UPDATES + Preliminary verdict on Mini Mono-Vision.
Posted , 16 users are following.
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!
5 likes, 86 replies
W-H
Posted
UPDATE-
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My situation-
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So today I visited Dr Angel for 3rd OCT scan of my retina since my wife was diagnosed with cataract 5+ months ago. The tiny fluid build up behind my retina right next to the Macula but not on it continues to exist but has not got bigger or smaller. My vision continues to be perfect 160% /20/12.5 so there is not much that needs to be done but hope that stress from my wife's cataract related stuff starts to ease and improves my condition. She sees direct connection between my wife's cataract related stress and my situation. I asked her if my condition possibly could have existed from before. Dr Angel does not think so. She said that if it was older, she would see scars etc, my situation is an "active" situation as fluid is being fed in there etc. Have to go back in half a year now.
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My wife's situation-
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Dr Angel is the emergency eye doc who originally diagnosed my wife's cataract, I asked her if she could look at my wife's cornea too. Dr Angel has previous cataract (+ YAG) related surgery experience too so not just a vanilla ophthalmologist.
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Dr Zeiss our surgeon has been very good to us but I wanted a second opinion from Dr Angel.
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Just to refresh you guys....my wife's Mini-Monovision, left/near eye is at -1.75 (perfect vision).
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Right/far eye is at -0.25. Right eye gives her far sharp vision but not consistently. She see sharp always until 4-6m but beyond it gets blurry. Even though on Snellen chart she reads 20/16 or better consistently. When she puts dry eye drops she sees very far sharp outside too but for few seconds/minutes only. Sometimes for 1 day too but then not for next few days.
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On our last visit to Dr Zeiss (1+ weeks ago), he said that slight cornea erosion of one side of her right eye could be the cause so put her on 1 drop of Dexa-free steroid before bed for 2 months!
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Dr Angel checked my wife's eye and cornea today, very thoroughly. She sees no sign of any erosion at present. Everything looks perfect on the back of the eye. The IOL is perfect and she said that Dr Zeiss did a great job. She just does not see any reason to continue with 1 daily drop of Dexafree steroid and that also for 2 months (Dexafree recommended dosage is for 14 days max on the bottle). What she does see though is EXTREMELY dry eyes! She did dry eye strip test and said that the tear film break in under ❤️ seconds, normal is greater than >10 seconds I think. She sees no reason why my wife won't be able to see far sharp. She has given us new dryness related stuff to use.
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She said that if you don't want to stop taking one drop of Dexafree steroid before bed like Dr Zeiss suggested then you could continue to take it and 10 mins later put the med that she gave us.
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We have to take her eye gel stuff every hour consistently and another cream when she sleeps. Hoping that is all resolves soon! Dr Angel said that the cornea has been through a lot so it takes time to heal sometimes. I feel bit relieved but until things get normal I am not jumping for joy yet!
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She sees no relevant signs of PCO either or any reason to YAG anytime soon. She also said not to worry about YAG as in the hand of an experienced operator it is nothing to fear. In the hand of an inexperience operator there could be damage to the cornea, retina and IOL. When she used to operate she used to do the circular YAG and not the X (cross) version.
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I have to say Dr Angel is a perfect balance of good listener + professionally very competent + thorough examiner + empathetic. I rarely see that combination in a Doc.
W-H
Posted
The heart sign = under 3 seconds. This forum is weird!!!!!! lol Let me type again-
Guest W-H
Posted
Oh, now I am seeing the full picture, you actually need to buy that Triumph to get rid of your stress, you just haven´t realized it yet 😃
It is never easy when two doctors says different things, but in any case I guess your wife will be fine when time passes and whatever it is heals up. Maybe she should buy a Triumph as well, so you both can get all that eye stuff related stress out of your heads 😃
ara21947 W-H
Posted
Wait. Are you saying you have an issue as well? I had no idea since you were posting so often about your wife that anything else was happening.
