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What is modified monovision like?
hi everyone.
I wanted to ask some questions about modified monovision for cataracts which has been discussed a lot on this forum, i am refering to setting the dominant eye for 0 to -0.25 and non-dominant for -1 to -1.25. I read that -1.25 maps to vision about 20/50 approximately.
1) If the refractive targets are hit what is the combined uncorrected visual acuity with both eyes ? Maybe the surgeons can comment on what they's commonly seen in their practice and if there are significant variations here.
2) how much does it usually impact depth perception? can one drive without glasses - i ask this because having one eye that can see intermediate means it is possible to operate a GPS device for instance at arms length. Would one still glasses for night driving?
3) if the non-dominant eye hits the intended target, what are the chances that the person will be able to read computer distance comfortably - does this mean just the larger fonts or normal sized text too?
4) Are there patients who dont adapt to it?
5) i remember reading on this forum that glasses create different size images than IOLs due to the distance from the retina, does this cause issues when someone with modified monovision wears glasses for either distance or reading vision?
6) How does modified monovision differ from say crstalens implants - in terms of the distances at which the person can see ? Are there distances between in between the two focal points where visual acuity drops ?
Would appreciate if you could please send in opinions from doctors and as well as people here who've had this done, thanks.
I wanted to ask some questions about modified monovision for cataracts which has been discussed a lot on this forum, i am refering to setting the dominant eye for 0 to -0.25 and non-dominant for -1 to -1.25. I read that -1.25 maps to vision about 20/50 approximately.
1) If the refractive targets are hit what is the combined uncorrected visual acuity with both eyes ? Maybe the surgeons can comment on what they's commonly seen in their practice and if there are significant variations here.
2) how much does it usually impact depth perception? can one drive without glasses - i ask this because having one eye that can see intermediate means it is possible to operate a GPS device for instance at arms length. Would one still glasses for night driving?
3) if the non-dominant eye hits the intended target, what are the chances that the person will be able to read computer distance comfortably - does this mean just the larger fonts or normal sized text too?
4) Are there patients who dont adapt to it?
5) i remember reading on this forum that glasses create different size images than IOLs due to the distance from the retina, does this cause issues when someone with modified monovision wears glasses for either distance or reading vision?
6) How does modified monovision differ from say crstalens implants - in terms of the distances at which the person can see ? Are there distances between in between the two focal points where visual acuity drops ?
Would appreciate if you could please send in opinions from doctors and as well as people here who've had this done, thanks.
Dr. Oyakawa is a big fan of the Crystalens. I think he's said that mini-monovision works well with this lens. I'd suggest that you re-post your question as a new thread on a day that Dr. O is responding. (I believe that he and Dr. Hagan alternate days.)
I'm scheduled for a modified monovision beginning May 10, 2011. I've so far decided to go with a crysalens in my non-dominant eye set at -1.0D and another fixed lens of same material in my left dominant eye aiming for plano distance vision. My alternative choice is to not use the Crysalens in which case my surgeon said he'd target -1.25D in the non-dominant eye. I've had monovision for years, originally about .5D apart, but as my cataract developed it has gone to a 2.0D difference, so I feel I will readily adjust to monovision. I'm still kicking around whether to go with one crystalens vs the standard monovision. My surgeon is very big on Crystalens and is in the top three Crystalens surgeons in New York State, but always has done two except for a few cases when only one eye was being worked on. I'm just wondering if I'm being wise going with "half a loaf" or whether I should go for two crysalenses, a "full loaf", or whether standard monovisio, "no loaf", would work fine. I am concerned about driving, heavy computer use, and also....my billiard game . Any comments and or suggestions would be very appreciated.
I had LRI's done as part of my IOL procedure, for residual astigmatism of about 2 D. My first eye was no problem, and the astigmatism is gone. The second eye required stitches (I'm not sure if it was from the LRI's or the IOL insertion incision), so I don't yet know if the astigmatism is all gone.
