what does monovision mean

[miria]

my MD discussed monovision with a monofocal lens implant. Does monovision  mean different settings for each eye- one with distance, the other near, with poor depth perception? I already have Restor 3 multifocal in one eye, with fairly good distance vision 20/25, but poor near and poor intermediate. We are discussing implanting a monofocal lens in the other eye, which has a severe cataract,  setting  the monofocal for near vision. Would this be what is meant by monovision?
Are these mix and math implants successful or are they problematic? How would I know beforehand if I am a good candidate for mix and match.?
Is  this also what is meant by blended vision>?I see the terms on the discussion forum but the terms are new to me

[miria]

Dear Dr. Hagen
I have looked through the archives and have not been able to find a guide to my specific concerns, which is why I posed my questions..  
What is the likelihood of "imbalance"  If the Restor multifocal is left in place and the other eye with the proposed monofocal lens is set for near vision so I can be more comfortable reading?  How is blended vision achieved and monovision avoided if it is problematic?
. You mentioned that monovision means that one eye is focused on distance and the other on near and they don't work well together. How is this addressed post-surgery if it occurs? What are the ways of restoring balance? I know there is info on monovision and blended vision in the archives,but I am still  not clear about all this though  I went through the archives.
" Thank you for your time and replies

[miria]

  Thank you again Dr. Hagen for your reply.
I have Restor 3 in the R eye for a year now, and got poor results with intermediate and near vision (can't  read without abt 3.5 readers and don't use that eye to read;  i read with with myopic L eye), but fairly good distance (20/25, 20/30) with R eye.. An opaque capsule formed right after surgery and a YAG is recommended.which will hopefully,improve distance vision even more in R eye..

THe question is what setting  is best for the other eye, that needs cataract surgery.. The MD says I would be best with a monofocal. I am a voracious reader, a reading teacher, and currently read  with my very L  myopic eye, but it's getting worse and hold the print closer and closer (and sometimes have been using -4 readers when I read with a student or use the computer). I am very worried about losing the ability to read  like I do now.. Problems reading with the Restor have been very distressing, and not what I was told to expect presurgery.

I am not clear from your reply re blended and monovision, what settings would assure that i get balanced blended vision, with both eyes working together, and blending comfortably. The Restor 3 is in place. . in the R eye, and if I understand the characteristics of the this lens, it was set for both distance and near, but the reality didn't work out that way, with poor near vision.  If the monofocal in my L eye is set for near, would that mean monovision, which you wrote is problematic?

How can I get blended and not monovision?

What happens when, post-surgery, someone is left with an "imbalance/" What does that mean in terms of life functioning? And, if it happens, how can it be corrected? Surgery, laser, explant?

I am very worried about making the best choices for the next step, and don't want a repeat of the problems I had.

That  my eyes are currently so disparate --I  have fairly good distance vision out of Restor R eye but  poor near/intermediate vision, and, with L cataract myopic eye, read but terrible distance-  can't even read the E anymore on eye chart. Isn't this "imbalance."?

By the way I live in NYC and have access to many fine surgeons.

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

blended vision = eyes work together to pick up different distances   ie distance and mid or mid and near     mono vision one eye distance other eye near don't work together.

mono vision no depth perception    blended fair to good depth perception

blended glasses work good monovision glasses often uncomfortable and not tolerated

JCH MD

[miria]

Thank you for your reply. Is monovision the same blended vision? Does monovision mean a fixed setting in one eye, that would decrease depth perception if the other eye doesn't have the same setting?

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

Monofocal means it has a single focal length.  Whereas a ReStor has many focal lengths (multifocal) or the Crystalens changes shape (accommodating) and has changing focal lengths.

A monofocal lens can be set for distance ( greater than 20 feet) and if an eye is healthy and does not have astigmatism it will see 20/20 further than 20 feet away but as things move closer glasses will be need to put the eye in focus. Or the eye can be left with minus focus power which will help a near (say -1.00 for computer, shop, speedometer and read in good light if print not to small.

Mix and match is common. Monofocal and multifocal is common. Monofocals are much less problem prone than multifocal and accommodating IOLs.


  Attempting to leave your cataract eye a -1.25 would generally give good intermediate and some reading in good light. Prolonged reading or computer would likely require no line bifocals.  

JCH MD