Contact lens monovision after CME

[BUTTERCUP109]

My question regards contact lens monovision. From age 40 to age 47, I sucessfully employed a contact lens monovision. I was very nearsighted (about -7) in both eyes. My dominant right eye was corrected for distance, left for near. As my presbyopia progressed, I was less and less happy with monovision. At age 48, I had Crystalens refractive surgery. I consider  it a failed procedure because my capsular bags fibrosed around the implants so that I get no accommodative effect from Crystalens. Now age 51, I want to try a contact lens monovision again, but have a new issue to deal with now. My left (non-dominant) eye has had a serious chronic case of CME. Although it can be refracted to 20/25 for distance, my vision is still spotty and distorted and I expect it always will be. It is less bothersome at distance than for reading. In fact, I really can't get clear near vision in the left with any type glasses I've tried. So my question: With much perserverance and determination, can I reverse the usual pattern; i.e...corrrect the dominant eye for near and my non-dominant CME eye for distance? I'm willing to try really hard to adjust! What do you think? Or, do you have any suggestions besides the complete dependence on readers I currently deal with?

[Sandra M Brown, MD]

Reverse monovision can work just fine and the adaptation can be easier than you might expect.  Certainly you should try it.  The key is initially to try not to create a large difference between the eyes.  Start with an undercorrection of your right eye of 1.5 diopters - see if you can learn to hold reading material a little further away.  Also, reading with bright light will make your pupils smaller and this automatically increases your depth of focus, meaning that you can pull 'closer in' with your near eye without needing a greater degree of undercorrection.

[JodieJ]

I hate to be pessimistic, but I don't think that you are a great candidate for monovision.  Reversing the usual pattern may not be a problem at all.  (I'm strongly right eye dominant, but I often mistakenly wore my distance contact in my left eye with no problems whatsoever.)  But you might not be too happy with the quality of your distance vision, since you won't have your "good" eye to cancel the distortion.  It's worth a try, though.

I have another suggestion you:  bifocal contacts, like those made by Gelflex (try googling.)   These are very different than the usual multifocal contacts, which would probably turn your vision with your left eye into a total blur.  The Gelflex contacts have a design similar to that of bifocal glasses, with a distance segment on top and a near segment on the bottom, so you would not be compromising your vision at distance or near.  In addition, you'd be able to use both eyes for each distance, which would probably give you much better vision than monovision.  The major disadvantage of this design is a loss of intermediate vision, so you'd have to adjust your distance from your monitor or wear weak readers when using the computer.

[JodieJ]

Addendum to above:  Gelflex makes both hard and soft versions of bifocal contacts, using several different materials .  I believe that both can correct astigmatism, if necessary.  I wore the soft version, which provided excellent distance and near vision (despite some distortion in my right eye due to a retinal problem).  I did miss the loss of intermediate vision.  However, this type of contact will probably work for you if you're determined to reduce your dependence on readers.  Your eye care provider can get a starter kit by contacting the manufacturer online.  As I recall, getting the script exactly right took some experimentation.  You might also try researching "translating bifocal contacts" online for contacts with this design from other manufacturers.

[BUTTERCUP109]

Thanks for your suggestion. I just briefly looked online, but have not really delved into the pros and cons of the different kinds of multifocal lenses. I really don't understand why there are the different designs...aspheric, concentric, translating. Do you know? Why did you choose translating bifocal lenses?  An optometrist made me  a single multifocal for my left eye to experiment with this option. With the strongest near power available, I could still not read at all with the left eye, so I was initially discouraged with multifocal. However, I don't know what type of multifocal was used and I did not have a lens for the right eye. It is 20/20 distance without correction, but definitely needs a lens for near. Perhaps, I just need to learn more about how all this works and especially how it would work with my particular situation and then experiment a little more.
I appreciate any of your comments.

[JodieJ]

The website www allaboutvision com explains the difference between the translating design for bifocal/multifocal contacts and the simultaneous vision design.  I've tried all the types mentioned.  My distance vision is also 20/20, and I have mild distortion in one eye related to a retinal problem, so my experience might be especially relevant to you.

My vision with all the soft disposable multifocal designs (and I tried several) was not satisfactory at any distance.  My distance vision (post cataract surgery) was noticeably sharper without the contact, and my near vision was not great, either.  The gas permeables with this design did provide better vision, but they became uncomfortable after a few hours.  This design will magnify any distortion from retinal problems.

A contact with a "translating" design should provide vision as good as what you'd get wearing bifocal glasses, with no compromise to either distance or near vision.  This is MUCH better than what you'd get with monovision. These contacts are made-to-order to your exact prescription for distance and near vision.  The disadvantage of this design is the lack of sharp intermediate vision.  But I think that it would be your best bet for eliminating your dependence on readers.  (In the soft contact version, these lenses are thicker and less comfortable than one-day disposables, but I could wear them comfortably for 12 hours.)    

[BUTTERCUP109]

I understand that with translating bifocal contact lenses one can only see near when looking down and the contact is held up by the lower eyelid. Is this correct? If so, this would not work well for me. I rarely, and I mean hardly ever, read a book or a paper on a desk or in my lap. I read at the computer, or looking up trying to read labels on shelves or papers posted on the wall near my computer at work.
Why were none of the other multifocals good for you?
I need to find out what multifocal was tried by my optometrist. I'm thinking of trying the near-centered concentric design for my non-CME eye set to a more intermediate focus for computers in a gas perm which I tolerate well. Any comments?

[JodieJ]

You'd have to learn to move your head (or reading materials) rather than shift your eye.  I had no problem doing this.  If you were able to adjust to progressive/bifocal glasses, than you can adjust to bifocal contacts.

The multifocal contacts tend to work best for people who only need a low add.  I tried several versions and none worked well for me.  (The gas permeable ones were better, but my comfortable wearing time was too limited.  I never tried the newer model that has a gas perm center and a soft "skirt.")  Even when the distance correction was "plano", my distance vision was blurred by the contact and my reading ability wasn't great.   But it's certainly worth your trying.  You could also try monovision.  Hey, whatever works!

[BUTTERCUP109]

Thanks for all your input; you've given me some great ideas. I'll try them all if I have to. Like you, I want to have the option that works best for me. You understand, I'm sure. I'll let you know what works best.