If you are going to get LRI's, I would have them done at the same time. But I would only have them done by someone who has done a lot of LRI's and is very comfortable with them. I would definitely choose them again, over glasses or laser surgery.
My doctor included the LRI's at no charge. Perhaps because I was paying cash (not insurance) for premium lenses (Crystalens HD).
If you are going to get LRI's, I would have them done at the same time. But I would only have them done by someone who has done a lot of LRI's and is very comfortable with them. I would definitely choose them again, over glasses or laser surgery.
My doctor included the LRI's at no charge. Perhaps because I was paying cash (not insurance) for premium lenses (Crystalens HD).
I'm not very knowledgeable about astigmatism-reducing procedures, but I believe that .75 D of astigmatism can safely and easily be eliminated at the time of surgery--probably at no additional charge to you. Dr. Hagan knows more than I do; you could post again about this to his attention. (Yes, you can correct only astigmatism with glasses or contacts--but it would be much nicer if you didn't need to do this. After all, the goal of blended vision is to reduce your dependence on glasses. My friend who has this correction only uses weak drugstore readers.) Best wishes.
Hello JodieJ, thanks a lot for all this information , I really appreciate the time and effort you put into this. Could you also comment on more question i have?
My right eye is dominant so i can potentially get that set for plano vision and the left eye for intermediate distance vision.
I was wondering - if i have residual astigmatism after cataract surgery ( i am -0.75 in both eyes currently) , then can i get a prescription for just the cylindrical correction and not the spherical correction. Then i would be able to correct the astigmatism and still have distance and intermediate vision. I could just keep a second pair of readers for near vision. I am thinking it might be better to be conservative and avoid LRI or lasik to correct astigmatism,
My right eye is dominant so i can potentially get that set for plano vision and the left eye for intermediate distance vision.
I was wondering - if i have residual astigmatism after cataract surgery ( i am -0.75 in both eyes currently) , then can i get a prescription for just the cylindrical correction and not the spherical correction. Then i would be able to correct the astigmatism and still have distance and intermediate vision. I could just keep a second pair of readers for near vision. I am thinking it might be better to be conservative and avoid LRI or lasik to correct astigmatism,
There is a significant difference between full monovision and modified monovision. For full monovision, the dominant eye is set at about plano and the non-dominant eye about -2.00 to -2.50. This correction should provide "good enough" (but not perfect) vision at distance, intermediate, and near. Some people never wear glasses, but others may need a weak prescription for certain tasks (e.g., night driving, sewing, etc.) Not everyone can adjust to full monovision, and it is not right for anyone with a history of strabismus.
By contrast, modified monovision has more modest aims. Generally, the dominant eye is set at around plano and the non-dominant eye at about -1.25 (good intermediate vision). There is generally no adjustment time needed. Distance and intermediate vision are very good to excellent. You can expect to need glasses for prolonged reading and seeing small print. Either full or modified monovision can easily be reversed by wearing progressive glasses.
There are no studies that I'm aware of comparing vision with modified monovision using aspheric monofocal IOLs to the Crystalens HD (which generally involves mini-monovision, too). However, it's known that monofocal IOLs have far fewer post-surgery problems, especially those involving glare. In addition, it's easier for the surgeon to achieve the refractive target with a monofocal. I've seen one or two posts here from happy Crystalens HD patients who report that they don't need glasses for reading. However, most of the Crystalens HD recipients posting here do need glasses for prolonged reading (and sometimes for using the computer.) It seems to me that in the majority of cases, modified monovision provides vision at least as good (and sometimes better) than the Crystalens HD, with fewer side effects and no out-of-pocket fees.
One more point: It's very important that the surgeon come close to achieving the refractive target with both modified monovision and the Crystalens HD, and significant astigmatism must be eliminated. In both cases, it's probably a very good idea to have a surgeon who is very experienced with the type correction you're seeking. In addition, find out beforehand about the charges for a LASIK/PRK touch-up, should this be necessary post-surgery.
Best wishes for an excellent outcome.
