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One eye set to -2.0D, considering best option for second eye

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judith93585
judith93585

I've just returned from a Thanksgiving dinner with friends. When I mentioned monovision they just stared at me. I said, it sounds terrible doesn't it. There was silence.

I've been home a lot since my surgery 2 months ago and realized when moving around my friend's house that I was reaching out to steady myself with one hand on the counter. I'm also thinking now I don't understand how near/intermediate mini monovision works!

I ask myself why I chose near in the first place. It was when completing the form which asks would you like to wear glasses for near or distance. I answered distance. What I didn't understand until it was too late that by choosing near I'll have to wear glasses to see across the room not just for outside activities.

This text is relevant but was not directed to me. I've bolded the text that applies to me.

(1) You may want to target both eyes for near instead of trying for mini-monovision as you would get best near and intermediate if your eyes could work together to improve visual acuity in those ranges (you lose most of that benefit at mini-monovision ranges for the benefit of better total DoF), or you might be able to target near at -2.5D or nearly whatever your actual reading offset is (hard to precisely test if you still have any accommodation in your natural lens as you lose that with the LAL and most other IOLs) for near and up to 1.5D towards distance relative to that for your distant eye (not necessarily plano). I think a good ophthalmologist or optometrist can give you a numbing eye drop which immobilized accommodation to do a more accurate preoperative test assuming your cataracts aren't so bad as to substantially interfere with the refraction. (2) **I have no idea if this type of mini-monovision can work OK as that is not normal for mini-monovision (always plano target for distance eye as far as I know). It is possible that the brain can only pick the best distance image if it is close to plano, so that option would require more research. **

I'd very much appreciate any thoughts about passage 1 or 2 above.

Many thanks.

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  • judith93585
    judith93585

    Edited

    Thanks Lynda. The unsteady feeling is unusual but caused I'm sure from one eye being at -2.0 D and the other cataract not yet replaced. What has me thrown for a loop is realizing that what I had thought of as reverse mini-monovision may very likely not work well for my particular situation in which I was holding out for a second lens substantially more myopic than plano (-1.0 D) to pair with my current -2.0 D IOL. I'm so grateful to someone in the group cautioning me that:

    I have no idea if this type of mini-monovision can work OK as that is not normal for mini-monovision (always plano target for distance eye as far as I know). It is possible that the brain can only pick the best distance image if it is close to plano, so that option would require more research.

    Now I understand why my surgeon gave me a choice of either plano or another -2.0 D IOL. This now makes perfect sense. With my current understanding, I'm leaning toward the option of another -2.0 D IOL rather than plano. As expressed by the same group member although not directed to me:

    You may want to target both eyes for near instead of trying for mini-monovision as you would get best near and intermediate if your eyes could work together to improve visual acuity in those ranges.

    So glad I have an appointment with my optometrist on Monday for clarification.

    • Lynda111
      Lynda111 judith93585

      Posted

      Be sure to think in advance the questions you want to ask for "clarification." Most medical providers seem to be in a rush, so make sure your optometrist clearly answers all your questions to your satisfaction.

    • trilemma
      trilemma Lynda111

      Edited

      Be sure to think in advance the questions you want to ask for "clarification."

      Having the questions printed out is better.

    • judith93585
      judith93585 Lynda111

      Posted

      Thanks Lynda. Yes, I'm compiling a list.

      I've forgotten, do you have a slight offset between your eyes? Maybe one eye is set for -2 and the other -2.5? If yes, are you aware at all of the difference? I'd be interested to know what the naturally occuring offset is among the general population, not including those who have had cataract surgery or lasik. I understand that's not the kind of statistic most people have immediately at hand!

    • Lynda111
      Lynda111 judith93585

      Edited

      No. I am an unusual case. Both my eyes were targeted for intermediate. That's all I told my cataract surgeon. I didn't go into optics. I fully expected to continue wearing glasses, but the lenses would be thinner. But apparently the "axis fell just right", my uncorrected 2D astigmatism helped, and I just go lucky. I really only need glasses for sustained print reading and rarely for night driving on unfamiliar roads.

  • jo61855
    jo61855 judith93585

    Edited

    You may want to add a small bit of distance vision for the second eye. Personally, I believe people should target distance with some intermediate for both eyes and use over the counter glasses for reading.

  • phil09
    phil09 judith93585

    Edited

    My situation is different, but maybe my experience would still be useful for you.

    I currently have "triple-monovision" - that is, ~plano in one eye and extremely nearsighted (-6 to -8 D) in the other. For the moment, both of my lenses are natural, but at age 64 my presbyopia must be pretty far advanced. I have very little stereo vision - everything I see is largely seen with one eye.

    Yet all of the issues you describe are alien to me. I have no trouble seeing steps or feet, no unsteadiness, nothing like that. Perhaps that's because I've had more time to get used to the monovision, or perhaps I will experience similar issues when I get older or after my natural lenses are gone.

    The moral of the story, if there is one: maybe with more time you can become comfortable with full monovision. Is there some visual therapy that could help? If there isn't, maybe there should be...

    Good luck with your decision.

  • julie66167
    julie66167 judith93585

    Edited

    I sent you a private message about where I live and the doctor I have seen who does the light adjustable lens.

  • judith93585
    judith93585

    Edited

    Thank you so much!

    I found a post written by an optomonogist which mentions target for distance-intermittent and near-intermittent mini-monovision.

    So one eye, normally the non-dominant eye would ideally be left with a post op refractive error of -1.00 if the dominant eye was set a 0.00 this would be "mini-monofocal distance bias" if the dominant eye was set at -1.00 and the non-dominant eye -2.25 that would be "mini-monofocal near bias" if the dominant was set at 0.00 and the non-dominant at -2.25 that would be "full monofocal" this is often difficult to get use to and the glasses it requires difficult to get used to.

    I'm still hoping to find out how this works physiologically.

    • trilemma
      trilemma judith93585

      Edited

      The human brain does a great job of adjusting to what is available.

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