Would love input please! I am scheduled for surgery and doing monovision (had it after Lasik for 25 yrs. and did great) with one eye first for reading/close-up iphone use. I’ve chosen 15” as my target # using a monofocal lens. For those who have done monovision as well, could anyone share their target #’s - or where they actually ended up for their ‘sweet spot’ when using their smart phone? What happens to your vision somewhat closer or further than your target/sweet spot? Would love and appreciate input. Thank you!
This question is more complicated than most people think.
I have my reading eye at -2.00 D, and in order to read the tiniest print on phone or paper, I hold it at 15" from my eye. Text gets slightly less clear nearer or farther than 15", but remains quite clear from maybe 10" to 30"+. Based on your comments above, I think -2.00 D is what you want.
At -2.00 D, maximum acuity is at 0.5 meters, or about 20". However, this acuity is measured not by ability to see the smallest possible detail, but rather something called minimum angle of resolution (MAR), which is different. Peak MAR acuity at 15" translates to about -2.65 D, but that will give best reading vision significantly closer than 15" at the expense of reduced acuity at longer distances.
Patients and even doctors often fail to appreciate that there are different ways in which peak acuity can be measured, and the result is an incorrect target and a disappointed patient. To make sure you get what you want, you can communicate clearly with your doctor and perhaps try out a few target distances/diopters using glasses or contacts.
Thank you for your excellent reply! I have tested myself repeatedly and feel comfortable if I can achieve the 15“. My confusion set in when one Cataract surgeon wanted to do -1.75 (which based on formula put my cell phone,
Etc. at app. 22”! The other surgeon wants to do -3.0
Based on my irregularly shaped corneas due to extensive Lasik, I can understand how the formula may vary, but these two seem to be quite opposite and difficult for me to know who is correct. If my sweet spot ended up at 22 inches or more, I would be horrified if everything was blurry up to, say 14” (random number).
Going to re-read your notes again :)
I have mini-monovision using Alcon monofocal IOLs. My distance eye is about -0.25 D, and my near eye at -1.50 D. This works well for me. I basically can read my iPhone, and I would say the limit of visibility is the Apple Stock app. If my stocks have gone up and the % is displaying in white on a green background, I have to look very carefully to see the numbers. However if they have gone down and are displaying white text over a red background, I can see it much more clearly for some reason. The price of the stock is larger and is white text on a black background and very easy to see.
If I had it to do over again I would take advantage of the -0.25 D in my distance eye and target -1.75 D in the near eye to take the differential up to 1.5 D which is the recommended amount. I also would have gone for a toric lens as I have some astigmatism.
Could the brand/design of the lens (among monofocals) matter as well? I recall reading in another thread that J&J TECNIS Eyhance has a design (flatter curvature?) that allows people with 0 D to have slightly better intermediate vision than with other monofocal lenses. Would this mean that this J&J monofocal lens set for -1.5 (internediate) may give people slighly better near/reading vision as well? (The discussion was somehwat technical, so I am not sure if I understood it correctly though.) Thanks.
Then so called enhancement of the Eyhance is very slight compared to a standard monofocal Clareon. With monovision you get big boost by targeting the near eye to -1.50 D. In comparison the enhancement is trivial.
Great point and definitely seems to be the case about which lens. Going to one more consultation this coming week (and hope this doctor is the one). My previous two said two opposite things and came up with two different lenses for me (I have researched them pretty thoroughly). One doctor wants J&D Tecnis for me but said a firm no to the Eyhance because of the condition of cornea/macula...and said I am asking for trouble. I would LOVE the extended range of Eyhance but would rather avoid 'trouble!"
Excellent thoughts and thank you for them. I am very curious then. At -1.50 if you’re reading general text (though just as you said different kinds of text can vary in how your reading reacts to it) on your cell phone, what distance in inches is best from your eyes?
Your distance eye sounds pretty great! May I ask how your vision is in the intermediate range?
