about monofocal iols, please

[betheplunk]

I'm recently diagnosed with cataracts, so now I have to make the lens decision.  From all I've read, the choice seems to come down to quality of image versus relative freedom from glasses.  I'm curious about how it would be to have long-range monofocals in both eyes.  From what I've read, it seems that double long-range lenses would give me the best clarity of image, depth of field, and almost no side-effects from 20+ feet in all light conditions.  I'm active outdoors -- hike, mountain bike, golf -- so optimal distance seems like a good goal, and I can accept glasses for near.  (That's how I live now.)  But what is the image quality WITHOUT GLASSES likely to be for near and mid-range?  Functional but not sharp?  Non-functional and helpless?  (I know those are subjective, but I'd like to hear what your patients have experienced and whatever you can safely estimate.)  Thanks, David

[JodieJ]

I have aspheric monofocal IOLs set at plano in both eyes.  My distance acuity is 20/15 in one eye and 20/20+ in my eye with a history of retinal disease.  (Yes, my distance vision is great!)  But everything within arm's length is blurry.  I need glasses for using the computer, cooking,  and all near vision tasks.  (I can read some restaurant menus in good light without glasses, but I have to squint.)

In the Community Eye Care Forum, Dr. Hagan recently posted a study of the results of "blended vision" (aka modified monovision) with monofocal IOLs.  As I recall, about 25% of the patients reported being spectacle free after surgery.  (I suspect that these patients weren't avid readers.)  My friend with this correction only needs glasses (from the drug store) for seeing small print or for prolonged reading.  I think that this is at least as good as what you'd get with the Crystalens HD, with much less risk of post surgery problems and no out-of-pocket surcharge.  I'd recommend that you seriously consider this option.

[Sandy Feldman, MD, MS]

Dear betheplunk,

Monofocal IOL’s do have some complications of glare and halo but much less induction than multifocal implants.  If you already have good distance and understand the loss of near, a constant dependence on reading glasses for midrange and near tasks, including reading a menu, computer, eating, shaving, etc., it should not be too different than what you already experience.  The exact “blur” at these distances will depend upon what prescription is left in your eye [i.e. astigmatism] and your ability to tolerate this.  Speak with your eyeMD further if you have any questions.

Dr. Feldman

Sandy T. Feldman, M.D., M.S.
ClearView Eye and Laser Medical Center
San Diego, California

[betheplunk]

Hi, londonbridge -

Yes, your experience helps very much.  My surgery is set for July 30 -- more than a month away.  I'll post my experience once I've gone through the recovery process.

Thanks for your help,
David from Massachusetts

[londonbridge]

Hi betheplunk,
I have my dominant eye with a distance contact and non dominant set for mid distance with a toric monofocal IOL, essentially the exact thing you are considering. I am pleased so far and function well for most circumstances without glasses. I do need glasses over my contact for reading and to correct a minor astigmatism. (Because my dominant eye is -7.5 and my new IOL eye is -.25 , mid distance focal point about arms length) I cannot wear glasses at all without my contact, but I am making do for now. When I need my other eye done, I will go for as close to plano for distance as I can.
Hope this helps.
londonbridge

[JodieJ]

Sounds like a good plan.  With all the disposable contacts now on the market, it shouldn't be expensive to experiment.

[betheplunk]

Thanks, JodieJ,

It's very helpful to hear from someone who has gone down the path I'm considering.  Since I'll have some time before I need to have my non-dominant eye worked on, I think I'll go with a longer traditional lens in my dominant eye and and experiment with different contacts in the non-dominant eye to see what I like.  This could get expensive, but I'll feel better with the final reslt.

Best,
David from Massachusetts