By contrast, modified monovision has more modest aims. Generally, the dominant eye is set at around plano and the non-dominant eye at about -1.25 (good intermediate vision). There is generally no adjustment time needed. Distance and intermediate vision are very good to excellent. You can expect to need glasses for prolonged reading and seeing small print. Either full or modified monovision can easily be reversed by wearing progressive glasses.
There are no studies that I'm aware of comparing vision with modified monovision using aspheric monofocal IOLs to the Crystalens HD (which generally involves mini-monovision, too). However, it's known that monofocal IOLs have far fewer post-surgery problems, especially those involving glare. In addition, it's easier for the surgeon to achieve the refractive target with a monofocal. I've seen one or two posts here from happy Crystalens HD patients who report that they don't need glasses for reading. However, most of the Crystalens HD recipients posting here do need glasses for prolonged reading (and sometimes for using the computer.) It seems to me that in the majority of cases, modified monovision provides vision at least as good (and sometimes better) than the Crystalens HD, with fewer side effects and no out-of-pocket fees.
One more point: It's very important that the surgeon come close to achieving the refractive target with both modified monovision and the Crystalens HD, and significant astigmatism must be eliminated. In both cases, it's probably a very good idea to have a surgeon who is very experienced with the type correction you're seeking. In addition, find out beforehand about the charges for a LASIK/PRK touch-up, should this be necessary post-surgery.
Best wishes for an excellent outcome.
Hello JodieJ,
thanks , really appreciate your inputs. Yes the astigmatism correction could certainly make some difference here. I noticed that the modified monovision patients had difference in their eyes by -1 to -2.25 , so some people in the study might have been more on the near focus rather than intermediate focus side.
One thing though that this study did not explain is how inspite of this the modified monovision patients still wore glasses for near vision tasks. It could still be due to the astigmatism like you pointed out earlier.
thanks , really appreciate your inputs. Yes the astigmatism correction could certainly make some difference here. I noticed that the modified monovision patients had difference in their eyes by -1 to -2.25 , so some people in the study might have been more on the near focus rather than intermediate focus side.
One thing though that this study did not explain is how inspite of this the modified monovision patients still wore glasses for near vision tasks. It could still be due to the astigmatism like you pointed out earlier.
Uncorrected visual acuity for the modifed monovision group was lower than expected because no astigmatism correction was offered to this group. (However, patients in the ReStor group with pre-existing astigmatism received limbal relaxing incisions.) In addition, patients who used toric IOLs for modified monovision were excluded from the study. Had patients in both groups received astigmatism correction, probably the modified monovision group would have had slightly sharper distance vision (IMO).
Perhaps the most surprising finding of this study was that the modified monovision patients had near vision that was just as good as the ReStor group.
Perhaps the most surprising finding of this study was that the modified monovision patients had near vision that was just as good as the ReStor group.
Hello Dr.Oyakawa,
First, i would very much like to sincerely thank you, Dr. Hagan and JodieJ. Quite honestly your inputs are very very educational.
I am myself considering both crystalens and modified monovision. I have been to a couple of Circle of excellence Crystalens opthalmologists in Seattle who said i was a good candidate for it, but i also saw a opthalmologist at U.W who advised me against it. The main reason was my pupil size which gave a higher size measurement while at U.W..So i am now keenly researching modified monovision..
I hope my questions here will be useful to other people as well. I found this study on the web http://ascrs2008.abstractsnet.com/handouts/000081_monovision_ascrs.ppt, (i hope the URL gets through) (google on patient satisfaction with modified monovision - is the first hit)
What grabbed my attention on this was that the uncorrected visual acuity numbers on this study for modified monovision were not that good, and only 70% people had 20/40 or better vision , could you please comment why this could be lower than expected?
First, i would very much like to sincerely thank you, Dr. Hagan and JodieJ. Quite honestly your inputs are very very educational.