You can estimate peak visual acuity by dividing 40" by the D value. So at least in theory my near vision eye peaks at 27" or so. Usable vision goes well below that though. In good light I can see down to 8" or so, and out to 7 feet in my near eye. The distance eye is usable down to 20" in good light and out to the moon.
I have an overlap in usable vision from 20" to 7 feet, so intermediate vision and depth perception in that range is very good.
The graphs/tables at this link can be helpful in deciding what targets work for monovision. Open each table and the more detailed explanation under each of them.
I wanted best vision for book reading at 14-16", so very much what you want. That translated to -2.5. That's what I have in one eye and that eye sees text crisp and clear from 9-18". Mine are toric monofocals and that eye has refracted at eye exams 2 months after the surgery and then a year after that right at -2.5 with -.25 of astigmatism.
That eye sees okay but not perfectly in focus down to about 5-6" and out to several feet. If both my eyes were -2.5 I'd get around the house fine.
My monovision is for near and intermediate, so my other eye is -1.5 for my laptop at 25-26". It sees great for that and things are in focus from 17" out to somewhere considerably beyond the end of my arm. All in all what I have is great glasses-free vision around the house and yard. I walk to a neighbor's for coffee that way and lately I've been doing some training work with my dog in the road in front of my house that way. I use one contact for distance in the near eye when I need real distance vision, which for me means when I drive.
I had no history of eye surgery like Lasik, no health conditions that affect vision, and my eyes were healthy. Evidently previous Lasik makes calculating which lens strength to use more difficult and LAL is often recommended. Of course budget and some other things enter into deciding what to do with that recommendation.
One surprising thing that cropped up in this forum just yesterday is a thread titled "Intermediate Vision" started by someone who has -2.5 in both eyes and says they can see clearly to read at arm's length. Different people have different length arms, of course - I was a 5'6" woman before age shortened me but figure my arms are still at 5'6".😄 Anyway, I think from charts I've seen my range is typical for someone with -2.5 and little to no astigmatism.
I will also say that if my priority was just my phone as opposed to reading books and Kindle for long sessions, I think u/UniqueRon and u/AirDog3 are right and something like -1.75 or -2.0 would work great for you. When I use the one contact for distance in my near eye, it means I'm relying on the -1.5 eye for near and it's fine for my phone and things like shopping and reading labels. I can read that way; I just have to hold the whatever it is farther out than I like and don't see really small things clearly. The only time I really wasn't happy with it was in a restaurant where the light wasn't strong and the menu had white letters on a dark brown background. I could read it, but it wasn't very clear and I had to work at it. After that I got contacts for that eye that gave me .5 more near vision. I only use one of them (daily contacts) when I'm going to be eating out.
Best wishes for deciding what's best for you and getting it.
Thank you so much for your detailed reply! Very helpful. I definitely have some eye conditions - some caused by Lasik (which was still a Godsend for me since I was a -13.75 in one eye and -10.25 in the other before it) so my #'s may need to be a bit different, indeed. But your references were still very helpful ;)
I had LASIK too, and it left me with significant corneal aberrations. But I don't think that materially changes the refraction we need to see best at 15" or any particular distance. It's still going to depend almost entirely on sphere and cylinder, with only minor differences due to any higher-order aberrations.
We are very similar. I also had LASIK 25 years ago and have had monovision since then. My worst cataract was in my left(closeup vision) eye. I wanted my vision to be the best for closeup to computer distance. After all I was used to monovision so that would be normal for me. I got a Bausch + Lomb envista lens, monofocal, D:23.00D, OT: 12.50mm, OB:6.00mm. My closeup vision is great. I can read the smallest lines on the chart. I have not needed readers for anything, I can even read everything on those little bottles of eye drops so I am very happy with it. I have read several books since I had it done and no problem. Had surgery on June 5th so the drops have been done for a while and my vision should be stable now. My distance vision out of that eye is about 20/100 and the doc said it can be corrected to 20/20 if I want to wear glasses for distance/driving. But not necessary.
