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Michael J Kutryb, MD
Michael J Kutryb, MD
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma, Laser Vision Correct
Interests: Ophthalmology
Male
Specialties: Ophthalmology, Cataract Surgery, glaucoma, Laser Vision Correct
Interests: Ophthalmology
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Cataract Surgery MonoVision Tips
Nov 27, 2008 07:53AM
- 29 comments
I've seen several posts in recent weeks about desired monovision after cataract surgery. Since this is a subject near and dear to my heart that I deal with every day at the office, I wanted to give you some tips on how I deal with this very tricky situation.
1. Monovision is not for everyone, especially if you are into athletics or want clean crisp distance vision. In general, it seems to appeal to people that don't like the look or feel of glasses on their face and are higly motivated and willing to make sacrifices in vision quality to achieve that.
2. You seriously need to have tried it successfully with contact lenses before considering monovision after cataract surgery. The intraocular lens implants used with cataract surgery are basically permanant and not easily replaced, so changing your mind after the fact is something to be avoided at all costs.
3. Decide what your vision priority first and try to get that accomplished before going for priority number two. You're not allowed to say "I just want to see at all distances without glasses" here. That would be a wonderful result and something to shoot for but being realistic, you need to decide if I had to choose, what would I most desire, the ability to see near or far without glasses. In my practice, I find out the main priority and shoot for that first and if I can achieve it in the first eye then the second eye has some wiggle room for me to add some near or distance vision as desired. It is more of a DISTANCE plus some near added in or NEAR with a little distance added in. This is a little of a mental game but my goal is to set expectations in a reasonable way and avoid giving in to the "I want it all, I want it now mentality" that has become more common, especially in the baby boomers.
4. Mini-Monovision is a very desirable result for many patients and usually provides excellent distance vision and some useful near vision for computer work, and light reading like price tags and menus. It is my favorite technique. For example, after determining the dominant, I would aim for 20/20 distance vision (as close as possible) in that eye and then aim for something like 20/50 in the non-dominant eye with about -1.25 of myopia or nearsightedness in that eye - just enough to support a small to medium amount of intermediate and near vision. It is such a small difference between the eyes that a great many patients can adjust to it quite well. These patients already can see almost perfectly for distance with one eye so that the non-dominant eye is freed up somewhat to be a little less sharp for distance and a little better up close. There is one caveat with this technique and that is that it is crucial to get the first or distance eye as clear as possible for distance. It it is a little off for distance, then I am occasionally forced to make the second eye for distance as well since these patients usually have distance vision as the main priority.
Keep these ideas in mind when considering cataract surgery, and I welcome your comments and questions. I really enjoy communicating with my surgery patients and getting to know what they want out of cataract surgery. I get to be the "Vision MatchMaker" every day and it's a responsibility I take very seriously.
Michael Kutryb, MD
Kutryb Eye Institute
www.kutrybeye.com
1. Monovision is not for everyone, especially if you are into athletics or want clean crisp distance vision. In general, it seems to appeal to people that don't like the look or feel of glasses on their face and are higly motivated and willing to make sacrifices in vision quality to achieve that.
2. You seriously need to have tried it successfully with contact lenses before considering monovision after cataract surgery. The intraocular lens implants used with cataract surgery are basically permanant and not easily replaced, so changing your mind after the fact is something to be avoided at all costs.
3. Decide what your vision priority first and try to get that accomplished before going for priority number two. You're not allowed to say "I just want to see at all distances without glasses" here. That would be a wonderful result and something to shoot for but being realistic, you need to decide if I had to choose, what would I most desire, the ability to see near or far without glasses. In my practice, I find out the main priority and shoot for that first and if I can achieve it in the first eye then the second eye has some wiggle room for me to add some near or distance vision as desired. It is more of a DISTANCE plus some near added in or NEAR with a little distance added in. This is a little of a mental game but my goal is to set expectations in a reasonable way and avoid giving in to the "I want it all, I want it now mentality" that has become more common, especially in the baby boomers.
4. Mini-Monovision is a very desirable result for many patients and usually provides excellent distance vision and some useful near vision for computer work, and light reading like price tags and menus. It is my favorite technique. For example, after determining the dominant, I would aim for 20/20 distance vision (as close as possible) in that eye and then aim for something like 20/50 in the non-dominant eye with about -1.25 of myopia or nearsightedness in that eye - just enough to support a small to medium amount of intermediate and near vision. It is such a small difference between the eyes that a great many patients can adjust to it quite well. These patients already can see almost perfectly for distance with one eye so that the non-dominant eye is freed up somewhat to be a little less sharp for distance and a little better up close. There is one caveat with this technique and that is that it is crucial to get the first or distance eye as clear as possible for distance. It it is a little off for distance, then I am occasionally forced to make the second eye for distance as well since these patients usually have distance vision as the main priority.
