UPDATES + Preliminary verdict on Mini Mono-Vision.

20th Nov. 2019.

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I have got few PMs about people wanting to go with the same mini monovision choice as my wife. Instead of replying privately I thought it would be more beneficial posting here to help others in the future. This thread and updated opinion supersedes everything I might have said in any previous thread!!!!

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Lens Used: Zeiss Asphina 509 Aspheric Monofocal (non Toric as astigmatism was negligible -.25 and -.50)

Surgeon used: Dr Zeiss (I love giving nicknames)

Rejected Surgeons: Dr Headstand, Dr Rockstar, Dr Career and Dr Oldstar (did not meet him though).

Left Eye operated: End of September 2019

Right Eye Operated: End of October 2019

Left eye target was:-1.25

Right Eye target was: -0.25 (dominant eye)

Time between first sign/diagnosis of Posterior Subcapsular Cataract and going virtually blind: 3-4 months!!!!!!!!

Wife: Early 40s, extremely active and had perfect vision without glasses (although cataract probably started forming 1+ year ago and we were just not aware)

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Question 1- Why did we pick those targets?

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Answer 1- Without benefit of hindsight. After days/weeks/months of torture the conclusion was that an error of 0.5 diopter could occur in either direction. Could be more if you end up unlucky or lucky depending on final results. So -0.25 far eye could end up anywhere from -0.75 to +0.25 and the near -1.25 eye could end up anywhere from -1.75 to -0.75.

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We were tempted to go with -1.65 for near eye but it seemed too risky in case it ended up at -2.15 or more and if the far eye went in opposite direction and ended at +0.25. That would have been a potential difference of 2.75 diopter!!!! Greater than 1.5 diopter difference is considered risky as lot of people can't adapt to it. Also the blend zone between the two eyes decreases.

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My wife had never worn glasses so we had no clue what it all meant in real world scenario. We could not even test anything realistically as her cataract progressed so fast! So -1.25 & -0.25 = difference of 1 Diopter seemed like a safer choice. We could have gone even more safe, for example both eyes to -0.25 or micro mini monovision.

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Question 2- Why did we pick Zeiss Asphina IOL?

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Answer 2- Well Zeiss is reputable brand and synonymous with quality and has been around for long time. I knew them from their excellent camera lenses. Then the surgeon we picked, Dr Zeiss recommended them and uses them. The only thing holding me back was that it apparently does not prevent PCO. Dr Zeiss said that as most patients specially young patients will get PCO irrespective of lens choice so that should not even be a factor. Also I saw online that people who went with anti PCO marketed IOLs still got it super fast and in addition had more issue from the anti PCO IOL sharp square edge causing glare etc.

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The Zeiss square haptic was appealing too. More stable and with less exposed edges. Also it seems to have less issues with glistening. The pure Acrylic hydro phobic IOLs seem to have more glistening related issues and I think micro cracks when injected. Zeiss has hydrophobic surface coating only but internally it is hopefully less prone to vision effecting glistening etc. Fingers crossed for next 50 years! lol

Dr Zeiss said that since he switched 100% to Zeiss IOLs his refractive error surprises have virtually disappeared.

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Question 3: Why did you not go with Multifocal IOLs?

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Answer 3: It was NOT an easy decision but with benefit of hindsight it seems to have been the right decision FOR US! Our research and logical analysis pointed us to mini-monovision. Towards the end emotion and fear played a part and we were tempted towards At Lisa Trifocal. Specially when a user here scared us by saying that my poor wife won't be able to see her face/food/read and be permanently dependent on glasses. Luckily calm head prevailed and Dr Zeiss also said to go with Mini-Monovision even though he is expert at installing AT Lisa/AT Lara and would have made $5000 more.

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EDOF we rejected as Dr Zeiss said that the results he was getting with them he had been getting with Monofocals for 10+ years. Initially he had got taken in with EDOF marketing and their lab test results.

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Other surgeons said same. If you want highest quality vision then don't go with EDOF/Trifocal etc.

-Monofocals more future proof to future eye health issues. We had to think about next 50 years and not just short term of next few years.

-Monofocals have possibility of add on lenses if required. Constantly evolving tech. Add on lenses much easier to add and replace.

-Monofocals still have option to use Multifocal contact lenses if required.

-Monofocals have less side effects.

-Mini Monovision adaption time few days to couple of weeks unlike months or never with multifocals.

-Monofocals have way less contrast loss.

-Monofocals require less brain gymnastics.

-Monofocals have better low light vision.

-Monofocals have no rings constantly or semi constantly visible.

-Mulifocals have no guarantee of being glasses free without add on Lasik surgery.

-We did not want to touch the cornea for corrective Lasik surgery.

-You can end up glasses free with mini monovison too and that was our aim as we are a very active couple. It seems like wife will be glasses free as things stand. For us using glasses was not end of the world anyway. Only for sports it would have been complicated but already she is doing sports without glasses.

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Question 4 - Finally, where did you end up and what are your real life results.