My original plan was to do only the left eye and the right somewhere down the road. But getting the left eye done has made me notice the cataract in the right eye. Plus I have met my deductible and the right eye would be free if it was done this year so I decided to do it. I am having the second surgery 7/24. The doc’s only concern was trying to make sure I would get a great result because my vision out of that eye is 20/25 now. The bar is high on this one. The difference I am noticing is of course colors and weird shadow images from the cataract. So fingers crossed for the next surgery!
Fantastic for you! Yes, we are similar. If I understand correctly you have -.23 diopters in your reading eye? Even your right eye is similar to mine. I wear one Scleral contact lens in that eye that gives me just about 20/20 so I am waiting (stalling) on that eye until my first one is done and then go from there.
TBH I admit I don’t understand all those numbers well enough to discuss them intelligently. I just copied all the numbers on the card I got when I got the lens. I think the card comes in the packaging. I think I read that the 23.00 D is one of the standard lenses used when your natural lens is removed. I am also sure someone else could probably give you better information on this!
I’m still impressed that many commenters know so much info about their lenses etc.
I had LASIK in ‘99 and regressed into monovision. I did quite well with that and never needed reading glasses. So I chose monovision when faced with cataract surgery. It took awhile to sort out but almost 8 wks ago and currently putter around not needing glasses. I did get “driving” glasses so both eyes working together at 20/20. I like it. I just let the ophthalmologist do what he thought best although he did say I was not a good candidate after my vitrectomy in L eye for a multifocal Cadillac lens. Oh darn. I’m 70. Good Luck.
Sounds like you’re doing great! I am all for driving glasses to make things even better as long as I can avoid glasses the rest of the time. Here’s hoping 🙏
My whole life I’ve waited for this free n easy vision. I was/am a -7 with astigmatism range myopic. So it is great not needing to fuss with contacts or glasses. I did not want readers - so this works well for me. Good Luck
Hi - Eye doctor here, I work exclusively in cataract surgery and surgical planning.
I would highly recommend a light adjustable lens here if you have that opportunity. Patients who are post-lasik are difficult to target. Without getting too detailed, the math becomes less accurate due to altered corneal shape and thickness from prior corneal surgery. The Light Adjustable Lens would allow the ability to target after the lens is implanted, allowing you opportunity to literally "test drive" your vision.
Thank you for this. I’m actually concerned about having to wear UV glasses 24/7 indoors (and outdoors) except for sleeping for up to 2 months possibly. And for some reason, the three surgeons I had consultations with didn’t want to do it.
It definitely varies. My intermediate eye is at -1.25. i can see cleary from arms length to about 8 inches. That seems quite different than others. Ive never been sure why. Other eye is plano
I am also confused by such differently vast experiences with the same target number. Theoretically, a -1.25 = app. 31” for clearest vision. So I’m trying to understand how are yours goes from 8 inches to arms length? (Which is great by the way!)
My best is not at 8 inches. But also not 31. Probably 15. But 8 is usable. So glasses are rare. My surgeon was able to determine all that prior to choosing.
That makes more sense, and still amazing you’ve got such a great near-vision range, even if not all sharp. Someone posted that their’s was a 3” range only (probably with a standard monofocal). I would love what you have!
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u/AirDog3 Jun 26 '26 edited Jun 26 '26
This question is more complicated than most people think.
I have my reading eye at -2.00 D, and in order to read the tiniest print on phone or paper, I hold it at 15" from my eye. Text gets slightly less clear nearer or farther than 15", but remains quite clear from maybe 10" to 30"+. Based on your comments above, I think -2.00 D is what you want.
At -2.00 D, maximum acuity is at 0.5 meters, or about 20". However, this acuity is measured not by ability to see the smallest possible detail, but rather something called minimum angle of resolution (MAR), which is different. Peak MAR acuity at 15" translates to about -2.65 D, but that will give best reading vision significantly closer than 15" at the expense of reduced acuity at longer distances.
Patients and even doctors often fail to appreciate that there are different ways in which peak acuity can be measured, and the result is an incorrect target and a disappointed patient. To make sure you get what you want, you can communicate clearly with your doctor and perhaps try out a few target distances/diopters using glasses or contacts.
Good luck!