Cataract surgery - monovision?

My brother is 65 and has reached the point of needing cataract
surgery. He is told he has severe astigmatism in his right eye, and
moderate astigmatism in the left. I don't know what this means in
terms of diopters - he doesn't have his prescription.

His understanding from talking to his doctor, is his left eye is
dominant at distance, and his right eye dominant close up. He
therefore proposed correcting the left eye for distance and the
right for close-up, with the hope that he would see well enough at
all distances not to need glasses at all. I know that some people
(my own ophthamologist is one of them) fit contacts this way, but I
wonder what percentage of people are unable to adjust to this. It
seems if you can't adjust, then you have to wear bifocals all the
time, and that having implanted lenses done this way is somewhat
risky.

In addition, the doctor is proposing to use a toric lens in the
right eye, and to do a LRI procedure, whatever that is, in the left
where the astigmatism is less severe. Does that make sense? Would
using toric in both be better?

I'd appreciate any comments or suggestions.

 

Alcon's toric IOL is supposed to work quite well for moderate to high
astigmatism. LRIs also work, but the results are reported to be less
reliable. From what I've read, the majority of people who try
monovision can adapt to it, but a minority cannot. When someone has
never attempted monovision before, modified monovision (AKA blended
vision) might be a better bet. This would involve correcting the
dominant eye for distance and the nondominant eye for intermediate
vision. With this type of correction, weak readers would be needed
for some tasks, although the person could probably function quite well
without glasses most of the time.

If your brother has concerns about his doctor's recommendations, it
wouldn't be a bad idea to consult another doctor for a second
opinion. I'd select an experienced, board-certified cataract/
refractive surgeon. If you live in the U.S., you can use the
directory at www.aao.org to find one.

 

Jane says...

Thanks very much for the reply.

It occurs to me that one should be able to test how he might
like monovision by investing in a cheap pair of
single-vision glasses, and wearing them for a few weeks before
the surgery. The dominant eye would be corrected to
distance, and the other eye to either near or intermediate.
Wouldn't this give you the same effect as post-surgery
monovision would? Well, except for the cataract of course,
but at least you would have an idea whether monovision makes
you want to throw up. What do you think? Worth doing?

 

Dear George,

Yes, it would be a good idea to test mono-vision -- before
the final operation.

Mono-vision works better with contacts.

But does your brother wish to do it?

Enjoy,

 

I agree with the above post. I don't think monovision would work with
glasses--you'd probably end up with double vision. You'd have to try
it out with contact lenses. Unfortunately, if cataracts were a real
problem, this might not be possible. For someone who has never
attempted monovision before, modified monovision would be a much safer
choice.

 

There's a lot of issues here, and I don't know very much about some of
them. Since your brother already uses one eye for distance and the
other for close, I would think much of the potential problem is already
eliminated. I have been told that glasses don't work for monovision,
and that contacts are much better. However, toric soft contacts don't
work for everybody.

Having posted the above, I wore monovision glasses for five years. I
wore them for one or two hours a day, after removing my contacts. They
worked OK, but not well. My doctor told me that they wouldn't work, but
after I explained that I had nothing to lose, since I couldn't see with
both eyes through glasses anyway, he wrote the prescription.

Best of luck to your brother. I have had cataract surgery in both eyes,
and it made a tremendous improvement in my vision.