Cataract surgery - monovision?

Discussion in 'Laser Eye Surgery' started by George, May 3, 2008.

  1. George

    George Guest

    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

    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.
    George, May 3, 2008
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  2. George

    Jane Guest

    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 to find one.
    Jane, May 3, 2008
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  3. George

    George Guest

    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?
    George, May 4, 2008
  4. George

    otisbrown Guest

    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?

    otisbrown, May 4, 2008
  5. George

    Jane Guest

    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
    Jane, May 4, 2008
  6. George

    Dan Abel Guest

    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.
    Dan Abel, May 4, 2008
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