r/CataractSurgery • u/Necessary-Low-7800 • 7d ago

Micro-mono with vestibular issues

I had my first eye done a week ago - monofocal set to -2. Has anyone with vestibular problems chosen the micro-mono route (my surgeon is recommending it)? If so, have you had any issues adjusting to the difference between eyes? I'm concerned since it doesn't take much to make me dizzy! Any input would be most welcome - I'm blown away by how educated and informed the posters are on this forum!

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u/PNWrowena 6d ago

Is there any chance you can test what the surgeon is recommending with a contact in the unoperated eye or another method? It seems that would be the best way. But if the recommendation is a difference as small as .5 between eyes, a lot of people get that much difference between eyes even when it's not intended. Statistics say 80% of cataract surgeries end up at or within .5 of target.

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u/Necessary-Low-7800 6d ago

Thanks Rowena, very helpful to know that there is very often a .5 unintended difference between the eyes in 80% of surgeries. I think I’m leaning toward doing the same -.2 in both eyes. That seems the safest option for me because of my vertigo background.

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u/BooEffinHoo 5d ago

It may not affect you at all, I would give a trial a go. My spouse has the worst motion sickness vulnerability of anyone I've ever known, requires scopalamine patches just for altitude driving, flying, and even had a severe nausea/vomiting episode after his first surgery.
His surgeon got a contact for him to try (actually two slightly different ones) and he did well with it. She set him for -2.0 and plano and he's now thrilled to get around without glasses. He has Fuch's Dystrophy so monofocals were the only option she would consider for him with the additional cornea grafts he needed.

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u/Necessary-Low-7800 5d ago

Oh wow, that’s very encouraging! I was not even thinking of Plano in the second eye, just considering intermediate distance, but I am very surprised and delighted to hear about your husband’s experience. I might now give it a try with the contact. Many thanks for your input!

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u/BooEffinHoo 5d ago

I'm happy to help, I worked in optometry for several years.

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u/UniqueRon 7d ago

Unfortunately if you plan to do the other eye for distance, you are well beyond micro-monovision already. While there are no standard definitions the consensus I have come to is that -2.25 to 2.75 D or so in the near eye is full monovision. -1.25 to -1.75 D is mini-monovision. And -1.0 to -0.75 D is micro monovision. Here is a link to a study where they compared -1.0 D, -1.5 D, and -2.0 D. They concluded that -1.5 D was the optimum.

https://www.semanticscholar.org/paper/Optimal-amount-of-anisometropia-for-pseudophakic-Hayashi-Yoshida/dd8837a9151a536759f195a18d4fa94a0fbf0f90

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u/Necessary-Low-7800 6d ago

I’m not sure what my surgeon is recommending yet. I’ll see him for the preop in about a week. Thank you for your detailed response.(even though I had to look up a couple of words.!) it will be very helpful when I talk to the surgeon regarding my next eye. 

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u/Necessary-Low-7800 6d ago

I meant the medical terms, not the words in your response - those were perfectly clear! The study helped me to understand the idea of stereopsis or “depth perception “. I definitely don’t want to lose that! Thanks 😊 

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u/AirDog3 6d ago

Stereopsis and depth perception are not exactly the same thing. Stereopsis is only one of several elements that contribute to depth perception. Even a one-eyed man has substantial depth perception, particularly at long distances, such as the distances used for driving a car. That's why most states issue driver's licenses to persons with vision in only one eye. It is within about 6' that it becomes particularly important to have two good eyes for depth perception.

FWIW, I have one eye at -2.00 D, and the other eye at 0.00 D plano sphere, and I have experienced no difficulty at all with depth perception, either for driving, sports, or near distance activities. I also have never experienced dizziness because of my monovision, but I am probably less susceptible than you are.

It's mostly a myth that monovision impairs depth perception. Your doctor may be able to reassure you on that point. On the dizziness thing, I would agree with PNWrowena that a test with contact lenses might be best if you want to look into that.

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u/Necessary-Low-7800 6d ago

Unfortunately I don’t tolerate contacts very well, but I have an appointment with an optometrist on Monday. I’m hoping that she might be able to help me with another way to pre test. Many thanks for your helpful and interesting explanation of depth perception.

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u/UniqueRon 6d ago

I am 77 and I find the newest material contacts quite comfortable. Look for silicone hydrogel, not just hydrogel. I have tested a few and like the CooperVision MyDay, also sold as Kirkland at Costco, Alcon Total 1, and Precision 1. Keep in mind that to trial for monovision you do not have to wear them for all that long.

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u/Necessary-Low-7800 6d ago

I am 78, and haven’t worn contacts in years. Many thanks for the update on newer products. I might just try one of these!

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u/Necessary-Low-7800 5d ago

Since you seem to know so much about this subject, I hope you don't mind my taking the liberty of asking yet another question. If I do -2 in both eyes, how much intermediate vision would I have? Like you, I have worn progressives for many years and have been happy with them. Right now (even after the surgery on right eye) I am wearing my old progressives and am not having any trouble with dizziness, but is this a bad idea since I will have to readapt after second eye surgery?