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