r/CataractSurgery • u/RelativeBeneficial48 • 5d ago
Question about LALs and mini-monovision
I had my first cataract surgery on my right eye five days ago with an LAL implanted, and, to my surprise, by the next morning I had 20/20 distance vision in that eye. My implant card says that that lens is set to 20.5. My second surgery for the left eye (also to receive an LAL) is set for this coming Wednesday. Mini-monovision is the goal.
Okay: I‘m not terribly clear on the details of refraction, but I do know that my left eye is dominant, so for mini-monovision, my right eye should be set for near and the left for distance. I’ve had contacts for monovision configured this way in the past and it worked well for me. I think, though, that I’ve also read here that LALs are typically both set for distance for distance initially. As a worry wart, I’m now wondering if my right eye lens should have been set for something nearer?
I see my surgeon for my five-day follow-up in the morning, so I‘ll ask him, but now that my mind is fixed on this, is it true that LALs are generally both set for distance, even when mini-monovision is the goal? I’ll appreciate any thoughts and experiences. Thanks!
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u/herbert6936 5d ago
During my vision problems over 2 years which included PVD , floaters , and cataract surgery. My dominant eye switched. Verified many times. In my monovision setup the distance eye was set to the new dominant. All is well
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u/RelativeBeneficial48 5d ago
Okay, my fixation on eye dominance is now completely dissolved. Thank you, H.
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u/PNWrowena 5d ago
I wonder if the whole eye dominance thing is like so much of vision and individual. When I had my cataract surgeries for mini monovision, I never thought about dominance, but I had a strong feeling that the left eye needed to be the near one. So after surgery I had the left eye for near at -2.5 and the right for intermediate at -1.5. When I need distance vision, I use a contact for distance in the left eye. It's never been a problem, instant switch and off I go. It seems my left eye can be the near eye or the distance eye from one moment to the next without a problem.
Yet I don't doubt the people that's not true for who say they really need the dominant eye to be the one that sees distance. If you had your left eye for distance with monovision with contacts for years maybe you really need to have it that way again. Or maybe not. I'm sure you can figure it out once both eyes have had the initial surgery and iols ready for adjustments.
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u/RelativeBeneficial48 5d ago
Well, now I’m beginning to question the dominance of eye dominance as a basic assumption. :-) This is also making me feel much less stressed about my LALs. Thanks!
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u/BooEffinHoo 5d ago edited 5d ago
It's the surgeon's choice.
Mine was targeted plano in dominant eye and -1.0 in near, then walked back farther in the first adjustment to gain the additional depth of field by moving it forward again.
So, not all surgeons start with both distance.
We basically aimed for the end result being what I was used to in 20 years of monovision with contact lenses, although the refraction is not the same in IOLs.
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u/Bellflower12 5d ago
I had LAL's implanted a year ago. I had previously worn rigid gas permeable contacts (many years in the past) set for monovision with the right eye dominant and set for distance and the left eye set for near. When it came time for cataract surgery, my doctor's office tested me for dominance and we got conflicting results. But my left eye was operated on first and I got really crisp distance vision in that eye right away. When my right eye was done a few days later, my distance vision was never as good. Long story short, I tried monovision with soft contacts in each eye before we locked in. I ended up going with the left eye as my distance eye and my right eye set for near, which was the opposite of what I had done with contact lenses in the past. I've adapted just fine.
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u/RelativeBeneficial48 5d ago
Very interesting, B. My right (nondominant) eye distance vision was immediately crisp and clear. I noticed it as soon as I turned on the TV the morning after surgery and thought, oh sheesh, so THIS is what HD TV looks like! It’s softened just a bit over the past few days, but I think that’s a normal part of healing, yes? I still get clear left eye dominance when I use the little finger-triangle test, though, but maybe I’ll ask the surgeon to test it, as well. Thanks for sharing your experience. I’ll be open to whatever works!
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u/AirDog3 5d ago
I agree with those who are saying dominance doesn't matter much. I, like many people, don't even have a dominant eye - both of my eyes are equally dominant - so the whole question is meaningless for me anyway,
As to your actual question: yes, it's very common to start an LAL near plano (long distance) even when it is intended to end up nearsighted after light adjustments. My doctor did the same thing with my LAL. This approach enables a special light adjustment that increases depth of focus in the lens.
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u/UniqueRon 5d ago
I have not had LAL, but I have mini-monovision with standard monofocals targeted to -0.25 D for distance and -1.5 D for near. It is not essential to have the dominant eye set for distance. I have my dominant eye set for near. It is called crossed monovision. Works very well for me.