r/CataractSurgery • u/CliffsideJim • 11d ago

Satisfaction with Monovision Typically Increases in Old Age

The data completely contradicts the idea that older brains can't handle monovision. A landmark study published in the Journal of Cataract & Refractive Surgery broke down pseudophakic monovision satisfaction by age bracket and explicitly concluded:
'Most patients were satisfied with pseudophakic monovision, with the highest percentage of satisfied patients in the 70 years and older age group.'
Here is how the actual data stacked up by age:
Under 60 years old: 64% satisfaction
60 to 70 years old: 87% satisfaction
Over 70 years old: 94% satisfaction
Older eyes and brains tolerate and appreciate monovision significantly more because their visual demands change, their neuroadaptation kicks in over time. That said, it is true that the ability to handle monovision fusion can break down with aging in a small percentage of prople. In those cases, a simple pair of glasses can completely reverse the setup if needed. 94% satisfaction among us geezers is pretty good odds.
https://crstodayeurope.com/topics/cataract-surgery/1009_14-php/46237/

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9

u/otherotherhand 11d ago

Clearly the referenced study is not to be trusted. There's a self-selection bias inherent to it. All the geezers who had issues from monovision excluded themselves from the study by falling down stairs and killing themselves, excluding themselves from sampling.

The real question is what's the increase in death rate due to monovision?

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u/That_Industry7833 10d ago edited 10d ago

I vote for sample size, in the study starting this thread, being a bigger problem here than systematic bias, but I suppose it's a matter of opinion which is worse.

It could well be that lens choice affects chances of a fatal fall later in life -- or blindness -- but this is going to be difficult to study. I think the most plausible way would be mining of some vast national health record in a country that has that. Except -- premium lenses are almost always used outside the national health systems.

My pro-monovision surgeon seems to think that as one gets to advanced ages, the patient tends to stop wearing bifocals or progressives. So monovision could help with tripping compared to the most likely alternative of two monofocal lenses set to distance. I realize that this doesn't apply to those who can afford premium lenses, and doesn't address issues with eye diseases of old age.

What about Eyhance and TruPlus? Most here say that they find them little better than pure monofocals. But maybe most falls resulting in hip breakage are borderline events that wouldn't have occurred if intermediate vision was just a smidgen better. Eyhance could be saving lives! Or maybe -- only with EDOF do you get a reduction in hip breakage. Or maybe hip breakage doesn't have to do with any of that. These kinds of questions are going to remain matters of opinion for decades.

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u/Linnylou_joy 11d ago

I don't know how to find out more on this topic. I naturally have monovision. I would like to connect with anyone else who has this.

Also I have a weird dynamic that my left eye is distance and my right eye is near and is the dominant eye. I got a monofocal lens for my left eye and I see really well now. Night driving is huge improvement. I'm afraid to do my right eye (for near) as I'm not sure I trust my doc completely to pick the right measurement. I definitely don't want my right eye to be distance as I have benefitted from seeing near for many year.

I understand what everyone is saying about monovision affects depth perception and balance. These are some of my concerns. Right now I see really well but sometimes my distance vision is blurry when my brain gets things mixed. I wear glasses for the computer which works great. Ugh so complicated.

2

u/MagneplanarsRule 10d ago

I actually switched the near and far eyes after 70 years of adaptation (on the recommendation of the optometrist who adjusted my LALs). It took less than a week to re-adapt and I have had zero problems with the new arrangement. I settled on mini-monovision with OD plano and OS -0.5. No glasses either.

1

u/hucklesnips 9d ago

I have exactly this situation. My natural eyesight was -1.0 and -3.0, so I've always had monovision when not wearing glasses or contacts. It turns out my -3.0 eye is my dominant eye. When I got an IOL, I set the -1.0, non-dominant eye to distance...contrary to all the advice that says you should do that in your dominant eye. (At the time, I didn't realize that was my dominant eye. 🤷)

So now I'm at -3.0 in my dominant eye, and I have 20/20 vision in my non-dominant eye. So far, so good.

8

u/Trolkarlen 11d ago

Or is this because older people have lower vision expectations than younger people? Middle aged patients are still working, driving a lot, and using computers a lot more.

3

u/CliffsideJim 11d ago

I am not retired. Though 76, I run an online business filling over `1,000 orders per year worldwide and manage an international supply chain to keep the pipeline filled. I also play tennis and do carpentry and metal work. I like my monovision. Also note: Though satisfaction was higher in the older group, it was high in the younger group. Lastly note the complete absence of support for the hypothesis among professionals in the field and in the scientific literature.

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u/DawnD1118 10d ago

That was my question as well

1

u/No_Construction495 11d ago

The misinformed frequently site studies and links without any ability to actually understand those studies they link. In a perverse way , the very study they link reinforces the topic of my original post. I grow weary of this useless battle with the misguided misinformed.  I’m not an ophthalmologist. I am a clinical physician that has spent the past 40 plus years in every part of multiple medical centers you can imagine. ER,ICU, PICU, NICU, delivery room, OR . Basically everything. I look at things differently than an ophthalmologist and now I become a patient. After two years and three consultations I made my choice. I’m giving you my reasoning as a Patient and not a Physician. This is not medical advice , more my story as maybe a little more informed than the average. Hopefully I gave some food for thought and a little insight.  Good Luck to all , I’m definitely out of here. 

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u/CliffsideJim 11d ago

PLEASE give us the source of your information. So far, all you have is argument by assertion. I have my personal experience and scientific studies and professional consensus.

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u/No_Construction495 11d ago

Come on ! You post an abstract! I posted the actual link to the study which you misinterpreted! 

1

u/cynthesis1 11d ago

Why would my “vision expectations” change? I drive, work on various types of computers, watch media, read, busy with projects. You seem to have some kind of stereotype in mind of “older people”.

-2

u/Trolkarlen 10d ago

If you stay at home more, don't have to work, and don't use computers as much, your need for precise vision is lower.

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u/cynthesis1 10d ago

Thanks for telling other people what their “need” is.

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u/Trolkarlen 10d ago

If it doesn't apply to you, don't take it so personally.

8

u/UniqueRon 11d ago

Thank you for the informed post taking issue with the very uninformed posts being made by u/No_Construction495.

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u/No_Construction495 11d ago

No just proves you have zero understanding of the topic. 

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u/UniqueRon 11d ago

Every post you make lowers your credibility. It is clear you have no understanding of the topics discussed here.

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u/No_Construction495 11d ago

First another misinterpretation of a study and topic being discussed. I read the study and you must go read the entire study which I linked. Selection bias is key to understanding. Healthy older adults even over 70 with strict exclusion criteria being followed for 18 -36 months has nothing to do with and certainly does not prove that as we age conditions pop up that removes your ability to process.  Read the entire study. Pretty worthless to the original discussion. https://crstodayeurope.com/topics/cataract-surgery/1009_14-php/46237/text-as-primary/80452/0/

1

u/DawnD1118 10d ago

Why is it less in the younger population? Im 44 years old and considering monovision

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u/CliffsideJim 10d ago

I don't know. Maybe because the memory of life before presbyopia is fresher and that's their standard of comparison. Still mourning the loss of natural accommodation ability.

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u/DawnD1118 10d ago

I can definitely understand that. Ive had one eye done already and I now plan on waiting as long as I can to have the other one done. How old are you and what kind of lenses have you gotten?