Please help me cut through 'information overload'

Darn it - forgot to manipulate to get paragraph spacing to show. Sorry.

Thank you, that sounds like very advice for me!

Thank you for your suggestions. I do worry about having too large of a numerical difference between each eye, but I really don't want to need reading glasses.

I didn't mention it earlier, but my doctor discovered a very slight astigmatism in my left/dominant eye that had never been diagnosed before. But he said he was going to correct it by laser so I wouldn't need a toric lens. I'm curious why you didn't have that done?

Also, did you ever consider using the Eyhance monofocal at all? I was just reading that "the Eyhance IOL has extended depth of focus (EDoF)-like qualities through the design of the central 1 mm of its optic. However, the Eyhance was not approved as an EDoF lens and surgeons cannot charge a premium fee for it."

Reading people's experiences, I'm definitely more hesitant to take chances, and am now leaning toward monofocals, but I can see myself opting for full monovision rather than mini. Perhaps the Eyhance brand would compensate slightly for the depth perception issue.(?)

On the astigmatism part of my issue is that it is irregular astigmatism, and the surgeon would not commit to whether or not a toric would help. He also told me I could get Lasik to correct it, if the outcome was not to my satisfaction. That turned out to not be true. I did consults with two Laser clinic after my surgery and they could reduce my astigmatism, but if they did, I would lose most of my reading ability. So, I asked if they could increase my myopia from the -1.0 D to -1.5 D and at the same time get rid of the astigmatism. The answer was that they can reduce myopia easily (flatten the cornea) but it is very difficult to increase it (make the cornea more steep). And, on top of that they discovered that I most likely have keratoconus (thin cornea) and the surgeon said Lasik is unpredictable with that condition. If you don't have this condition and you don't need to increase myopia you may be fine with it. Normal practice is to predict residual astigmatism and correct it with a toric if it is expected to be 0.75 D or more.

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As far as my reading ability goes, I am 95% free of wearing eyeglasses. I keep a pair of +1.25 D OTC readers around, and perhaps use them once a week or so for very fine print. I don't need them for my iPhone or computer work, or paper documents. I also have a pair of prescription progressives that I keep to use when driving at night out in the country where it is dark. That is almost never as I don't often drive out of the city, and for city driving at night I don't use glasses. When I go out shopping or for dinner I don't bring reading or prescription glasses. I do just fine without them, and even in restaurants reading the menu in dim light. My wife has a distance set monofocal and often forgets her readers, so I end up reading the menu for her...

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I did consider the Eyhance, but not for long. They add about 0.35 D to the depth of focus. It is really not that significant. If I was going to use a Eyhance for the near eye, I would have asked to be left at -1.25 D compared to -1.50 D with a monofocal. It is next to a trivial difference. In Canada I am not aware of the Eyhance being available at no cost. I didn't consider it long enough to find out what the cost would be here. The price of an Eyhance is a line or so loss in distance vision, so I would only use it in the near eye, and not the distance eye.

Oh yes, your astigmatism is definitely more complicated. Glad you found a good work-around.

I just went off on another tangent and started looking at the newer Apthera IC8 lens which is made for monovision use with a monofocal lens in the dominant eye, and offers significantly better reading vision. As long as there's no predisposition for retina problems, it sounds like it could be a game-changer. I don't know if my doctor has implanted any yet, but one doctor interviewed said there was no special trick to it. I couldn't find any comments from patients though.

Yes, I am aware of the IC-8 and briefly investigated it. The popularity of it does not still seem to be very high. As I understand it the principle is like a pinhole camera. It increases depth of focus by restricting the light. It would seem to me that it may not be the best in dimmer light when the pupil opens up. I don't recall anyone here actually going ahead with implanting it and reporting on it.

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If you want to investigate other lenses for monovision you could also look at the B+L enVista. It has an increased depth of focus and is probably quite similar in that respect to the Eyhance. It claims to be more tolerant of less than perfect eyes. Like the Eyhance it compromises some distance vision to get the increase.

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Another lens that has been specifically designed for monovision is the RayOne EMV from Rayner. The EMV stands for enhanced monovision. It gives a small boost of vision to the left of the standard peak vision point. This is of no value in the distance eye, but it does help a little bit when it is set to a closer value like -1.5 D for the close eye. I have looked at it, but I am not sure the increase is really that significant. It may also be hard to find a surgeon that will use it.

That's true, that as we age, something unforeseen could happen to one eye. An injury? A sudden loss of vision? A progressive loss of vision? That was one reason, albeit a minor reason, I chose binocular vision.

