Modified monovision?

[mmrudy]

I plan cataract surgery for my non-dominant left eye in three weeks. I've worn progressive eyeglasses for ~18 years, bifocals or singles since 1950 or so. MR data on the left: -6.50 sph; +1.50 cyl. Further testing indicates the astigmatism is closer to +2.

The cataract is small but nicely centered on the left lens and is both anterior and posterior. I also have guttata, 2-3+ and PVD, not a happy combination. Thus, I'm not a candidate for multi-focal or adaptive lenses, or LRI, or laser correction. I am considering an Alcon toric for the left eye. Otherwise, it will be the Alcon aspheric. I expect to wear glasses. Cost isn't a consideration.

I'm trying to determine what target to set. The surgeon suggests plano, but I'm thinking something between -.75 to -1.5. (I'll want plano in the right, dominant, eye at a later date.) It would help to know the following:

Is there a table showing vision range for each diopter retained? Previous messages to this board seem to indicate, for example, that a -1.25 gives a range of ~30" to 15'. I can calculate the focal point, but I'm hazy on the range of vision available at each focal point.

Is there a way to find out if I'll be able to handle modified monovision? I rarely have binocular vision, probably due to a "lazy" eye in my youth, not diagnosed as amblyopia. For the last three months, I have not much used the left eye for distance. I do use it for reading without glasses (love the near vision). Don't use it often for reading with glasses. I do use both eyes with the computer despite the blurriness. I don't think I am a good candidate for a trial with contacts. The last time I tried them, about 1996, I had trouble getting them in and more trouble popping them out.

Finally, considering the guttata and PVD...would it be better to schedule cataract surgery for the right eye (trace cataract at this time) sooner rather than later?

My dominant right eye is corrected to 20/50 with glasses, if I'm reading the chart correctly. Sph is -6.75, Cyl is -1.5 but astigmatism should be +.25 after the lens is removed.

[John C Hagan III, MD, FACS, FAAO]

Glad to be of service. Don't say doctors never gave you anything other than a bill.

JCH MD

[mmrudy]

Thanks for your comments and advice. My surgeon must be in league with Dr. Hagan (or great minds think alike) as he also recommends the -1.25/-.5 solution as "making most people quite happy". He foresees no long term difficulties adjusting after the right eye gets an IOL.

Jodie, like you, his assistant, a PA?,  suggested a contact lens as an interim solution for the imbalance problem. That should be interesting, but I won't borrow trouble. I did learn that I have three trace cataracts in the right eye. The second surgery may occur sooner than expected!

This forum, the experience of others, has been helpful to (a) organize my thoughts (b) know what questions to ask (c) learn the terminology.

[John C Hagan III, MD, FACS, FAAO]

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[JodieJ]

You sound like a great candidate for Alcon's toric IOL.  It could reduce/eliminate your astigmatism, giving you better uncorrected vision.

Elsewhere on this forum Dr. Hagan has suggested targets of -.25 (dominant eye) and -1.25 (non-dominant eye) for modified monovision.  I'm a little concerned about how you will cope between surgeries with your dominant eye -6.75 (plus astigmatism) and your non-dominant eye about -1.25.  I don't believe that glasses would work; you'd have to wear a contact lens in your right eye to have comfortable vision.  With your dominant eye corrected to near plano with an implant, you could always reverse your modified monovision by wearing progressive glasses.