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OK to put IOL in dominant RE with closer focal target than IOL already in LE?

Result of my surgery:

I had surgery on my left eye because the cataract was much worse in that eye (and astigmatism) .  I wanted to target my left eye for a computer monitor.   I got an AcrySof iQ Toric IOL which is  15.0 D, 3.00 CYL.
I'm happy with it.  As it turns out my focal point after 1 month is around 31 inches with a depth of focus providing a comfortable range from 27 to 36 inches.  Functionally I can read most text closer still if I need to, but blurry, up to around 16" away.  On the other hand, I notice I can be 8 feet away and still make out the smallest text that might appear in television programming on a 32" non-HD TV that I have in my office.  The absence of astigmatism in my left-eye has been awesome.  I can see at a distance at around 20/30 and I had thought that I would see sharply at computer distance and then everything else would be blurry.  From a practical standpoint, not so.  I walk around feeling like I have 20/20 vision unless I'm trying to read the score on a TV twenty feet away, or a grocery display at 20 feet or more, etc.

Question:

With that realization, I have thought about bringing the target focal point of my right eye in a little closer.  I'm using a contact lens in my right eye that brings my focal point in about 10 inches.  I starts bringing into focus at about the point they start falling out of focus with my left eye, at around 26 inches, and then gives me another 10 inches of range to around 15 inches.  This is an astigmatism correcting contact lens, but it can't correct it as perfectly as the IOL has with my left eye.

But given my right eye had always been my dominant eye, does this cause some issues if I have it set as the nearer focus eye after cataract surgery on it?   I'm wondering if my right eye as the dominant eye will continue to try to struggle to get into focus at the longer distances 27" to 36" where my left eye can see clearly.  

Would I be better off targeting my right eye to match where my left eye is now, and then use Lasik to bring my left eye in nearer (or correct it to nearer vision with a contact lens)?


My plan is to wear glasses I'm not working at my desk and just take them off when I need to read something (or else just wear a distance contact lens in my right).

Had I realized how much overall, functional depth of focus my left eye IOL provides for my day to day activities, I would have  targeted it as the nearer vision eye since it is my non-dominant, and planned on having my right eye targeted at where my left eye is now.    


Thanks for any advice!

Here are some measurements if they factor in:


LenStar
Measuring mode : Phakic  (default mode)

Right Eye:
* Axial eye length 25.61mm  
* Cornea thickness   488 μm
* Aqueous depth 3.55 mm
* Anterior chamber depth incl.  4.04mm
* Lens thickness 4.23 mm
* Retina thickness 200  μm
* Flat meridian  44.20 D @ 146°
* Steep meridian [email protected]°
* Astigmatism in plus (default) 1.35 D @56°
* Keratometric index  1.3375
* White to white   12.97mm
* Iris barycenter  ICX -0.10    ICY  0.14
* Pupil diameter 5.11 mm
* Pupil barycenter   PCX 0.11   PCY -0.01

Refraction  Jan 2019  (before surgery)
OD: Sph -5.50 Cyl +1.50 Axis  048  VA - Dist: 20/20-1   ADD: 2.25
OS: Sph -7.00 Cyl +2.50 Axis  090  VA - Dist: 20/60-   ADD: 2.25
3 Responses
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177275 tn?1511755244
I'm not going to tell you what to do just like I wouldn't tell you what car to buy even though I've been very happy with my audi S5.  

Generalization  is set dominant eye for distance and non-dominant for near.  Very few people in my long career are happy with their dominant eye set for 10 inches away.
Helpful - 0
2 Comments
No I wouldn't set it for a focal target of 10 inches away from my face, but bring the focal point in 10 inches closer than where my left eye is.  My left eye focal center is about 31" away, so I'm talking about the idea of having my right eye target at 21" (or 22 perhaps) with the idea that I might add a useful range for that eye of around 26 to 15 inches away from my face.

This would be for when I take my glasses off for work at my computer, etc.  But then I would have my glasses set for distance vision in both eyes (allowing that one eye might have to be less than 20/20 if the disparity in diopters dictates that).

I'm not concerned about preferences in distances that one person might have over another, but whether it would be problematic for me to have what has been my dominant eye set for nearer distance viewing when I take my glasses off than what my left is.

I guess if it was something that would begin to bother me depending on how many hours I did this I could pop in a contact lens in my right to make it equal to my left.


I can't answer that. You could try trial contact lens on the unoperated eye with the focal point about the distance you want to target.
Avatar universal
I've been meaning to follow up on this.  I ended up getting my right eye's vision set just slightly better seeing at distance than my right.  Same type of lenses.   I go around without glasses most of the time.   I don't mind not being 20/20 and didn't have to adjust because I was already used to it from having lived a year with glasses that no longer corrected to 20/20 due to the progression of the cataracts as well as just being an outdated prescription.   I seldom feel like I'm lacking in my distance vision.  I'll have an occasional day where I notice my vision is slightly more blurred (perhaps due to some unusal blood sugar that morning)  and put my glasses on then (I got progressive lenses).  I also like to where my glasses for  any long distance driving, night driving, or driving places where I'm not familiar (sharper vision helps at night and also for seeing business signs from very far away).

Since I work a lot on computers I like that my vision is sharpest just beyond arms length.  (Also the distance of looking at over someone's shoulder at a computer screen if someone wants to show me something on their screen.)  I can set a large monitor at that distance, but also see text just fine on a laptop held a little closer.  For lengthy use of text that is a little closer, if its uncomfortable I'll pop on some readers.  

If for some reason I decide I don't like it anymore and want 20/20 in one or both eyes, I believe laser correction is an option.  But I can't imagine that would ever happen.
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177275 tn?1511755244
Thanks for follow up. Glad it worked out well.
Helpful - 0
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177275 tn?1511755244
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