Interesting feedback about negative possible outcome with advanced aging and monovision. Never thought of that.

Since you have AMD, which is progressive, I would think having binocular vision might be a key consideration for you.

Keep in mind that prescription glasses are always a plan B. They tend to be easier to prescribe with monofocals as compared to EDOF lenses. And they are just as easy to prescribe when there is a monovision split between the eyes. When you consider that glasses are a backup issue, it is really a non issue.

I really don´t want to rain on your preference for monofocals.

But tell me how prescription glasses would help on an eye, that is failing in the future due to other reasons than refraction error.

Glasses won't help an eye that has gone blind of course. But, my point is that the world has not come to an end if you can't go eyeglasses free. You just get eyeglasses. It is nice to be eyeglasses free, but far from essential.

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My wife is essentially blind in one eye and when we were selecting an IOL for her only eye with vision we considered a PanOptix and Vivity. Cost was not a consideration. When she looked at the risks with those lenses and considered that it was her only eye, she selected a monofocal set for distance. She now needs reading glasses or progressives which she has but almost never wears. If her only eye was -1.5 D for example that would be quite OK too. She would read and see most intermediate things without glasses but would need glasses for distance.

Yep, you´re right, when you´re willing to use glasses on and off all day, or use progressives.

But for me though, EDOFs are a nice balanced compromise between multifocals and monofocals, presumed there are no drastic surgery outcome surprises.

And later, in very old age, i think i would prefer better functionality over the advantages of a monofocal.

I have no info. on that. Can you elaborate? That could be a key point?

For sure putting glasses on and off all day is an annoyance. I don't like that much, which is why I chose mini-monovision with monofocals. I almost never use glasses. I often use the computer at 14" or so and watch TV at 12 feet away at the same time, and can do it all with no glasses.

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But on the other hand I wore progressives for decades and managed.

I get it. Interesting! I know you chose binocular intermediate which I was supposed to do originally. This is now something new to review.

If you were to choose straight binocular with a basic monofocal what do you feel would be the best choice given that you of course would have to wear glasses. I wonder about -01? Someone in a past discussion actually chose that for binocular.

How did you end up with good distance vision (I assume you pass the driver's test) if you went intermediate binocular at -01.5 possibly? I believe you had something unusual occur during surgery possibly that rendered both good near and distance vision? That may not apply to others, however? Thanks!

Spring,

This is how Ron explained how it worked out for me as it did in a private message. It was related to my uncorrected astigmatism, which actually helped me to see better after cataract surgery. My situation was unique

"Astigmatism is tricky. Think of your eye as a pie cut into 4 pieces. Now look at two diagonally opposite pieces, and consider them set for more distance, while the other two pieces of pie diagonally opposite are set for nearer vision. The pie overall in your case is set for intermediate distance on average, but the individual segments are set for nearer and further. If, and it is a really big IF, you brain can make sense of those different focus images and put them together then you have a wide range of vision. It sounds like you can."

Spring I am going to send you a message

If you mean -1.0 in both eyes that would give you about 20/40 for distance. That is on the borderline for not qualifying for a driving license without glasses. Close vision would start to become difficult at 15-18" or so without readers.

Thank you. I do like many things about the Vivity for monovision. How has your reading vision been so far? Did your doctor use ORA as a final check during surgery?

I don´t know if he used ORA, but it seems to be a great additional tool for surgeons to get closer to targets, which is essential. It´s amazing to read here in the forum, how often surgeons just don´t manage to hit target refraction outcomes.

But in my case he had the help of numbers and outcome of my Panoptix to compare, as i had an explantation of bilateral Panoptix in favor of inserting bilateral Vivity in mini-mono setup, resulting in plano for the dominant right eye, and -0.5D outcome for the left, nondominant eye.

Take a look at my posts in the other thread called "IOL explantation" and my actual outcomes.

With mini-mono Vivity, i have now a very natural feeling range from perfect distance down to ~ 30 cm near vision, needing only glasses for the absolute tiniest of print, so basically free of glasses.

No halos at all, but a slight contrast weakness in very dim light situations.

A breeze, compared to the horror "lightshow" of my earlier Panoptix, with which i could not read computer and smartphone very well, because there were always shadows/double images around letters, which drove me crazy.

But there are many people being happy with their Panoptix, so you just can´t know for sure, prior to the surgery. At least, people should always wait with inserting their second multifocal IOL, until the first eye has settled, and see if it´s really working for them.

Anyways, reading my smartphone is now a pleasure with Vivity, but only because we had hit targets perfectly.

@karbonbee here has had both eyes done with ORA in the past week, and could probably comment on it. Your can find a very detailed post on how it went.