I do hope all is well with you and yes, you need to get that car or whatever to help with stress 😃
ara21947
Posted
why are things cut off on this format? Re-try
Im trying to say do what you need to help resolve your own stress. Your wife sounds like she is doing fine.
W-H ara21947
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Yes Ara I got an issue with my left eye as a direct result of my wife getting diagnosed with cataract. I have small fluid build up behind my retina directly next to the Macula. I got diagnosed with it few weeks after my wife's initial cataract diagnosis.
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Stress hormones released by the body can cause it and Dr thinks it is directly related to my wife's situation as I don't have any other stress in my life.
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The headache of choosing IOL, surgeon while wife almost went blind in short span of 3 months for eyes that never required glasses in 42 years did not help matters.
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Then stress kept coming due to wife having reaction in both eyes during/after operation. She took lot longer to see... the "new normal" .
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So since July it has been constant stress. I have zero control over what I feel when it comes to anything to do with my wife. We have been 20 years together and everyone says that they have never seen a couple so devoted to each other lol Life can be funnily cruel, she got cataract diagnosis right before our 20 year relationship anniversary! I had booked 1 week in the mountains and she was seeing everything blurry for first 3 days. Anyway hopefully stress goes now and my body re-absorbs the fluid.
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W-H Guest
Posted
Funny 😃
Dr Angel has been on the money consistently though. She told my wife at the initial Cataract diagnosis that wife needs to operate both eyes within 3 months or she won't see much or anything. Any that is exactly what happened. Contrary to what Dr Career had said, "Right eye will be perfectly fine for 1+ years" lol
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Dr Angel's meds are working magic right now. Wife is consistently seeing far now for last 2-3 days since the visit. So it is looking the most promising it has looked. If Dr Angel's verdict that wife will see far sharp normally materializes, then my wife's vision will be perfect and virtually equal to her pre cataract vision. Maybe even better as presbyopia won't be kicking in ever. Hope these drops give the space my wife's cornea needs to heal.
ara21947 W-H
Posted
That is fascinating to me on several levels. Ive been involved with medicine for many years and truely understand how stress plays an enormous factor or at least the mind does. There is so much we can (and also so much we cant) control about our own selves with the mind. You have been incredibly devoted and it took me awhile to understand you were writing about another person and not your self on this site.
I too had a cataract come on very quickly becoming legally blind in my right eye (tho I wore glasses for distance) so I know how scary that is. This whole cataract and IOL stuff is very scary frankly.
Please take good care of yourself now that your fears have subsided. Im sure you know about breath work and meditation. Im sending warm thoughts and good energy to you.
ara21947
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ugh what is it with this site???? I wont blab on but send you warmest thoughts and best energy. Im so sorry the thoughtful reply I sent got screwed up
Deb03 W-H
Posted
I am sorry to hear that you are still experiencing fluid build-up. Regarding your wife and her vision, I have a question. When her vision is sharp in the distance, does she lose any range in the intermediate/near? I have noticed that to be the case with mine. It seems to fluctuate about .25 diopters. So if intermediate/near is better than my far is worse and vice versa. I asked retina specialist about it and he wasn't surprised. He said it could be from the cornea healing - swelling I believe.
W-H Deb03
Posted
No, when she sees far sharp it does not come at the expense of closer vision. Her issue seems to be purely cornea surface/ tear film related and I assume not cornea swelling related.
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Hope it turns out eventually ok for my wife and you too! Both of you have been very patient.
DonDiopter W-H
Edited
Hi W-H,
Just wondering how things are going with your wife's Mini-Monovision procedure and what if anything has changed?
I have to see Dr Genial again soon who is now back from his holiday and I will have to make a decision on which IOL option to choose ?
Look forward to hearing from you?
Kind regards,
DonD
W-H DonDiopter
Posted
Hi DonD and everyone on the forum. Hope you all had a good start to 2020. Sorry I did not respond to your post earlier as I don't visit here much (trying to get on with life). Just saw the email saying that I had a private message from you, so here I am...