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Answer 4-

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Left Near Eye:

Near eye seems to have ended up at -1.75 ( to be confirmed at next appointment). It seems to have stayed stable there since day 7 (today is day 54). With benefit of hind sight, if we had hit the target of -1.25 then wife would definitely not have been happy as reading etc without glasses would have been an issue. So we got lucky for once!!!

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My wife currently requires no glasses for PC, mobile phone, laptop, writing reading, eating, cooking, watching TV....she can see herself super sharp in the mirror too. She has been working 8+ hours a day for last 1 month at the office without requiring any glasses. No headaches either although she did have it for first few days when brain was adapting.

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She can read J1 in all real life lighting conditions. Sweet spot is at 45cm/17in but can read at 35cm/13in too . Usable vision 35cm/13in to 2.5m/98in. For example she can see electronic alarm clock in the bedroom 2.5m /98in away. I feel anything closer than 30cm/11in is wasted diopter so the lowest I would ever go with near eye is -2.0. You do risk then ending up at -2.5.

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Far Right Eye:

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Far eye was targeted for -0.25. This eye has taken or is still taking lot longer to heal unlike the left eye. We don't know where it has landed. We entered week #4 now (Day 26) so still not fully stable as we have to wait 6 weeks. We are seeing Dr Zeiss end of this month so will know the real number. The reading we had were +0.25 then -0.25 but these are very old readings. So we could be at -0.75 or -0.5 or even -0.25 currently. No clue!

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On Snellen Eye test chart she now seems to have 20/20 in lock down (1.0). Yesterday she was hitting perfectly two lines below the 20/20 line, I think line No.10 is 20/12.5(1.6). With this far eye she can read close too!!!! J1 at 60cm/23in. Can read even closer than that but sharpness decreases.

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So it is difficult to guess where she is currently. Her really far vision is not always super sharp yet, it keeps changing from one day to the next. Drops make it super sharp. So could be healing and dry eyes related. The swing is getting narrower though. It is amazing that she started at 20/200 after OP!!!!! Took 3 weeks to get to 20/20 and looks like maybe some more healing still to come!

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Side Note-

At one point my wife's near eye was at -2.0 and far eye at +0.25. So a difference of 2.25 Diopters. She loved that too and we could not detect any loss of binocularity in real world usage. Obviously someone else in similar situation might not have been able to adapt. Psychologically it was scary knowing that the difference was 2.25 though.

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PCO status-

Left eye 1 day post OP- Had remnants of lens cells. I guess polishing the capsule more would have been risky for that capsule. Intact capsule is very important for younger active patients.

Right eye 1 day post OP- Capsule was crystal clear.

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IOL Edge issues-

No lens issues as such. My wife's left pupil at 6.25mm is larger than the IOL middle part at 6mm. In very dark situations when pupil is fully dialated she sometimes can see slight IOL edge. She kind of enjoys it and says that the Zeiss Asphina is saying HELLO to her 😃 When we walk on a dark street she always say "Come on Asphina, say hello or are you going to be shy again and hide" lol

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No glare, starburst , halo or edge light bounce issues though.

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Recovery-

This varies a lot too so don't panic! To fully know if the surgery was successful you need to wait 6 weeks.

My wife's first eye took 1 week to be stable despite severe reaction to the disinfectant plus steroid drops. 2nd eye took 3 weeks to get to 20/20 or better vision and still healing even though the reaction was lot less.

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Overall Conclusion-

Do your research and pick a good surgeon. Follow up care can end up being very important. Dr Zeiss despite being super busy ended up exchanging 17 emails with us and some include funny comments at a time when we were in panic mode! lol

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He replied within one day to us and 15 of those mails were within 3-4 hours!!!!! In comparison Dr Rockstar took 9 days to answer a simple question. Also most surgeons here operate and then pass you on to someone else, kind of washing their hands off you. Dr Zeiss on the other hand even contacted us twice to check up on our progress.

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Anyway take everything I have written or what anyone else tells you online with a pinch of salt. Don't let people's personal bias and mental issues swing your decision or scare you.

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Also some people online are too attached to their IOL and take any valid crit of their IOL as a personal attack. Results can also be very subjective, one person's excellent vision can equate to average vision for someone else.

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Mini-Monovison is not an answer for everyone. Maybe At Lisa would have given us even better results. I am not close minded to think that our way or the IOL brand/choice was the best way. We don't know and it is something no one can know. If the far vision gets even more sharp then it would be a 100% perfect result. As things stand it is already a very good result, we take the results we got with open arms. The fact that it seems to be glasses free is a very welcome bonus.

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My personal recommendation for what it is worth, go with Mini Monovison using quality Aspheric Monofocals followed by latest generation Trifocals. Where you target it is something you will have to decide for yourself plus with your surgeon. No two eyes are the same. Even the two eyes on the same person are not same lol

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**GOOD LUCK!!!!! **

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I hope this info helps. I will update final numbers and eye condition news after seeing the surgeon in a week.

Lot of people helped me with their time, here and in other forums. THANK YOU!

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