-1.0 doesn't sound very good for me. I think mini mono of -0.50 LE and -1.25 could be good or -0.75 LE and 1.5 RE might work.

Binocular vision might be good for AMD as one eye could become weaker than the other. Possible a mini-mono like -0.75 LE and -01.25 might be a lighter mini-mono rather than straight binocular? Do you have any suggestions for straight binocular or a lighter form of it?

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In the short term it is really what you want to see without glasses. If you do a mini or micro monovision you will see a wider range of distances. If you do unfortunately lose vision in one eye I am not sure it really makes that much difference if you are left with close vision, distance vision, or intermediate vision in the remaining eye. You just deal with the outcome with glasses. I still think blue light filtering is a zero cost way of reducing the chances of losing vision over the long term. There is no down side to doing it, as there is no upside to a clear lens.

I was thinking that also....would have to correct the remaining eye with glasses as it is rather hard to go binocular. A smaller gap between eyes could work also.

I now would like -0.50 LE and -1.25 RE.I guess doctor will have to re-order lens since she ordered -0.27 LE already. -027 LE would be fine with me if the -1 gap between eyes would not be too risky. Chances are it will work for me but have not tested it so unsure. Thanks Again.

As I said in another post if your choice is -0.27 D or the next step in powers, it will be -0.65 D. There is no -0.5 D choice. If it were me I would choose -0.27 D to get better distance and have some assurance that I could get a driving license without glasses.

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If you want to reduce the differential between the eyes, it is probably better to do it with the close eye, rather than the distance eye. You can make up for that by resolving that you may have to use readers more often. But, don't make that decision now. Wait until you see what you get with the first eye. If you end up with -0.5 D then you can go for closer vision with the near eye. Keep in mind these are only projected outcomes at this point. The real measure is when you go to an optometrist at 6 weeks post surgery.

Re: "instead of Eyehance or Monofocals, which require a huge difference between both eyes for the monovision setup, to achieve reading range"

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I just had both eyes done almost two weeks ago (only two days apart due to my extremely high myopia -- -13.00 D and -12.50 D) using the Eyhance with mini-monovision, and the difference between both eyes ended up at only 0.85. I targeted -1.25 D for my non dominant eye and according to the ORA results, the surgeon thinks he hit -1.21 D. I targeted -0.5D for my dominant eye -- the surgeon thinks he hit -0.36D with that one. My blended vision is amazing! I'm not aware at all which eye is doing what, they're working together so well. Sharp vision with both of them from about 13" out to infinity. Granted it might change but my outcomes so far have been great. My non dominant eye two days after surgery checked out at 20/25, though it dropped to 20/30 by the third day, but seems to be staying around there, maybe a just a little less two weeks later. The dominant eye checked out at 20/20 the next day, and looks to be staying there. With the "near" eye, my near vision is really good, reading my phone (6" screen) easily at around 12" (even in a completely dark room with screen brightness reduced to minimum), and my laptop screen (15" screen) is sharp and clear from about 18" to 36". I've been reducing the font sizes and zoom levels on all of my tech. It's the intermediate vision though in the "near" eye that freaks me out cos it's so weirdly excellent -- the small print on small pill bottles is sharp and clear at 22" to 30", even in dim light by a 40-watt bulb behind me -- in many ways it's far better than the near vision is. Intermediate with the dominant eye, is decent from about 38" out. I've only used cheap readers a couple of times to read some really tiny print on things like a movie ticket. Other than that, I'm glasses free til further notice, lol.

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Colours are bright and true, and contrast in general is excellent even in dim and dark areas. I've had no problems with driving down dark backroads on moon-less nights. No halos, etc. There's a bit of glare around headlights coming toward me at a distance, but they pretty much resolve themselves as they get closer and in general they're not bothersome at all. And even that should disappear when my eyes have had more time to heal. Interestingly enough, I now find myself less bothered by cars approaching (or following) that have their bright lights on than I was before. I can also see the stars clearly before the moon rises, or without any other backlighting needed.

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I chose the Eyhance after months and months of research and asking questions because of what that little bit of unofficial EDOF it has provides, without sacrificing distance vision. Because of it, I didn't have to target much myopia in order to get good results in all areas. Yet like monofocals, it isn't prone to visual positive dysphotopsia side effects. I initially was interested in the Vivity, but backed off after reading multiple complaints of loss of contrast in dimmer lighting situations. I also read results from people not being able to see the moon, or the stars in the sky, clearly unless there was some sort of "backlight" around from street lights and such. I did not want to take a chance of that happening to me as I'm a big night time person.