.75 D of astigmatism or more after surgery, I would go for a toric lens. You don't need it if you plan to always use progressive glasses as they will correct the residual astigmatism. But, if you want to be eyeglass free it is best to get a toric if you have enough astigmatism to warrant it.

Hi freddi23948,

It's so upsetting to try and decide on a target when you don't know exactly what the outcome will be. I have mini-monovision with 1.25 diopters difference between my eyes (distance is -0.5D, near is -1.75D, also with J&J monofocals.) I too was concerned about losing depth perception, so I asked the doctor to target the second (near) eye at 1.25D offset from the first eye, so that if I ended up more nearsighted with that eye my depth perception would probably still be ok. I don't drive at night, but am able to legally drive without glasses and don't have a problem with depth perception. My preference is to wear glasses to sharpen things up, but in an emergency or if I've misplaced my glasses I'd be safe without them.

I would be very careful counting on your vision to be good for reading if you end up at -1.5D with your near eye. When I use 1.0 readers to set my distance eye to -1.5, having sharp reading vision doesn't happen within arm's reach. I can make things out closer than that, but it's not what I'd call good reading vision. You might end up with vision that allows you to read at -1.5D, you might not. If you can pop into a drug store with a reading glasses display, you could try on different strength readers on your plano eye to get a rough feel for what your vision might be like with different power IOLs--although your astigmatism in your plano eye may give you a little boost in your reading ability. Another thing to seriously consider is delaying your second surgery/IOL decision until you've had some time to really be sure what you want.

You've got great advice so far. As you plan on wearing progressives after your second surgery then mini-monovision seems like a good option.

You'll forgo the chance of binocular 20/20 or better distance vision without glasses but gain intermediate and some near vision with mini-monovision.

I don't think it will help when doing eyedrops though. If you have some readers now you can do a quick test by putting your fingers near where you'd hold the eye drops bottle while wearing the readers. Move the readers up out of the way and then back in place and I suspect that the level of blur will be very similar for anything that close to your eye. It is when I do that quick test. That said, I think you get used to the blur. I wondered if I could do an eye drops after surgery but it turns out to not be a problem and I have both eyes set for distance.

I wouldn't think that depth perception or contrast will be a problem because you plan on wearing progressives after your second surgery. The progressives will correct your vision.

If you weren't planning on wearing progressives then you could search Google and read up on Pulfrich effect or Pulfrich phenomenon. There's a pdf titled "Monovision and the Misperception of Motion" that's worth reading for anyone driving with monovision. We believe what we see but our brains can create an illusion so what we "see" might not be accurate so it's good to be aware of that.