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Hybrid Monovision? Any Dr familiar with this?
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Hybrid Monovision? Any Dr familiar with this?

I recently read about something called hybrid monovision, a monofocal  IOL exchange in dominant eye as a rescue approach for problems from bilateral multifocals. I am looking for additional information and opinions  if  this has the possibility of helping to resolve the problematic  side effects from the Restor IOLs.   I just had the first Restor IOL exchanged but cannot yet judge  improvement due to haziness from corneal swelling which after 3 days seems to be resolving overall, it has been checked and rechecked, though it is worse in the morning and improves over course of the day. Will ask surgeon about this hybrid monovision next post-op, but while I wait, since I  don’t know the extent of it being studied, and thus realize getting an answer  may be a long shot, but hope one of the doctors has more insight and access to information if this is a viable consideration.
  The original plan for my Restor IOL exchange was for mini monovision,  targeting  near/intermediate. Any idea how long it might be until I will be able  to  judge if there is  a worthwhile difference in vision sharpness with the first exchanged to monofocal IOL,  before I decide on doing a  2nd exchange surgery? Or is that not an option to consider?
Because my dominant eye was more problematic to me I asked the surgeon to do that one first, so by coincidence, it fit with this hybrid monovision description, which could mean no more surgery, if the targeted vision of -1.00 may work ok if leaving the other multifocal in place, and hence the reason for my inquiry. I’m looking for any help as to the how, why or if  this concept can be put into a  perspective and if it can render enough increased satisfaction vs doing the second surgery. This may be a challenge to answer, but anything  just for me to think about might be useful before making the next decision
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This may work. The good news is that waiting several days or weeks won't hurt at all. If you think that leaving the ReStor multifocal in place will work, then give it a try especially if the eye with the multifocal has a final prescription close to zero (little to no astigmatism), there's no capsular opacification, and there's no dry eye or eye surface problems (all three of these issues notoriously interfere with the function of multifocals and if not addressed, then the multifocal won't function well). If leaving the multifocal in place doesn't work, then have it exchanged.
Best wishes,
Timothy D. McGarity, M.D.
www.tmcgaritymd.com
8 Comments
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Thank you for responding. If possible an opinion on the following-- Between the added invasiveness of explanting the multifocal and the corneal edema (now much improved), but as of 6 days post-op, my concern is the monofocal vision is of no improvement; much less to think to do the 2nd eye. Do I need more healing time for return of clear vision, my one specific question is ** HOW LONG might it be until, or should it have been apparent already, to judge the hoped for  improved, sharper quality of vision in the eye that had the lens exchange?  
   Right now I’m losing optimism and I am almost at the point of feeling that I am only going to go from bad to worse. Maybe I should  resign myself, get a good pair of  whatever custom prescription glasses I need, as I  basically  need to wear  reading glasses most of the time for many  everyday tasks if within arms reach distance, I lost the one thing I asked not to be sacrificed, the functional close vision, despite the small cataract, from my pre-surgery being mildly nearsighted. I was never made aware the Restor IOLs would diminish my quality of near vision.
Just asking to have unbiased opinion of what to consider before I discuss this at next Dr appointment.
thank you for your kind attention

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Avatar_f_tn
I have been reading about hybrid monovision.  I have one tecnis lens in my left eye.  I am scheduled to get a monofocal lens in my right eye.  I am not sure if this will work because my left eye is currently the dominant eye. I don't know by how much or which eye was dominant before the surgery.  The lense has been in my eye for almost 11 months.

There is research to support that it works in your type of situation.  Keep in mind that you have a new visual system  that's going to require neuroadaptation.This probably the study you are referring to

http://www.ncbi.nlm.nih.gov/pubmed/22018364
http://ophthalmologytimes.modernmedicine.com/news/monofocal-lens-bilateral-implantation-allays-discontent
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Avatar_f_tn
Keep me updated on your progress. I am interested to know how you are doing
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Avatar_f_tn
This link is to article that addresses mixing a Restor lens with a monofocal IOL.  The issue is discussed on p.63 in a box.

http://www.crstoday.com/PDF%20Articles/0807/CRST0807_08.pdf

This article also has some info on multifocal + monofocal along with other types of monovision.  The references at the end are helpful.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3214420/#ref13

I'll keep you posted on how I'm doing.  I'm having the surgery in March. I have perfect 20/20 reading and distance vision in my left eye with the Tecnis lens.  My problem is the halos and glare.  I'm trying to avoid having an explant since I have had a post vitreous detachment in that eye and still have flashes after 6 months.

How's your vision now with glasses?  Do you have a halo glare problem now or is hard to tell?

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Avatar_f_tn
I will check the articles you mention, appreciate the information. I did want to answer you so briefly my story is  my prior posts explain I originally  had the Restor lenses in both eyes, and found that they did not deliver what was promised, creating aberrations and trade-offs that were never disclosed. Once it was decided lens replacement was the only real option, I had the feeling to do the dominant eye first only because I felt it was the one that was more problematic, and just by coincidence found it fit the hybrid monovision concept. The monofocal lens cut down some of the problems such as halos, but never achieved the refractive target of slightly nearsighted to give me back some of my close vision, instead it seems to have fallen into the intermediate to distance range Personally, I don’t believe the neuroadaption thing is all that real, no miracle is going to happen, I think it is more that with time a patient either gets used to it or just resigns to their fate. If I knew then, what I know now I never would have had multifocal implants, but I won’t get into my opinions here.
Its not that I’m doing the hybrid monovision by choice, I need reading glasses to sharpen my vision for anything within arms distance. I am going to try contact lenses and if that improves my vision, then the option could be to do laser surgery, or just use contacts when needed, but will likely still need glasses for some or most close range tasks. Bottom line is the multifocal gives me distance, and some close vision if the lighting is bright enough, but  I can no longer  easily do what the practical sharp close vision I had being mildly nearsighted allowed. Even though I'm told my vision is 20/20 I often don't feel the quality is all it should be. I don't know if i answered anything to help you, but please let me know
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Avatar_f_tn
Thanks for the info.  You answered my question about the halos.  I'm hoping a monofocal lens will improve the image of my halos/night vision.  My indoor vision with the mulifocal is excellent.  My concern with if I got a second multifocal is the night vision.  I can read with one multifocal lens in my left eye.  I have no longer have correctable reading or intermediate vision in my right eye due to the cataract.  I hope trading reading vision with two eyes for at least making sure my night vision doesn't get worse is the right decision.  I'm only 43 so I need to be able to drive at night.  A greater percentage of the younger patients in the study were satisfied.  My surgeon never checked which eye was dominant before the surgery so I don't know which eye was dominant before the surgery.  I'm left ear dominant, left foot dominant,  and right handed, don't take pictures so I really don't know which eye was dominant before the surgery.   Right now I suffer from eye pain and headaches from the eye strain.

I don't want to chance getting  a second multifocal and then needing an explant.  The explant surgery sounds like it was painful.
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Avatar_f_tn
I think you can check yourself for eye dominance, look at an object across the room with both eyes, center it in a small circle made using your hands/fingers, close one eye, then the other, it should stay in place looking with one eye, that’s the dominant, and it will move out of range when viewed only with the non-dominant eye.
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