I am myself considering both crystalens and modified monovision. I have been to a couple of Circle of excellence Crystalens opthalmologists in Seattle who said i was a good candidate for it, but i also saw a opthalmologist at U.W who advised me against it. The main reason was my pupil size which gave a higher size measurement while at U.W..So i am now keenly researching modified monovision..
I hope my questions here will be useful to other people as well. I found this study on the web http://ascrs2008.abstractsnet.com/handouts/000081_monovision_ascrs.ppt, (i hope the URL gets through) (google on patient satisfaction with modified monovision - is the first hit)
What grabbed my attention on this was that the uncorrected visual acuity numbers on this study for modified monovision were not that good, and only 70% people had 20/40 or better vision , could you please comment why this could be lower than expected?
I was torn between going for mini-monivision or Crystalens HD for myself in the past 4 months reading this forum.
The postings about Crystalens problems make me nervous, not mention that there is no surgeon in my county who has done more than Crystalens implants though I have the budget for the additional cost. I would have to travel to get the Crystalens and I don't really have time for it. So I decide to go for the AMD Technis.
I will be seeing my surgeon (the 2nd one) this afternoon to try out with contacts to see whether the mini-monivision work for me.
The postings about Crystalens problems make me nervous, not mention that there is no surgeon in my county who has done more than Crystalens implants though I have the budget for the additional cost. I would have to travel to get the Crystalens and I don't really have time for it. So I decide to go for the AMD Technis.
I will be seeing my surgeon (the 2nd one) this afternoon to try out with contacts to see whether the mini-monivision work for me.
Re #6: According to the professional literature, there would likely be a loss of acuity for intermediate vision if the difference between the eyes exceeds 2 diopters (e.g., plano and -2.50). This would obviously apply to cases of full monovision only.
When I did full monovision with contact lenses, my distance vision with both eyes was about 20/25 and near vision was 20/20, with no apparent gaps in acuity. I sometimes wore glasses over my contacts for night driving and movies. I can't imagine that this would be necessary with modified monovision.
Modified monovision would allow you to function well without glasses in most situations. My friend who has this correction with aspheric IOLs only needs glasses for prolonged reading or seeing small print. (He had no adjustment period.) This is probably about as good as what you'd be likely to get with the Crystalens HD (based on recent posts on this forum.)
When I did full monovision with contact lenses, my distance vision with both eyes was about 20/25 and near vision was 20/20, with no apparent gaps in acuity. I sometimes wore glasses over my contacts for night driving and movies. I can't imagine that this would be necessary with modified monovision.
Modified monovision would allow you to function well without glasses in most situations. My friend who has this correction with aspheric IOLs only needs glasses for prolonged reading or seeing small print. (He had no adjustment period.) This is probably about as good as what you'd be likely to get with the Crystalens HD (based on recent posts on this forum.)
MEDICAL PROFESSIONAL
-1.00 to -1.25 can have distance vision from 20/40 to 20/80. I target the non-dominant eye for -.50 for Crystalens HD.
1) Distance vision with both eyes should be 20/20 and 20/30 to 20/40 at near with a -1.00 in the non dominant eye and plano in the dominant eye with no other problems such as dry eyes, or residual astigmatism.
2) There should be no problems.
3) It can be as good as 20/20 but probably less.
4) Most adapt. However, there are always exceptions.
5) This small difference will not cause a problem in image size.
6) There may be gaps in vision and distance, intermediate and near may not have continuous vision.
I would suggest you find a good Crystalens surgeon considering the time you have spent on this forum regarding this issue.
Dr. O.
1) Distance vision with both eyes should be 20/20 and 20/30 to 20/40 at near with a -1.00 in the non dominant eye and plano in the dominant eye with no other problems such as dry eyes, or residual astigmatism.
2) There should be no problems.
3) It can be as good as 20/20 but probably less.
4) Most adapt. However, there are always exceptions.
5) This small difference will not cause a problem in image size.
6) There may be gaps in vision and distance, intermediate and near may not have continuous vision.
I would suggest you find a good Crystalens surgeon considering the time you have spent on this forum regarding this issue.
Dr. O.
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