Very interesting ophthalmologist views

My surgeon's views were very different.

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1. Yes, there are some theoretical benefits from using EDOF lenses with monovision. I carefully reviewed it all and concluded that what really made sense was to use a monofocal in the distance eye to get the best distance vision especially at night. The EDOF I considered was the Vivity and it gains about 0.6 D in depth of focus. But, there is a hit to the peak visual acuity and a big hit to the contrast sensitivity. Google Vivity Patient Insert PDF. My plan was to use it only in the near eye to get the extra depth of focus and to take advantage of that to target it at -1.0 instead of -1.50 D. The theory was that the monofocal would give me the distance and night vision contrast sensitivity to make up for the loss in the Vivity eye. And targeting -1.0 instead of -1.5 would close the gap between the two lenses for intermediate vision without giving up any near vision due to the EDOF of 0.60 D. My surgeon disagreed. He said he had another patient that had considered similar and had higher expectations for vision. This patient was disappointed with the Vivity outcome. He thought I was similar in expectations and I would be disappointed too. He recommended a monofocal in both eyes, and that is what I did. As it turned out there is no intermediate vision gap, and I can see the whole range of vision from about 8" on a computer monitor to the moon.
2. This statement of targeting hyperopia convinced me that this surgeon is incompetent. Nobody that is at all informed does that. I had a power option to get me very close to 0.0 D and my surgeon recommended I go to the next step more myopic which was about -0.375, which is where I ended up, and still have 20/20+ vision in this eye. He said that outcomes are not always predictable and nobody ever thanks him for leaving them hyperopic. Being hyperopic means a loss in distance vision and a loss in near vision. The near vision in the distance eye helps close the intermediate gap. And if you end up at -0.25 D in the distance eye you can target as much as -1.75 D in the near eye to get better near vision without exceeding the recommended maximum anisometropia guideline of 1.50 D.
3. Benefits from blue light filtering are controversial. Using blue light filtering is the "do no harm" option as the Alcon lenses use it to restore the colour balance of a young person's natural eye. Clear lenses expose the eye to a much higher level of blue light than the retina has ever seen in your lifetime. What I find is that surgeons that use Alcon lenses use the blue light filtering option because Alcon has it. Surgeons that are in bed with J&J use clear lenses and of course recommend them. Until very recently J&J had no blue light filtering option. Not sure if it was a patent issue or what but they have now come out with an OptiBlue option on some lenses. I think it is slightly different in filtering with more of bias to violet, but I suspect that may be due to patent infringement avoidance. Just a guess.

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   This said I think a case can be made, particularly in younger patients to use a hybrid mini-monovision with an EDOF in the near eye, if one can accept the optical risks associated with the EDOF technology. A younger person typically has larger pupils and at least until they get older do not benefit from the pinhole effect of smaller pupils which adds to the useable depth of focus. The article below talks about using hybrid monovision in younger patients with good success. This article convinced me it was worth considering, and I was going to do it, right up until the surgeon discouraged me.

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   Clinics in Surgery 2018 | Volume 3 | Article 2027

   Monovision Strategies: Our Experience and Approach on

   Pseudophakic Monovision Published: 16 Jul, 2018

   Misae Ito CO* and Kimiya Shimizu

I agree with you except for #2 above. Your surgeon must have had a reason to give you more myopia. He probably sensed that is what you wanted.

Not correct. At that time with my first eye procedure which is over 3 years ago, I was very naive about the complexity and reality of cataract surgery. If my surgeon had recommended targeting 0.0 D I probably would have be ecstatic, because I did not know any better. It was the surgeon that recommended going one step down into slight myopia. He very bluntly said it would be perfect if he could give me assurance that 0.0 D is what he could achieve, but that was not his experience, and followed that with "when I miss and leave the patient far sighted they never thank me for it".

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The reality is that even with the best IOL Calculation formulas you are only in the 90% range of hitting +/- 0.5 D of the target with non complicated eyes. You can probably tolerate being left at +0.25, but +0.50 or in the case of this surgeon's recommendation at +0.65 is bad. Even with LAL which is said to have +/- 0.25 accuracy one would not target hyperopia. Targeting hyperopia in the distance eye is nothing less than incompetence.

The target is for the near eye, not the distance eye. To gain more near vision, the D power is increased. It was in my case.

Sorry, I don't follow that. Targeting hyperopia in the near eye makes less than zero sense even if the lens is an EDOF.

My guess is that the surgeon targets each eye so that combined effect of both eyes working together is up to +.15. How the surgeon targets each eye, and adjusts the power for the second eye surgery based on the outcome of the first one, is a technique known to the surgeon. EDOF hybrid monovision is likely more forgiving of small misses.

I don't believe his theory about hyperopia. There is nothing good about hyperopia. A natural lens can deal with hyperopia, but a non accommodating IOL cannot.

"At that time with my first eye procedure which is over 3 years ago, I was very naive about the complexity and reality of cataract surgery."

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I'm trying to picture that naive, innocent, doe-eyed RonAKA of three years ago.

Nope, can't see it.

😉

Could be partly due to accommodation, but my guess is it's mostly because I got my monovision young (LASIK) and the anisometropia later increased gradually over several years (due to a recent cataract), so I had a long time to become accustomed to it.

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Maybe not hyperopia, per se, but focusing closer than your natural focal length, which I suppose you do all the time if you are hyperopic. It's news to me also, but I do see this in a textbook called Clinical Methods: Both pupils constrict when the eye is focused on a near object (accommodative response).

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I haven't looked at the research yet in any detail, but it did start me thinking. I don't need cataract surgery on my distance eye, but if/when I do, maybe I should go for plano, rather than leaving a small amount of myopia for conservatism.

i set both eyes for slight myopia because i have been a lifelong myope. that too with multifocal lenses interested in pupil constriction because i see lens edge glare arc with one eye. also the large pupil increases astigmatism at night.

"hyperopia constricts pupils?"

Sounds more like wishful thinking that fact to me.

i wish for my pupils to be 1mm smaller at all times!!

Don't worry. Father time will make you dreams come true!