Seeking Monovision - trying to finalize Rx for non-dominant eye after RX screw-up in dominant eye.
Posted , 5 users are following.
Greetings all - this is a great site with incredible resources!
Quickly, I had my dominant eye done on 1/21. I was initially thinking of the Vivity lens, but it turns out that my eyes couldn't work with it . I was uncomfortable with visual affects and loss of clarity with the PanOptix, so I went the single-vision route.
The screw-up was mutual - I wanted to be able to read my phone somehow, and so the Dr. suggested "reading distance". Sounded good. She said that would be about -3. I had no idea how to envision that, since I was about -10 or so. We went back and forth a bit, but ultimately, that's what she did. And the surgery went perfectly. But I can't stand needing glasses. I realized after the fact that it might have been OK for the non-dominant eye, but not the dominant eye, given that I was "choosing" something.
We realize now we both goofed. Her idea of reading distance (a book) and my idea of reading distance (a screen) were a bit off.
Her suggestion for the most straightforward/safest fix - correct the non-dominant eye at -1.75 to -2, and it becomes good for reading screens, and then look at Lasik on the dominant eye if I still want that. I've been using contact lenses in a monovision mode for about 15+ years, so this seems reasonable.
My main question now is the same as before - what's in focus with -1.75 to -2 vision? Is that about right for reading the phone at night, etc? I'd asked about using contacts to simulate, but she has been concerned that with the cataract still there, it doesn't give an accurate impression.
Thanks for any thoughts/suggestions!
0 likes, 13 replies
rwbil AHMDelaware
Edited
Uggg, how a doctor could recommend setting your dominate eye to -3 diopters is beyond me. I cannot understand or relate to that logic. Dominate eye IMHO should be set to plano or maybe -.25D. To me most of life occurs at distance. And distance vision will take you down to 3’ or so. They should have had a serious conversation with what -3D vision would mean before doing that.
My best advice would be:
2)If you are in the US, read US News & Report Top Ophthalmologist and if there is one even within a day’s drive from you go see them and get a 2nd opinion of all your options at this point. I personally would contact them first to get a rough idea of their thoughts and how they interact with you and then schedule an appointment.
Sue.An2 rwbil
Posted
couldn't agree more with you. I didn't have a big grasp of defocus curves but I do remember in discussing monofocals with my surgeon (as I was used to being near sighted all my life thinking that would be best) him discouraging that arrangement. He said targeting for .25 I would see far closer than I thought and really wearing readers far better than having yo need glasses every time I drove or watched TV or even seeing someone's face across s dining table in hos opinion far worse. In the end went with EDOF and happy with the decision. I think surgron's target best distance as the range of vision you get is far greater than targeting for reading distance.
AHMDelaware rwbil
Posted
I'll answer #2 first - my opthalmologist IS on the US News List for NJ. And I've been seeing her for about a dozen years, so I had no reason to doubt her recommendation. For some reason, she isn't a fan of monovision, even though I've done that for years with the contacts.
I'll do some investigation into the Defocus Curve - never heard of it. The lens I've got is the Alcon Clareon.
#2 is scheduled for this week, and I asked about putting it off, which puts me to about April 1 - and it's driving me crazy to have things crosseyed, especially this week, when I'm not supposed to wear my old contact lens. So I guess we'll see.
AHMDelaware Sue.An2
Posted
Would have loved EDOF (Vivity)! Sadly, wasn't a candidate. So it was either PanOptix or monovision IOLs.
rwbil AHMDelaware
Edited
Before you have the non-dominate eye set to -2D, I stick to my advice and that is get a 2nd opinion and maybe a 3rd.
There can be so many factors like other eye conditions that affecting the choices.
As for defocus curve. Typically done during clinical trials. This is where the doctor takes the time to determine a patients visual acuity after implantation. Now everyone results are different so many times it includes the standard deviation.
The defocus curve is not perfect but it will give you a rough idea of what your vision will be like for any individual IOL at all distances. Setting your best vision to - 3D, off the top of my head, is around 13 inches and things will get blurry very fast as you get further out. And -2D will be about 20 inches.
This means most things in life will be blurry. IMHO just looking across the table faces will be blurry.
My advice is just make 100% sure you have a good idea of your visual acuity based on your decision and that is 100% what you want to do.
RonAKA AHMDelaware
Posted
The Clareon is a new lens and you may not find defocus curves for it, but it is optically the same as the AcrySof IQ. Just google that and defocus curves, and search for images. You should find some. A couple of tips. LogMAR of 0.2 is considered the limit of good vision. To convert defocus position to distance divide 1 meter by the defocus number. -1.0 is 1 meter, -2.0 is 1/2 meter, and so on.
Bookwoman AHMDelaware
Edited
I had -2 monofocal lenses implanted in both eyes (although one wound up at -2.5) so I can tell you exactly what I see: computer distance (a desktop with a large screen) is perfect, as is reading a book, using my phone, etc. I can also do everything at home, in a slightly blurry fashion, without glasses except for watching TV. I was -8 in both eyes before the surgery and I'm still sometimes amazed, 2+ years later, at how good my vision is.
Good luck with whatever you decide to do!
AHMDelaware Bookwoman
Posted
Thank you! That sounds like the end result as I was initially expecting. What I ended up with couldn't see computer distance or much else beyond 12 inches with the first eye. Sounds like a big difference, in terms of end result!
So, your eye that's at -2, about how close can you focus?
I'll survive either way, but it would be good to be as comfy as possible with the plan.
Bookwoman AHMDelaware
Edited
Perfect focus is about 18", and I can still read comfortably at 12" and 24".
RonAKA AHMDelaware
Posted
That is an unfortunate mistake. I would suggest that the standard mini-monovision approach is to target -0.25 D in the dominant eye which is full distance. In the non dominant eye -1.25 D to -1.5 D is the normal target. A target of 1.5 D gives good vision down to about 1 foot and is suitable for computer screens, smart phones, and normal 10-12 point text on paper.
AHMDelaware RonAKA
Posted
You're right, it was. Didn't really know what to ask. To be fair, I was guided somewhat by my mother, but didn't quire recognized how that would turn out.
Thank you - I'll clarify with them tomorrow, and verify -1.5D, and then also ask about the net affect of the astigmatism (per the next comment).
RonAKA AHMDelaware
Posted
Another thing to consider is astigmatism. About 50% of the cylinder power contributes to the overall effective power. So for example if you expect an astigmatism cylinder value of -0.5 D, and want a total effective power of -1.5 D, the target for sphere should be -1.25 D.
AHMDelaware RonAKA
Posted
Interesting point about the astigmatism. I did have the -0.5 @82 degrees astigmatism (on top of -9.75 sphere) before the surgery, and ended up with -2.5 with -0.5 astigmatism (or -3.0 with +0.5).
The left eye, yet to be done, is -10.00 sphere plus -1.00 astigmatism correction.
I'll clarify with them tomorrow!