prescription choice for iols

[Tabby69]

I wonder if you can advise me.  I am having refractive surgery and because of dry eyes I have been told IOLs are the only option to correct my shortsight.  I also need glasses for reading.  At the moment I am trialling monovision contact lenses with great difficulty because of my dry eyes, but I am finding distance vision particularly difficult to cope with with these contact lenses.  Would you recommend monovision IOLs, to be able to hopefully discard my glasses and how long do they take to settle down, or a compromise of middle distance vision IOLs( so sometimes I'd need distance glasses + reading glasses).  I have astigmatism too so have only been offered  monofocal IOLs.
Do hope you can help.

[Tabby69]

Thank you for your detailed reply.  I use eye drops at night, have punctum plugs in both lower tear ducts and take a nutritional supplement so my dry eyes are managed.  I've been told Restasis would not help me.  Your suggestion of blended vision  or social reading vision could be a good solution for me!  My monovision contact lenses inserted again last night started to 'kick in' and my distance vision was much better.  However, I'm still concerned that I'd be happy long term with the great variarion of prescription between the 2 eyes + wonder if I'd cope more successfully if not fully corrected for near vision.  Would you advise going back to my surgeon + ophthalmologist to try contacts with a blended vision  or social reading vision ?  Also can I ask you if adjustable IOLs are  widely available yet?  
To:

[Tabby69]

Thank you for your detailed reply.  I use eye drops at night, have punctum plugs in both lower tear ducts and take a nutritional supplement so my dry eyes are managed.  I've been told Restasis would not help me.  Your suggestion of blended vision  or social reading vision could be a good solution for me!  My monovision contact lenses inserted again last night started to 'kick in' and my distance vision was much better.  However, I'm still concerned that I'd be happy long term with the great variarion of prescription between the 2 eyes + wonder if I'd cope more successfully if not fully corrected for near vision.  Would you advise going back to my surgeon + ophthalmologist to try contacts with a blended vision  or social reading vision ?  Also can I ask you if adjustable IOLs are  widely available yet?

[Michael J Kutryb, MD]

Your best option may be to just wear bifocals.  If you have such significant dry eye problems - you could consider treatment with restasis, punctum plugs, oral flax and fish oil supplemments and other treatments.  I would have surgery until you get the dry eye situation well under control.  Then only have monovision cataract surgery (one eye distance, one eye near) ONLY if you really know what you're getting into and are well aware of what monovision is like.  In the end if you've never tried monovision, your safest bet may be to just have aspheric monofocal implants for distance and wear reading glasses for near.  I have had good succes with what I call social reading vision or blended vision which is distance vision in dominant eye and weak reading vision in non-dominant eye.  For small print or extensive reading - glasses are needed, but for price tags, menus, magazines - reading glasses are often not needed as long as lighting is good.  Good Luck.

MJK MD