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Here is the situation with my wife post OP, 4 something months for left near eye and 3 something months for right far eye.
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Right eye settled on -0.25 (exactly as the intended target)
Left eye finally settled on -1.50 (target was -1.25)
PCO- No post OP growth so far.
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As far as Mini-Monovision, wife is 100% satisfied/happy with the choice.
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My wife's biggest and only problem has been eye dryness caused by reaction to drops/OP disinfectant/cornea erosion etc. Dryness/tear film fast breakage causes her far eye vision to fluctuate. Some days/week she sees very far very good some days not so good.
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Recently very far vision has started to continuously stay good. I think it is a matter of time. Wife sees far away mountains very good currently. My research shows that in stubborn post OP dry eye cases it can take few months to a year for dryness to go away (assuming one did not have dryness issues before the OP). So we are continuing to use dryness gel at bed time and dryness drops during the day to help the healing.
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So in conclusion, wife functions very well and has no glasses or contact lenses. Near vision is super perfect, TV, PC, phone, Laptop, fitness classes that she gives...all perfect.
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Contact lens to make far eye plano will further improve her very far vision if she ever feels like getting them.
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My advice, Go for plano for far eye but if it overshoots then you might end up having soft areas in the mid range, depending on the diopter difference between the two eyes.
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Just do what my wife did. Hope that helps.
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Plano in one eye and -1.5 in the other eye I think is the perfect spot in general if you can hit it.
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P.S- Wife has no halo, glare etc either.
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P.S-2- Just pulled out eye test chart for you after putting it away many weeks ago. Wife could see 2 lines below 20/20 and see it very sharp. I think it is 20/12.5.
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Good luck.
soks W-H
Edited
congratulations on moving on and great news on the PCO!
DonDiopter W-H
Posted
Hi W-H,
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Thank you so much for your update and information. Very glad to know your wife had such a good outcome too! It also sets my mind at ease and I believe confirms that MMV is the right decision for me as well!
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As mentioned I'll be seeing my 4th ophthalmologist Dr Genial again this week after seeing Dr Duo (his colleague) just before Xmas for a second opinion and who had the Oculentis Comfort implanted in him by Dr Genial! I will still be telling him my preference is MMV,
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I'll also ask him about the likelihood of incurring dry eye/s after surgery and the type of drops he uses during the procedure etc. I know for sure he utilises anaesthetic spray instead of injection which I believe is a good thing.
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Based on your experience I'll be requesting optimal MMV targets of plano in left (dominant) and -1.75 in right but I'm sure he'll want to set the targets at least -.25 less to provide some tolerance in case he over shoots on the lens placement etc.
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Thanks again for all your help and assistance with this quite complex matter and decision as well as the information on navigating and understanding the very different and sometimes contradictory advice optical clinicians provide!
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Anyway, time to move forward and get my right eye done to start with, so I can start seeing the world clearly again! 😃
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Kind regards,
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DonD
W-H DonDiopter
Posted
The outcome is good but could have been better without all the drama but that was not mini mono vision related. Wife has been through psychological hell since the OP. I wish it had gone smoothly like it is apparently supposed to go for most normal people. That is life, you got to take the sweet with the bitter. She sees good and is not blind which is a technological miracle! Only 1-2 life time ago she would have been blind at only 42! Just even the thought of that kills me!
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Sounds good but keep in mind that potentially you could end up +.5 in far eye and -2.25 in the near eye. During early healing stage my wife had much greater difference between the eyes (2.75 to 3 diopter difference) and her brain could handle it but with some mild soft areas in the mid range. For someone who can't handle the difference could be a nightmare.
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Maybe go for -1.5 and plano or -1.75 and plano or -1.75 and -0.25 😃 Tough decison!
Even with benefit of hindsight I would not know what we would pick if we had to choose again as no target is 100% guaranteed!!!
W-H soks
Posted
Thanks. Did you operate?
Sue.An2 W-H
Edited
thanks for the update. Glad all is well with your wife. Glad she is able to move on and enjoy life after cataracts. All the best.