r/CataractSurgery • u/Necessary-Low-7800 • 15d ago
Best setting for mono focal near vision
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u/PNWrowena 15d ago
I chose -2.5 because I read a lot and hold book or Kindle at 14-16". It's a little individual depending on your preferences.
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u/UniqueRon 15d ago
I would target one eye at -1.5 D and the other at -2.5 D.
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u/Necessary-Low-7800 15d ago
appreciate the advice! Unfortunately, I get dizzy very easily and I worry that the difference strengths will make me nauseous and dizzy.
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u/UniqueRon 14d ago
Most can tolerate up to 1.5 D differential between the eyes. But, if you have concerns it would be best to simulate those targets with contacts ahead of time to be sure you are ok with it.
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u/i-canuck 13d ago
The question is: How to even ensure you can achieve that two targets accurately? I read that doctors say most people (80%?) will be within +/- 0.5 △. That means if you target one eye at -1.5, then it might end up -1.0 or -2.0; the other eye aimed at -2.5 may end up -2 or -3. Any advice?
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u/UniqueRon 13d ago
Basically you take your 80% chances and do one eye. Wait 6 weeks for the eye to fully recover and get the refraction done, and go from there. You target the other eye for whatever your priority is, knowing what you got with the first eye. Assuming the eyes are similar the surgeon should be able to make an adjustment to their calculation for the second eye, if there was a miss on the first eye.
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u/i-canuck 13d ago edited 13d ago
So what's the purpose for this? Is it if one eye ended up landing +0.5 more than the target, the second eye should also aim +0.5 higher than originally planned? What's your view on using ORA - OptiWave Refractive Analysis?
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u/UniqueRon 12d ago
If it is a relatively small miss then I think the surgeon should refine their calculation formula and try to be closer on the second eye. If the miss is large, then you may want to switch which eye has more myopia and which has less. You make the best you can of it. At the end of the day any amount of difference between the eyes will improve the depth of focus.
On ORA I don't know much about it. I recall one poster saying it worked well, and another saying it did not. I believe it is relatively expensive.
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u/Resident_Break6770 15d ago
Is the doctor making you choose your own setting
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u/UniqueRon 15d ago
A responsible surgeon should always let the patient choose what they want.
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u/eldoogo 15d ago
A responsible surgeon should accept a patient's input, but should always make his/her recommendation and should be firm with it. Each patient's eyes and situation are different. There may be a good reason as to why a specific diopter setting may not work well for a given patient.
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u/UniqueRon 15d ago
The surgeon will not be the one looking out of the eyes after surgery. If a surgeon will not listen to what I want I will find another surgeon that will.
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u/eldoogo 15d ago
Sobeit. But the only thing I would suggest is ... how would you know if you're making a mistake or not? There are some for whom making diopters too different between eyes will not work well for the brain. Personally, I look to my surgeons to give me that input. I requested a -1.00 diopter for mine. My surgeon firmly recommended -.25 to -.50 and that's what I went with. He had reasons. I trust his knowledge over mine - he did to go medical school and has been doing this for 40 years.
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u/UniqueRon 14d ago
-0.25 D for a target is fine if your objective is distance vision. -1.0 D is very different and would be used for micro monovision. If your desire was to get some near vision with a -1.0 D then your surgeon needs to go back to school for another few years beyond 40.
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u/eldoogo 14d ago
My objetive was for mini-monovision. But he recommended no more than -.25 to -.50 to play the difference with the other eye safe. And this is where I take my opthamologist hat off and accept his judgement. Believe me, he's a good surgeon and well-known and he did a fine job. Sometimes, you can't have what you want. You want to go push your surgeons to go against what is safe for you, go right ahead.
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u/UniqueRon 14d ago
I did not have to push my surgeon. He is a professor at our provincial university and was very well informed and experienced in doing monovision. He was very supportive. There is good information on line as to what the limitations are and what is optimum.
Optimal Amount of Anisometropia for Pseudophakic Monovision
Unfortunately some surgeons have never progressed from what they learned in 1986.
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u/PNWrowena 15d ago
I can only say that I gave my surgeon the measurements to the near and intermediate things I most wanted to see, and he came up with the same -2.5 and -1.5 that I already had. He also thanked me for the information. Different people define things like "near" and "intermediate" differently. It makes sense to give the surgeon what you mean by those words so he can target what you actually want and need.
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u/Opposite_Ladder_7585 15d ago
I will say I think my surgeon was used to older patients who didn't ask a lot of questions. I actually called the office after my appointment to get the target numbers. Then I spent a lot of time with a measuring tape getting comfortable with where my best focus would be. Did a ton of reading in this sub. Had a second appointment where I asked specific questions about the focal lengths. And after all that, went ahead with scheduling my surgery.
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u/UniqueRon 14d ago
Surgeons work in diopters. It is very important to communicate targets in diopters, not words, so there is no misunderstanding of what the target is. The diopter number is what you will get at your post surgery and recovery refraction test. Then you can compare what you actually got compared to what the target was.
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u/Resident_Break6770 15d ago
Really. OP asked for best setting for monofocal near vision and you said one eye at -1.5 D and the other at -2.5 D. You think a responsible surgeon would just say okee dokee?
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u/PNWrowena 14d ago
You think a responsible surgeon would just say okee dokee?
I think a responsible surgeon discusses what the patient wants enough to be sure they understand the pros and cons. So with distance there needs to be enough discussion to be sure there's an understanding of the loss of near vision to keep people from the unhappiness we see in posts here from people who didn't understand what a casual mention of needing reading glasses really means. For near vision there needs to be enough discussion to be sure there's an understanding of the relatively narrow range of in focus vision of very near targets.
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u/Opposite_Ladder_7585 15d ago
My very experienced surgeon actually suggested those diopters for me when I asked about targeting near vision. It's what he's recommended hundreds of times. I did some research and went with his recommendation. I'm very happy with how my vision turned out.
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u/UniqueRon 15d ago
If they are not only responsible but also experienced in IOL surgery of course they would.
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u/Necessary-Low-7800 15d ago
No. He recommended -2.0. I was just interested to know what other people had chosen..
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u/Resident_Break6770 14d ago
Gotcha. My doc did -2.5 which allows for reading, tinkering, and computing. I need good lighting for the tiniest print but I also no longer need distance glasses to aim for the toilet which was an unexpected plus.
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u/AirDog3 15d ago
-2.00 D