Distance/Distance or Intermediate/Distance

Based on the feedback here I made the decision to go with the AMO Technis acrylic IOL. I had my dominant eye (right eye) done on Wednesday. I am totally amazed at how much color clarity I had lost with cataracts. I thought my wife had on a yellow shirt when we went in for surgery. Later on that day I noticed that her shirt was actually white when viewed through the corrected eye. Wow!

My situation is a little different in that I had RK (8 cuts) about 15 years ago. My surgeon has cautioned me that it may take two weeks to two months for my eye to stabilize. My day after visit was about 1 line from the 20/20 with pin-hole being 20/20. It is much better than it was before and is even better than the left which was much stronger prior to surgery.

My problem is that I cannot get a good feel for the Intermediate vision with the corrected eye. I am going to have to tell the doctor whether I want to go with D/D or I/D. That is such an irrevocable decision. I have read a number of posts pro/con here, but most do not have the previous RK complication.

Consider the following vision tasks: Golfing, driving, computer work, photography, map reading, grocery shelf items, TV watching, magazine reading.

If I understand what I have been reading, D/D or I/D solutions should allow one to golf, drive and watch TV equally well without glasses?

The I/D solution would allow one to do the vision tasks of grocery shelf items and some computer work without glasses?

The I/D solution would require Rx readers (since the eyes are different) for map reading, magazine reading, long time and detailed computer work (to avoid eye fatigue)?

In comparison, the D/D solution would require readers (half glasses?) for medium to small print vision tasks (grocery shelf, computer work, map reading, magazine reading, and other detail vision tasks. However, these readers could most likely be inexpensive off the shelf varieties since both eyes are approximately the same?

I am not sure about photography. Cameras have diopter corrections for the view finder. However, one needs to be able to read the settings, view the histogram, and so on. That would suggest that one would need some form of readers in either the D/D or I/D setting?

What about sun glasses? If one needs readers then off-the-shelf sun glasses may not work?

My doctor says that only about 10% of his patients do blended.

I would appreciate any feedback from those having experience or knowledge about these issues.

If were to wear a contact lens for a few days on the uncorrected eye to simulate blended would it be sufficient to help me make an informed decision? Of course, that assumes a contact lens would work on an eye that has had 8 line RK?

Thank you.

Mike

[John C Hagan III, MD, FACS, FAAO]

The way you posed your question indicates you understand your options. Ultimately only you can make the call.

JCH MD

[JodieJ]

I am plano in both eyes with IOLs, and I disagree with some of your conclusions.  If you go D/D, you will probably need to wear prescription progressive glasses (or bifocal contacts) most of the time, unless you are comfortable having everything within arm's length fairly blurry. You will need correction for tasks such as cooking, grooming, shopping, using the computer, reading just about anything without squinting, and finding your glasses.  You can probably forget about the drug store readers, unless you want to have more than one pair (one for near; one for intermediate), which you are continuously putting on and taking off.

On the other hand, with D/I you'd probably be able to function pretty well in most situations without correction.  You could get by with drugstore readers (the eye with the clearer vision would carry the burden), although prescription readers (or progressives) would be better.

I have a history of strabismus/double vision related to monovision contact lens wear, and I was warned not to attempt monovision again by the surgeon who corrected my eye alignment.  This is why I chose D/D.  However, I think that D/I is by far the more desirable correction for most people.  If, as you say, only 10% of the patients do blended vision, it's probably because most of the remaining 90% were unaware that they had a choice.

I don't think that most people experience any difficulty adjusting to blended vision.  Off the shelf sunglasses would work just fine for distance vision with either correction.  

[John C Hagan III, MD, FACS, FAAO]

-

[MikeV99]

Thank you for your feedback. I had been leaning toward the I/D approach, but wanted an outside perspective.

Mike

[jaymor]

i had cataract surgery on both eyes one month apart with the second eye now being six weeks ago......i was fitted for D/D on both eyes.....because of the '**** shoot' nature of the power estimation of the lenses i seem to have landed where i am able to see distance with my  dominant left eye and intermediate with the other (up to and including a computer monitor), but am unable to read w/ ease and so i use drug store reading glasses.....

i have slight double vision which i am now trying to resolve....hope tthis helps.

[stewardrobbins]

I had a distance aspheric IOL implanted in my left, NON dominant eye in June.  My right eye is nearsighted, so I have de facto crossed monovision.  I find that I can get by without glasses for everything, but I have been spoiled by the convenience of progressive glasses which give me great vision at all distances.  My priority has always been the best vision, not being able to see pretty well without glasses.

Whenever I have surgery on my dominant right eye, I have to decide whether to go with another distance IOL or to replicate my present vision with a near vision implant....

[twikle]

I went with I/D correction. I can watch TV, use a computer, and drive without glasses. I only need glasses for reading. The I/D solution has worked well with me.

[MikeV99]

Thanks all. I am scheduled to have my left eye done on Thursday. I will be getting the blended or offset or intermediate (I/D) correction. Let the fun begin!

Mike