Keep these ideas in mind when considering cataract surgery, and I welcome your comments and questions. I really enjoy communicating with my surgery patients and getting to know what they want out of cataract surgery. I get to be the "Vision MatchMaker" every day and it's a responsibility I take very seriously.
Michael Kutryb, MD
Kutryb Eye Institute
www.kutrybeye.com
Thank you, Dr. Kutryb, for posting this detailed summary about this excellent option for many people. I'd like to add a couple of possible contraindications to monovision: a history of strabismus or an existing phoria (called "latent strabismus" in the LASIK literature). Most people with a mild phoria (like me) probably don't know they have it, but it's easy for the surgeon to test for it. After developing double vision from monovision contact lens wear, I learned that this type of breakdown is not uncommon for people with "latent strabismus" doing monovision with contacts or through LASIK/PRK. I assume that the same type of breakdown might occur with monovision from implants.
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I am 35 years old and had cataract on both eyes this year. Had the right eye done in Aug and the left eye done in Sept. My Dr said the cataracts was so bad that there was no other option but the surgury. Honestly, I think my eyes are worse now. I had to get a new perscribtion in glasses with bi focals. I hate them !!!!!!
Right after the left eye was done and sitting in the recovery room, I kept telling them that it felt like something was in my eye. They searched and searched and found nothing. 2 weeks later I went to my post op and he found that the lens wrinlked. OH WHAT A FEELING !!!!!! the itching and burning is out of control.
To make a long story short, I no longer have insurance that will pay to have it fixed. So now I must live with this until I can afford to get it fixed.
I sometimes wonder If I would have been better off not getting the surgury
Right after the left eye was done and sitting in the recovery room, I kept telling them that it felt like something was in my eye. They searched and searched and found nothing. 2 weeks later I went to my post op and he found that the lens wrinlked. OH WHAT A FEELING !!!!!! the itching and burning is out of control.
To make a long story short, I no longer have insurance that will pay to have it fixed. So now I must live with this until I can afford to get it fixed.
I sometimes wonder If I would have been better off not getting the surgury
I recently had cataract surgery on both eyes. My opthamologist recommended using the RsStor lens. However there was a problem because my left eye was extremely myopic and elongated and the ReStor lens could not be used. I chose to have a ReZoom lens in my left eye and a ReStor lens in my right eye. I now get 2 images and my brain has to sort it out. Both eyes focus if I look straight ahead or look down, but if I look up my left eye image goes up and to the right. I don’t know if it’s the ReZoom lens or my myopic left eye causing it. I now have 20/30 vision in my left eye and 20/25 vision in my right eye. It's a great improvement over what I had but I have to use reading glasses to clearly see a computer screen or read a newspaper.
Thanks for your comments. Every patient is different and multifocal and accommodating lens technology is far from perfect. In some ways at 20/25 to 20/30 you have a nice result but I suspect there's something unnatural about your vision - but I guess we're all imperfect in many ways. At least you have some pretty good vision.
Regarding the young person with pain after surgery - that is related to a scratch on the cornea or an irritated incision. it should only last a few days. The wrinkled capsule is extremely common in young cataract patients with PSC type cataracts. A yag laser will help the problem in about 99% of cases but need to wait a few months after the original surgery.
MJKMD
Regarding the young person with pain after surgery - that is related to a scratch on the cornea or an irritated incision. it should only last a few days. The wrinkled capsule is extremely common in young cataract patients with PSC type cataracts. A yag laser will help the problem in about 99% of cases but need to wait a few months after the original surgery.
MJKMD
If one needs to have cataract surgery what methods are being used to avoid
post surgical glaucoma. Does this condition occur because the IOL sooner or
later causes the aqueous fluid to clog or not flow thereby building up pressure,
thereby causing glaucoma. What should one look for when selecting a
surgeon in order to avoid post surgical problems. Thank you very much for
whatever information you can provide.
by laura5121
post surgical glaucoma. Does this condition occur because the IOL sooner or
later causes the aqueous fluid to clog or not flow thereby building up pressure,
thereby causing glaucoma. What should one look for when selecting a
surgeon in order to avoid post surgical problems. Thank you very much for
whatever information you can provide.
