Targeting both eyes for near vision?

[TillyMack]

Are there advantages to targeting both eyes to near versus trying for mini-monovision? I have one eye corrected to -2.0D and would like to explore the options of having my second eye set to near versus trying for  mini-monovision with near bias. I should add that a contact lens trial would probably not be useful since I have a significant cataract in the unoperated eye.  Would love to hear about any other options if available.

Thank you!

[JohnHaganMD]

There is no one size fits all.  In my practice I have seen everything. People that set both eyes for distance, both for reading monofocal distance bias or near bias. I have had near sighted patients that think the greatest thing in the world would be not to have to wear glasses for distance but had surgery (elsewhere) and were stunning to find they could no longer read without glasses. I would suggest you read about light adjusted lens. At this time 11/2023 it is the state of the art and what I would choose if I were having cataract surgery. It allows the IOL power to be changed after surgery just using a special light.

[TillyMack]

Thank you!  There seem to be several practices that implant LALs in my area. That said, both my general ophthalmologist and primary care physician are not able to offer a recommendation.  

I do have a specific question with regard to mini-monovision with near bias.  Do you believe that targeting a distance between the eyes of 1 diopter or less would reduce the risk of failing to adjust?   My top priority is to adjust well to mini-monovision but I have not experimented using contact lenses.

With one eye set to -2.0 and the other eye with a significant cataract and myopia, my vision inside the house is more blurry than I would like.  I'm fine with wearing glasses for driving and outside activities but would love to see clearly throughout the house.  Would a target of -1.0 likely provide crisp vision inside the house or would I need to select a more distant target such as -.75D or -5.0D?  

Many thanks!

[Ron_AKA]

As you know my view is that you need to get a final refraction on your eye now that it has fully healed. The refraction at one week post surgery should not be counted on as being accurate. Then you will know where you are starting from. The standard recommendation for mini-monovision is to not to use more than 1.5 D between the eyes, but those with full monovision often do more. Using a differential of 1.0 D is very conservative, as is a differential of 1.25 D. But of course you need an accurate refraction from your operated eye to calculate what is needed in your second eye.

From personal experience with mini-monovision where my calculated SE for the distance eye is -0.375 D and my near eye is -1.625, for a differential of 1.25 D, my experience is quite good. I have had up to 1.50 D and that is OK too. My distance eye has slipped to a bit more myopic in the 3 years since surgery. I would prefer to have more than I currently have. However, when I had my distance eye operated on, and the other eye not, the differential was 2.0 D. I did not find that acceptable and used a contact to reduce it. So I think there is a limit.

Since your current issue is limited distance vision, I would push the differential to at least 1.0 D for the second eye to see an improvement. If you really want to push the limit to the max then as was suggested you may want to use the LAL process if cost and time is no concern.

[MrPresley]

Speaking only from my experience with trying out mono-vision with contacts once about a decade ago, I did not like it and would not myself roll the dice with trying it out again with IOLs. Thus my LE with a monofocal IOL placed in 2017 is -4.5D and my (so far) non-operative RE is/was -6.0D, and I continue using contacts or glasses for distance.

[Ron_AKA]

Was the -4.5 D eye with an IOL a miss, or intentional?

[MrPresley]

Intentional

[Ron_AKA]

I can't think of anything positive about being -4.5 and -6.0 D. I presume you were trying to minimize the differential between the eyes? It is unfortunate to be put in that position.

[MrPresley]

No, it is not unfortunate. My choice, my vision, and my cataract surgeon (not Dr. Google) concurred. I had, and still have today, no intention of having unnecessary cataract surgery on my RE. This is not a thread about me anyway, but my outcome after six years remains outstanding.

[Ron_AKA]

It is good that you are happy with it. I sure would never do anything like that or recommend it to anyone else.

[MrPresley]

The only recommendations that carry any actual credence here in this Eye Care forum are those from Dr. Hagan. Non-medical opinions from an anonymous layman internet poster such as yourself do not. Consider responding not to me but rather to the O.P. with any actual personal experiences you may have had as a patient, like I do, and leave recommendations to medical professionals.

[JohnHaganMD]

=

[MrPresley]

Speaking only from my experience with trying out mono-vision with contacts once about a decade ago, I did not like it and would not myself roll the dice with trying it out again with IOLs. Thus my LE with a monofocal IOL placed in 2017 is -4.5D and my (so far) non-operative RE is/was -6.0D, and I continue using contacts or glasses for distance.

[TillyMack]

Thanks MrPresley!  Do you find your glasses and contact lenses to work equally well in terms of visual acuity and balancing your eyesight?  

[MrPresley]

Pretty much. My LE (dominant eye) consistently corrects to 20/20, while my RE can attain 20/20 to 20/30. This is using either contacts, which I predominantly wear, or glasses. RE has a asymptomatic ERM and relatively minor cataract, LE had successful ERM/vitrectomy surgery eight years ago, followed by cataract surgery 18 months later.

[TillyMack]

Thank you!