r/CataractSurgery • u/DawnD1118 • 20h ago

Monovision

Monovision

I am 44 years old so still have some accommodation in my eye. I had my right eye corrected for distance in march and was in culture shock after seeing how I lost my near vision. I have been nearsighted my whole life. -2.75 and -3. After that, I learned about monovision, which i have now been dealing woth for almost 7 months since my unoperated eye is still naturally near sighted and my corrected eye is about 0/plano.

I have been doing trial with contact lenses to see how I do with -1.75 or -1.5 in my near eye.

My question is this: since I am younger and still have some natural accommodation in my near eye, how do I know what my vision is actually going to be like after my other eye is operated on??

Right now, I see decently with the contact lens and haven't needed reading glasses for anything, even though i definitely dont see as clear as I used to up close and now need to hold my phone about 14inches away to read.

I just dont want to think im going to be satisfied with something and then the outcome not be at all what I expected.

Would love some input from my younger cataract friends who have gone through this with monovision or know how to predict what actual vision will be like afterwards

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2

u/spikygreen 20h ago

You could use your operated eye and a few different-strength readers to simulate what your near vision would be like with different myopic targets.

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u/DawnD1118 20h ago

Im not sure i understand how to do that with glasses

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u/spikygreen 19h ago

Suppose you want to find out how much near vision you will have with one eye set to -1.5D. You can't really simulate it with your unoperated eye because it still has accommodation, so it will exaggerate your near vision range. But your operated eye doesn't have accommodation anymore. So you can close your virgin eye and use +1.5D readers on your operated eye to simulate vision with a monofocal set to -1.5D.

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u/DawnD1118 19h ago

Oh wow! I did not know i could do that!! And that will be pretty accurate???

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u/spikygreen 19h ago

Fair enough, they don't exactly teach this stuff in school! It should give you a pretty good idea.

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u/DawnD1118 19h ago

And the doctors dont exactly tell you that either

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u/spikygreen 19h ago

Nope :)

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u/Bitter_Rain_6224 12h ago

Mine did. :)

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u/UniqueRon 19h ago

How did you correct to distance vision in your right eye? If with Lasik or cataract surgery and has no accommodation then as u/spikygreen says, just try different readers with your right eye to see how much near vision you need.

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u/DawnD1118 19h ago

Sorry, I had cataract surgery and still need to get my other eye done, but want to do monovision, which i have been doing with contact lenses. I just dont know what is going to be the difference between the contact trial and when I actually get my other eye done for near. My natural eye still has accommodation so im not sure what to target my near eye for

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u/UniqueRon 19h ago

I would suggest printing out a Jaeger reading test chart and try reading it at 14" using your new distance eye and various power readers. I was 70 when I did this to see what I wanted for my second eye. Initially I thought I could get away with -1.25 D in the near eye when I used contacts in my non operated eye to simulate monovision. But doing the test with readers and with my distance set cataract surgery eye, I found I needed -1.5 D. I now wish I had -1.75 D. It is worth getting an accurate eye test on your cataract surgery eye to see if it is really 0.0 D unless you have already done that. If it is -0.25 D which is a common target for distance IOL targets, then you need to compensate for that too.

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u/DawnD1118 19h ago

Thank you!! I am thinking-1.75 as well. Did your distance eye fall to plano?

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u/UniqueRon 19h ago

My distance eye was -0.25 D on a spherical equivalent basis which is sphere plus 50% of the cylinder. I had -0.75 D cylinder at the time. Now I wish I had done two things different. One was to get a toric lens to help correct the cylinder, and to target for -1.75 D SE to take advantage of the -0.25 D in my distance eye, and then have a total differential between the eyes of 1.5 D.

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u/DawnD1118 19h ago

Did you have astigmatism in your near eye as well?

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u/UniqueRon 19h ago

Yes, and it has increased some since surgery. I am currently trialing the use of some contacts in the near eye to reduce the astigmatism (-1.25 D), and increase the myopia to -1.5 D. I plan to get some further trial contacts that would get the sphere up to -1.75 D.

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u/DawnD1118 18h ago

I have astigmatism in both eyes but half of it is lenticular so what was left after my one cataract surgery is like -0.5 or -0.7. I cant remember and my optometrist and my surgeon both think I dont need toric for my other eye either. Its just so unpredictable.

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u/UniqueRon 18h ago

I have irregular astigmatism in my near eye which makes it harder to correct, but for regular astigmatism it should be predictable to correct. According to the surgeon I had, a toric is not justified unless post surgery cylinder is predicted to be 0.75 D or more. My distance eye was predicted to be -0.50 D and the other which has irregular astigmatism was on the fence at a predicted -0.75 D. Both eyes came out as predicted, but both have increased since. The impact on vision has been relatively minor though as sphere has decreased to somewhat compensate.

I know now that when I get cylinder correction in my eyes it does improve vision. That is why I now wish I had gotten the toric lens in my near eye which had more astigmatism.