by laura5121
Dear Dr. Kutryb,
Thank you for this excellent posting and for all of the helpful ideas which you have given me personally. I especially value your idea of the mini-monovision and may consider that for myself. From your comments and Dr. Hagan's, I learned that, as a prior RK patient, I need to go with a monofocal lens. I learned that I have a positive spherical aberration and therefore am likely eligible for the Technis lens (which may be especially helpful for night vision). Just to clarify one point, I am hyperopic at about +1.50 in my dominant eye ( I erred the other day when I wrote -1.50). I hope to be communicating with you further in the future before making a final decision to proceed with a lens implant. May I add, as an aside, that your comments are not only beneficial to patients, like myself, but they are also helpful to your fellow physicians. As a result of your wonderful shared information, you save other physicians many hours of answering questions that patients have in their decision-making process. Thank you again for all that you do for us. Best wishes, Starman aka Frank
Thank you for this excellent posting and for all of the helpful ideas which you have given me personally. I especially value your idea of the mini-monovision and may consider that for myself. From your comments and Dr. Hagan's, I learned that, as a prior RK patient, I need to go with a monofocal lens. I learned that I have a positive spherical aberration and therefore am likely eligible for the Technis lens (which may be especially helpful for night vision). Just to clarify one point, I am hyperopic at about +1.50 in my dominant eye ( I erred the other day when I wrote -1.50). I hope to be communicating with you further in the future before making a final decision to proceed with a lens implant. May I add, as an aside, that your comments are not only beneficial to patients, like myself, but they are also helpful to your fellow physicians. As a result of your wonderful shared information, you save other physicians many hours of answering questions that patients have in their decision-making process. Thank you again for all that you do for us. Best wishes, Starman aka Frank
I have printed this off. Thanks for this great information, Doctor K. I wish you were in my city. Do you have a clone? (-:
Dear Laura5121,
Yours are excellent and very important questions; let's hope some knowledgeable person happens along who will attempt to answer them.
Yours are excellent and very important questions; let's hope some knowledgeable person happens along who will attempt to answer them.
my vision is 20/400, and i use contacts to see far away. can this be corrected w/o having to wear glassed for near vision?
my 18 yr old son did mushrooms more than once and other drugs. now he has double vision, accom insuff, focus and memory problems, severe enough that he says he cant work or go to college til its fixed.
can drugs cause that much damage. he says all his friends do them all the time and have no problems.
can drugs cause that much damage. he says all his friends do them all the time and have no problems.
Your only chance is either bifocal contact lenses (which don't work well for some people) or monovision with one eye for distance and the other for near with contact lenses. Tell your son that drugs are a very bad idea and that his friends don't know what they are talking about.
Thanks, for your answers here, Dr. Kutryb, and for referring to me as a "young cataract patient" - it's been a while since anyone called me that!
You're worrying me, though by saying that a wrinkled capsule is extremely common. Yikes! I had my right eye done a couple months ago and the results were perfect (my vision is now 20/20 in that eye). My left eye is next month, and now I'm wondering if I'm not expecting too much by hoping that the result will be just as good. What exactly are my odds of encountering this complication, and how long will I need to wait to get it fixed if it does occur? Why is this more common in younger patients? Or is it just that it's more common with PSC cataracts, which are, in turn, more common in younger patients?
And why do you believe it's imperative to have tried monovision with contact lenses previously? Are there some people who just can't learn to see that way? When I wore contacts I only wore them in one eye - the other didn't need correction. Would this experience count as having tried monovision?
Thanks in advance for your input. And, again, for the "young" thing. I'm only 44, but the cataracts are making me feel old :)
You're worrying me, though by saying that a wrinkled capsule is extremely common. Yikes! I had my right eye done a couple months ago and the results were perfect (my vision is now 20/20 in that eye). My left eye is next month, and now I'm wondering if I'm not expecting too much by hoping that the result will be just as good. What exactly are my odds of encountering this complication, and how long will I need to wait to get it fixed if it does occur? Why is this more common in younger patients? Or is it just that it's more common with PSC cataracts, which are, in turn, more common in younger patients?
And why do you believe it's imperative to have tried monovision with contact lenses previously? Are there some people who just can't learn to see that way? When I wore contacts I only wore them in one eye - the other didn't need correction. Would this experience count as having tried monovision?
Thanks in advance for your input. And, again, for the "young" thing. I'm only 44, but the cataracts are making me feel old :)
I am 35 years old...I have perfect 20/20 in my left eye and need cataract surgery in my right eye...would you recommend a monofocal set for reading....that way i can see far with my left eye and have both eyes for reading (essentially monovision)...and eventually when i hit over 40 and my left eye starts losing the reading then i will have my left eye for seeing distance and my right eye for reading...
I am right eye dominant...is it okay to put the dominant eye as the near vision...
