Need advice on selecting dominant eye IOL

[SinisterOcular]

I'm posting this here specifically because Dr. Hagan also is a shooter, and I have questions about which IOL to select for my dominant eye to best accommodate my shooting needs.

I'm soon to be 60 and had been blessed with such exceptional eyesight that I never needed glasses until my late 40s (slightly far-sighted, no astigmatism), which was about the same time the first cataract appeared.  Last year I had the more advanced cataract removed from my non-dominant (left) eye and was fitted with an IOL.  I took the decision to go with monovision because it optimally could leave me needing spectacles least often, so the non-dominant IOL is for near vision.  My ophthalmologist had me try a contact lens to simulate the monovision and my adaptation to it was almost instantaneous.  The IOL is an Alcon SN60WF, power 22.5 D.

I do IT for a living and quite often find my head stuck inside of a computer and having to read small print on circuitry components just inches away.  I also still am outdoorsy and didn't want to have to be dependent on spectacles for things like disassembling a gun or tying a lure on a fishing line or adjusting the derailleurs on my bicycle, so my prime objective for the left eye was to be able to do all those fiddly close-up tasks unaided.  My ophthalmologist hit the target focal distance exactly and I have perfect clarity from about 8" to 18" and can read ridiculously small print in most any lighting condition.

But now the dominant (right) eye needs the cataract removed.  And since the non-dominant eye was done to accommodate how I earn my living, I want the dominant eye done to accommodate my lifestyle.  I do everything from wing shooting to small game to big game and predator hunting, plus I have a handgun permit and regularly practice defensive shooting.  Based on earlier posts from Dr. Hagan, I see the purchase of a lot of holographic red dot optics in my future, but I need advice on which focal length of IOL would best accommodate my use of a telescopic sight.  Ideally, for hunting I obviously would want a longer focal distance IOL to be able to spot my prey.  One problem I presently am having (owing to the cataract in my dominant eye) is I can't tell a dove from a non-game bird until it is quite close, but shooting a song bird would put me in dutch with the game & fish folks.

So the operative questions are, if I get an IOL in the dominant eye to support a quite long focal distance, such as would favor spotting prey at a few hundred yards, how will that impact my ability to use a high magnification telescopic sight.  All scopes have some measure of diopter adjustment, but I don't know if that is enough to allow a "distance vision" IOL to clearly see the scope's reticle.  And second, would there be any drawbacks to having such a long focal distance in the dominant eye when the non-dominant eye's focal distance is quite short.

Thank you for your time.

[JohnHaganMD]

Yes best of luck.  I remember that episode of Twilight Zone also. Always a pleasure to speak to someone that understands the importance of 'the second".

JCH MD

[SinisterOcular]

I didn't note it specifically but I think I recall him stating the refraction in the LE (OS) was 2.25, so you pretty well bracketed that number.

I won't be heartbroken if I need spectacles for some limited functions, but I still have some moderately risky hobbies where the inability to see small details close-up could put me in a serious pickle.  I never want to be put in that sort of a predicament for lack of eyeglasses (as a child, I was traumatized by that Burgess Meredith episode on the Twilight Zone ;) ), so the uncompromised near vision was a deal-breaker.

I though I had made a rational decision but it was only after I had had the non-dominant eye done that it occurred to me I should have been considering my eyes as a system and not separate and independent components.  Only after did I consider that a long fixed focus in the dominant eye probably would leave me unable to focus on a front sight, which your other posts confirmed.  But I didn't take for bad news.  Fortunately, it's becoming more "normal" to use red dots on handguns, even self-defense sidearms (Glock only just has begun selling guns with a factory red dot).  Plus, now I have a medical excuse.

I've tested with a couple of Aimpoints I already have and found I can use them fine as I am now, regardless which eye I sight through the optic with, but that's largely because I always shoot with both eyes open.  Even the near vision non-dominant eye can see the red dot relatively clearly, and the dominant eye superimposes the target image on it.  However, I'm aware I still have adaptive focus in the dominant eye, so I've been particularly anxious about how the change to a fixed focal length would affect the use of telescopic sights.

I understand the concept (and function) of circles of confusion, so I also understand the point about peep sights.  I hadn't considered the implication but I already have a shotgun and a .22 rifle with peep sights, which certainly gives me a leg up.

Doc, thank you so very much for the information.  I love my ophthalmologist and was exceedingly satisfied with the result of the first surgery, but he's neither a hunter nor a shooter, so he wasn't in a position to make me comfortable with his advice in this regard.  I consider this a very weighty decision, not only because it involves surgery to such a critical sense organ, but also because of the potential impact on some of the things I enjoy most in life.  It is a tremendous comfort to get such an unequivocal answer from someone who can speak directly and authoritatively to my concerns.  I am beholding to you.

[JohnHaganMD]

Sinister:   I'm sure you've read this post but for anyone picking up this thread this is important basic information. SEE:  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You

Do you know what your refraction is in the non-dominant LE? I suspect about -2.00 to -2.50.

If you correct your dominant RE for distance your RX will be zero or what we call "plano".  The refractive choice is "full monofocal"  Since you have used a contact lens to simulate this and liked it you may do better than most people that try it for the first time after cataract surgery and have big problems.  Know also that if you did not adjust to full monofocal after surgery on both eyes the "fix" may not make you happy since it would be correct the reading eye with lasik and you would need progressive multifocal glasses or and IOL exchange on one of the eyes.

You might be able to find some articles on this in shooting magazines and websites. If you have reasonably small pupils (which create a peep-sight) you might have a reasonably clear sight picture with a shotgun and ramp sight.

If you have plano in your RE post op you will have no trouble using a red dot holographic sight or a telescopic sight.  However telescopic sights allow dialing in hyperopic + or myopic -  correction so even if a person has a -2.50 distance RX they would be able to dial that in and shoot without glasses but the easiest and what I do is just wear my glasses when I shoot.  Binoculars (high quality) allow eyes to be corrected individually. So you could dial in on your LE -2.25 (or whatever your distanceRX is) and plano on the RE and use binoculars without glasses just fine.

Best of luck.

JCH MD

[SinisterOcular]

I should add that owing to previous unsuccessful trials with multifocal contact lenses, I only am considering a monofocal IOL.