issues relating to monocular vision after cataract surgery

[dorisb]

I will have cataract surgery in Dec and Jan.  My surgeon wants to give me fixed focus IOLs for distance only in both eyes because I have too much astigmatism for any multifocus lens.  During my cataract surgery, he will also correct my astigmatism with AK.  
My surgeon recommends against monocular vision because of depth perception issues.  However, for many years, I very successfully had a distance contact lens in my dominant (right) eye and a reading contact lens in my left eye.  
I want to request that a

[dorisb]

I appreciate the information, although yes, it does worry me.  So I'd like to know what the tests are that an eye doctor can perform to rule out possible defects in my binocular vision system.  I'll be phoning him tomorrow to discuss all these issues.

You mentioned strabismus.  Isn't that the condition where eyeballs wiggle involuntarily?  I'm the only person I've ever known who can voluntarily cause my eyeballs to "jitter".  I discovered this "ability" as a child and used to freak out my friends.  Do you think this should be mentioned to my surgeon?

[JodieJ]

I'm hesitant to answer your question because I don't want to scare you again, although I've posted this info elsewhere.  I developed binocular vision problems from doing monovision!  As I understand it, monovision activated what had previously been a latent defect in my visual processing system, and my eyes began to lose the ability to work together as team.  I started experiencing fleeting episodes of double vision (with an eye turning inward), which became more frequent over time.  And the optometrists and ophthalmologist I consulted didn't know what was causing the problem or what to do about it.  My own research eventually got me to a strabismus surgeon, and a 40-minute outpatient procedure completely eliminated my symptoms.  But I was warned not to do monovision again, and I'm still mourning the loss (after more than a year.)

It's extremely rare for monovision to cause such problems.  And there are some simple tests that an eye doctor can perform to rule out possible defects in your binocular vision system.

[dorisb]

Jodie, you were quite right that my surgeon scared me.  I'm 70 and don't want to fall and break any bones.

Like you, I never noticed any loss of depth perception when wearing monovision contact lenses but didn't realize that one would be aware of the problem. I imagined it to be some sort of unseen force that only a formal assessment could evaluate -- similarly to my surgeon telling me years ago I was developing cataracts, before I was aware of it.  Thanks so much for setting me straight.  Your very vivid description of what the loss was like to you is very helpful to me.

I'm curious about your binocular vision problems.  How did they develop and how did you overcome them?

[janjan99]

Hi I had monofocal iol implanted for distance in April and June.  I love mine.  Have not had any problems with depth perceptions and night vision.  From reading what others here wrote about multifocal and halos with driving at night, I didn't want to chance it.  I read computer, watch tv and drive during the day just fine without glasses.  I find I am more comfortable driving at night with my glasses (everything is sharper).  I do need my reading glasses for small print and sewing, but that all.  

My dr. gave me a prescription to change the lens in the operated eye, so that i could still drive and function after the first surgery.  

Hope this helps

Jan

[JodieJ]

In my experience, people either love monovision or they hate it.  If you were successful with monovision contacts, then why are you so hesistant about doing monovision with IOLs?  During my four years of successful monovision contact lens wear, my loss of depth perception was so subtle that I never even noticed it.  (Did you notice it yourself?)  At a later time, however, when I truly did experience impaired depth perception due to binocular vision problems, such activities as walking down stairs became so terrifying that I'd cling to the banister for dear life.  In other words, you don't need a formal assessment to tell whether your depth perception (or lack thereof) is a problem.

I'm guessing that your surgeon's experience with monovision is entirely theoretical/academic, and s/he is scaring you unnecessarily about depth perception issues.  One of the cataract surgeons I consulted has used monovision contacts himself for many years, and he told me confidentially that he believed monovision to be far superior to the multifocal/accomodating IOLs which he implants in his patients.  (This converation naturally took place after we agreed that I was not a candidate for multifocal/accomodating IOLs.)  And from everything I've read in journal articles, successful monovision contact lens wearers are quite happy with IOLs set for monovision.

[dorisb]

Jan,

Sounds like both your eyes are set for distance and you're really happy with the results.  I'm looking to mix and match my eyes and hope I'll be as happy as you are.

Thanks for your post.