I am right eye dominant...is it okay to put the dominant eye as the near vision...
Thanks for the info. I had lasik monovision correction six years ago and now have cataracts in both eyes. I am planning a monovision correction with cataract surgery. Has anyone had any experience with this?
What can you tell me about the success of presbyopia correcting lens for multiple distance? I have been extremely nearsighted for the past 50 years (I'm now 61) and cataract surgery (recommended two weeks ago my opthalmologist) seems like a miracle if I can have improved vision. I read your comments with great interest about monovision but didn't see anything about presbyopia correcting lens. I really want to make an informed decision and only found out about the presbyopia CL in my search for info on the internet. Can you give me some information? I guess I'm one of those boomers who "wants it all and right now".
To EGD, yes this can certainly be done after lasik with excellent results. In fact I just the exact thing for our office mananger's mother and she is 20/20 distance and near. Great care need to be taken to get exact corneal measurments preferably with a pentacam, orbscan or zeiss atlas toprapher in order to utililize the post-refractive lens calculation formaulas. Mistakes can be made if surgeon is not very familiar with these types of cases.
To Tuggy128 - that's really a big question. In my personal opinion I would go with distance for both eyes or distance one and mini-monovision in the non-dominant eye or last resort is crystalens which often utilizes mini-monovison anyway. I cannot really make a recommendation for any of the other presbyopia correcting lenses. Crystalens HD is the one least likely to cause terrible visual side effects but it can be off target sometimes, and may require a lasik or prk or piggyback lens procedure to tune up the vision for disappointed patients (this is done up to 10 % in some practices.) With my standard aspheric monofocal patients this type of tune up is something I would do about one in 500 patients or about 0.2% of the time.)
Thanks for your input. I really appreciate getting your professional insight to help with my decision. What vision I have left is worth preserving and I certainly want a good outcome without making things worse, or at least difficult to adjust to.
I had surgery on my right eye 6 days ago & am experiencing being öff balance" & not sure on my feet. Has anyone else experienced this? So far am not getting a good answer to my question. My doctor wanted to do the left eye 2 days from now & I cancelled that surgery until I get some answers. She put a contact lens in my left eye to bring it more in line with my right eye but that has not helped. Jo
Dea Michael J Kutryb
Thank you for your valuable suggestion on Mini Monovision.How much additional power can I add for near, in cases of Mini
Monovision cases?.
I would like to add one more point on suitable patients for mono vision,countries like India women prefeer
to weare saree.For them it is difficult to carry glass,I found they are the happiest people afeter this kind of surgery.
With Regards
Dr Marpuri
***@****
Thank you for your valuable suggestion on Mini Monovision.How much additional power can I add for near, in cases of Mini
Monovision cases?.
I would like to add one more point on suitable patients for mono vision,countries like India women prefeer
to weare saree.For them it is difficult to carry glass,I found they are the happiest people afeter this kind of surgery.
With Regards
Dr Marpuri
***@****
You can go up to -1.50 or all the way up to something like -2.75 or -3.00 (but then it is regular monovision.). But you need to have a feel for how you will adapt to those different degrees of myopia - a contact lens trial is helpful.
Michael Kutryb
Michael Kutryb
Dr.Kutryb,
I had cataract surgery done on the left eye 2 weeks back. Now I am able to see and read things which are at a distance of 20 inches to 30 inches (my computer screen) without the help of any glasses. My Dr. says that he tried to set the eye for distant vision but it has ended up being intermediate vision. He says when I get my right eye done he would set it for perfect distant vision. Here are my concerns.
1. Is 20 to 30 inches intermediate vision or near vision in the first place?
2. Will I not end up having depth perception issues with one eye set for distant vision and the other eye set for 20 to 30 inches. Currently with the combination of my operated left eye and the non-operated right eye I am having depth perception issues of varying degree while looking at things at different distances, even with corrective glasses on for the left eye (power is -0.75, the power seems to be fluctuating).
3. I do not mind wearing glasses but I want the perfect vision which I had before I developed cataracts. I am only 32 yrs old and never wore glasses. I do not want to have issues judging depth.
4. If I set my right eye too for 20 to 30 inches will there be no issues of depth perception at all? Is this advisable? If not, what is the best distance that I should get my right eye set to?
5. I do not mind wearing progressive glasses all through my life but I do not want to have issues judging depth all the time. What is my best option?
Please advice. I only have one shot left now. All you feedback / suggestions would be greatly appreciated.
Thanks,
Sri
I had cataract surgery done on the left eye 2 weeks back. Now I am able to see and read things which are at a distance of 20 inches to 30 inches (my computer screen) without the help of any glasses. My Dr. says that he tried to set the eye for distant vision but it has ended up being intermediate vision. He says when I get my right eye done he would set it for perfect distant vision. Here are my concerns.
