Mini-Monovision and we have narrowed down to 2 surgeons. Dr Hagan please advice!

[Researching4Wife]

We have narrowed our choice to two excellent surgeons, both with 10,000 operations etc.Both recommended Mini-Monovision over multifocals, but both recommend different directions.

First for patient facts:

Posterior subcapsular cataract (PSC) in both eyes, patient in early 40s and has never worn glasses or contacts! Only 2 Months ago first sign of blurry vision.

Current status-
Left eye cataract: Very dense.
Right eye cataract: Semi dense but changing.
Dominant eye- No one knows truly. Currently Right eye is dominant but that could be because left eye has bad visibility. Patient is right handed and writes and throws with right hand.


SURGEON-A

- Will operate left eye first (dense cataract eye) and set it for plano or -0.20

-  Right eye 1 month later or more and set it for -1.0 or -1.20

- So a difference of 1 diopter

SURGEON-B

- Will operate both eyes together or if we prefer, left eye only first. He will set left for -1.60

- Right eye for -0.2 a month later

- Difference of 1.40 diopter, with Right eye set for far unlike Left eye for far like Surgeon-A

______________________________________________

Worst outcome for patient: Needing glasses for near and far!!!!

Ideal outcome for patient: Needing glasses for near only!


Based on the above data, Dr Hagan, would you reccomend Surgeon A or Surgeon B?

[JohnHaganMD]

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[JohnHaganMD]

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[JohnHaganMD]

I wrote a long answer out which apparently the MEDHELP software has destroyed or deleted.  MY short answer. I would never go to any surgeon that routinely operates on both eyes at the same time.

[Researching4Wife]

Thanks for replying though Dr Hagan! My loss I guess with the Medhelp forum malfunction! I normally copy the text before hitting submit as I have lost long posts on so many forums.

I am in Europe and it seems lot of surgeons operate both eyes on same day these days. I would never go for it though.


One final question! Taking the possibility of error shooting .05 Diopter either way, which Mono-Vision combination would make most sense to you?

-.02 & -1.60     (Difference of 1.4 Diopter)

vs  

-.02 & -1.02  (Difference of 1 Diopter)


Thank you very much.

[JohnHaganMD]

Most people would not be able to tell any difference between those two.   It's also ridiculous to target -0.02  as the margin of error is +/-  0.25 diopter      So Plano  in distance eye and -1.50 in near biased eye works well.  Close to what my wife had when she had cataract surgery.

[Researching4Wife]

Sorry that was -0.2 (like in opening post) and not -.02 :-)

"So Plano  in distance eye and -1.50 in near biased eye works well.  "

So that would be close to -0.2 & -1.60   (Difference of 1.4 Diopter). The reason I was not targetting plano is that due to error it could go for example +.25 and that would be wasted range.

[JohnHaganMD]

As I said most people would not be able to tell the difference between the two.    using -0.25 as a target for distance is something surgeons frequently do.   With the error range it allows  plano to -0.50    The goal is not to leave the eye hyperopic (+) numbers