1. Is 20 to 30 inches intermediate vision or near vision in the first place?
2. Will I not end up having depth perception issues with one eye set for distant vision and the other eye set for 20 to 30 inches. Currently with the combination of my operated left eye and the non-operated right eye I am having depth perception issues of varying degree while looking at things at different distances, even with corrective glasses on for the left eye (power is -0.75, the power seems to be fluctuating).
3. I do not mind wearing glasses but I want the perfect vision which I had before I developed cataracts. I am only 32 yrs old and never wore glasses. I do not want to have issues judging depth.
4. If I set my right eye too for 20 to 30 inches will there be no issues of depth perception at all? Is this advisable? If not, what is the best distance that I should get my right eye set to?
5. I do not mind wearing progressive glasses all through my life but I do not want to have issues judging depth all the time. What is my best option?
Please advice. I only have one shot left now. All you feedback / suggestions would be greatly appreciated.
Thanks,
Sri
I am very unhappy with the results of my surgery Mono vision. Can any of it be redone ?
Sorry, I should explain more. I am over 50, and cannot see from near or far. developed cataracts. made the decision to have one eye [right eye done for seeing close] and later left eye for distance. Terrible decision for me. I WISH I had made them both for near [reading] vision, and just worn glasses for distance. Now I can't see near or far. It is worse that when before the cataract surgery I had the sharpness of the distance, yet the blurreness when trying to use both eyes together. Same for the near. haven't got the two galsses yet, but how crappy to hav to need two different pairs of glasses. I was miserable at a dinner lastnight due to this very uncomfortable vision situation. Is there any way that i can get lasik or anything to get both eyes thae sme to see good for near ? I hate the mono vision. is was a terrible mistake for me. perhaps it works well for some. Pease doctor respond as soon as possible. thank you so much...bes7172, email ***@****
Gee, my vision must be so bad, that I can't even spell words right in the above post. Actually I'm a bad typist. Please help Dr. can .my cataract surgeries be changed to take the implant for distance out of the left eye. How risky is that ? Or is it even possible ? Can lasik be done now to help ? Thank you very much . This mono vision is horrible for me. The near in right eye is good but the distance in left causes extreme blurriness
I am going to have cataract surgeries shortly, and have to decide whether to go with mono vision or with distance for both. I am a golfer and tennis player, and very active 60 yr old woman. I am near sighted, and my visions are -6.5 on both eyes, and my right eye is dominant. My Dr let me try -6.5 for the right and -4.75 contact lenses for the left eye. I can read menu at restaurants and things at supermarket, but I can't read books comfortably in this combination. Among your patients, what percentage would choose mini-monovision over distance bor both ? Do you think I should try -6.5 and -5.25 (-1.25 from 6.5) as you suggested in your blog ? Thank you very much !
Dr. Kutryb,
Thank you for the information about mini-mono vision. I had a Toric implant put in m right eye one week ago since my Dr. said it was my only option since I had astigmatism. According to my eye exam yesterday, my distance vision is 20/30. I cannot see anything in the intermediate or near area with that eye and am very unhappy with the result. I really do not feel my distance vision is great with that eye, either. Now, the question is...should I go with only distance in my left eye or ask my surgeon to shoot for intermediate. I don't mind wearing glasses for reading. Any suggestions would be helpful.
Thanks you.
Thank you for the information about mini-mono vision. I had a Toric implant put in m right eye one week ago since my Dr. said it was my only option since I had astigmatism. According to my eye exam yesterday, my distance vision is 20/30. I cannot see anything in the intermediate or near area with that eye and am very unhappy with the result. I really do not feel my distance vision is great with that eye, either. Now, the question is...should I go with only distance in my left eye or ask my surgeon to shoot for intermediate. I don't mind wearing glasses for reading. Any suggestions would be helpful.
Thanks you.
I have in the Left Eye a Baush & Lomb Monofocal Lens Akreos Adapt Plus 12.5 diopters. My Right Eye has a bad Cataract with a -5 Myopia. I'm confused whether to replace it with a Monofocal Lens -1.5 or -2 which will give me a Blend Vision or should I replace it with a Multifocal Lens? Would you please let me know which Multifocal Lens is the more successful in my case? The Crystal Lens HD Version or the Restore Lens? I also heard good reports on the Tetraflex Lens. Some Doctors' opinions prefer not to mix Multifocal with Monofocal. They say that Multifocal works better on both Eyes rather than one? Please let me know?
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