Recently Had Modified Monovision

[Craig10x]

Hi...

I'm new to the community...I had cataracts in both eyes (i am 61 yrs old) and just recently had Cataract Surgery..
The doctor used Alcon Acry-Sof Aspheric Toric monovision lenses and had told me about doing Modified Monovision (Dominant eye set for 20-20 vision and non dominant eye i believe was set at around 20-125 to cover mid range and close vision)...He explained that most of his patients get that and are very satisfied because it minimizes the need for reading glasses..

I just had the two eyes done within the last 2 weeks (dominant eye then non-dominant just several days later)...
I like that i can see mid range to close without reading glasses (which i realize wouldn't be so if i had gotten both eyes set to distance)...
  
What i have been noticing is that things seem a bit blurry...not only at distance but mid and close as well...
Even when watching TV, which is a 32" lcd tv that i am only about 6 to feet away from) it is pretty clear but has a slight blur to it (when looking through both eyes as compared to just the distance eye)...
  
My doctor at the follow ups says i am doing fine...no apparent problems...
  
My questions: will things likely get more crisp and sharp as time goes by?   If so, usually about how long?
Also, it seems like the brain blends both eyes together...the brain doesn't actually switch from one eye to the other,
So, if that is the case, how will it get sharper?
    
Thanks in advance for all feedback!  

[shirdisai]

Hi Craig

Did you reverse the mini-monovision to make both your eyes 20-20?

Is that better that the mini-monovision?

Thanks!

[Craig10x]

Hi! Thank you for your feedback on my old post here about it...

To help the dry eyes, i would suggest taking flaxseed oil capsules (at least 1 or maybe 2 per day) they will take about a week or so to start working...i took fish oil caps originally but found i was allergic to them so switched to flaxseed oil instead...that should improved the dry eyes after a while...

Like you, even after all this time, i am still not sure if i should stick with the mini-monovision...I do get the starbursts at night but that isn't from that i know and nothing can be really done about that but it doesn't really bother me that much..

I hate to give up more of the close end range but like you i find that doing distance things are a bit difficult because it seems like my brain can never COMPLETELY filter out the blur and still get a slight blur at many things i look at...TV is not quite as crisp as it could be and while i can do the computer without much, it is still not as sharp as i would like...

I can do some light reading (clear but not entirely crisp) if i hold things away far enough but extended reading requires reading glasses anyway...so still tempted to consider another lasik touch up to move me up to the 20/20...

I'll be seeing my doctor this week...I am going to ask him to put in a contact lens for that eye to correct to 20/20 (i live 10 minutes from the office) and i want to walk around outside and go home and get an idea of how that will be...then i will come back to the office a few hours later and have him remove it...I will post here about it after i experience it...

One way you can test of the difference is to have a pair of glasses made up to correct that eye to 20/20 and see if you will like it better that way...I did that and i think i do but i figured that the contact lens experiment might help me make up my mind for sure...

Let me know here how you and you husband are doing also...i would like to hear about your progress as well...I know it's a "tough call" because either way involves compromises...

[Kelleyyy]

Hello, my husband and I had lasik surgery not quite 2 weeks ago (mono vision modified) and we are both struggling with the blurriness (still).  We have a lifetime guarantee so we can go back and have the non dominant eye changed to 20/20 if we are not satisfied with this.  My dominant eye is 20/20 and my non dominant eye is 20/40.  I can't see close up to read very well at all but my husband (with the same results) can read up close clearly.  I am also hopeful that over time my vision will clarify.  I need eye drops consistently as my eyes have NEVER been so dry.  The Dr also said that the surgery would correct my astigmatism.  I still see heavy "haloing" and "starbursting" with lights especially night driving.  Please keep posting on your progress as I am eager to hear of your improvements.  THANKS!

[Craig10x]

Thanks JodieJ and in fact that is what the eye doctor who examined me said...she said: It doesn't get any better then this! (meaning i had a great outcome) yes...she said i read 20/20 in distance and was able to read all lines clearly on the near vision test as well!

I may need to get very weak readers just for extremely fine print or extended reading..but for brief reading and even extensive computer and other mid range stuff i have no problem at all...

As far as reading, i can see it clearly down to about 1 foot...less then that it will start to get fuzzy...

If both eyes had been set for distance, in my case, anything closer then about 4 feet would have been fuzzy (i can tell that when i just look through the right eye)...

Oh, and my friend who does mini monovision with his contact lenses told me that after say 2 months or so, it is possible that the brain may adopt a bit better to pulling the extra "tad" of sharpness that the distance eye gets but i should be patient and stop throwing the brain off by doing "A/B" comparison tests (between the right eye and the blended vision) LOL

Really appreciate your help by the way JodieJ!

[JodieJ]

Like monovision, multifocal torics also involve compromise.

Craig, you've reported that you have 20/20 distance vision with both eyes and you could read all the lines in the near vision test (i.e., 20/20 near vision), although neither of your eyes is set for near vision.  Your outcome is truly amazing.  

[Craig10x]

Yes that does seem to be the case, JodieJ...Seems like you have to give up just a slight bit on the distance in order to get the wider ranges of vision that is provided by mini monovision...

I sure would have liked that extra "tad" of sharpness in the distance although i have to admit that i wouldn't have been happy having to be pretty dependent on reading glasses for most mid range to close activities...with this i do have those capabilities without the glasses...

After 50 years of wearing glasses (since 10 yrs old) it is such a pleasure not having to wear them...

I guess i was hoping that over time, the brain would pull in just a bit more of that crispness that the right eye is seeing...though perhaps i am expecting too much on that possibility...

They just released multifocal torics here in the United States...but based on what i have read about multi-focals, they can have various problems that monofocals don't generally have, so i guess i didn't miss anything by not getting those...

[JodieJ]

The truth is that (mini) monovision involves compromise.  With only one eye set for best distance vision, distance vision is NEVER quite as it would be if both eyes were set for best distance vision.  For most people, the slight loss of acuity is more than compensated for by the wider range of focus.  If you can read the 20/20 line with both eyes, that's an excellent result.

[Craig10x]

Hi again JodieJ and everyone again...I had been to the eye doctor's office yesterday...

His opthmologist that examined me told me that i was healing very nicely...
I did ask what the left eye had been corrected to, and she told me it was actually 20/100 (right eye to 20/20 of course)...

My combined vision is 20/20 and for the reading test, with the chart held at a distance that was comfortable for me (about 1 foot at this point) i could read all lines on it without difficulty...

I did ask her about my concern that using the combined vision it wasn't quite a sharp as it is just looking through the right eye (particularly at distance) and she essentially confirmed what it said in that article
excerpt i posted in my last post...

She said, everyone heals differently and she said it will probably take some more time and also that the brain needs time to make the full adjustment to obtain the "optimal vision"....

It is really only a very small difference at this point (in the combined) but hopefully eventually i will see that "tad" extra sharpness within the next few weeks or so...i guess i needed to be more patient...

But please don't discourage people who post as i do (with the modified monovision) if they post similar concerns...it is not necessarily true that what you see within a day or two of the operations is what you will always see...

it can and actually should continue to get better as time goes by and that process can take anywhere from two weeks to perhaps as much as even a month or two depending on the individual, his healing and brain adjustment rate...

So i am still hopeful yet...and by the way, i will follow up here on my progress...

[Craig10x]

Thank you JodieJ...i will definitely do that...I should have some interesting questions now to ask him at our follow up this coming week...

Overall, it is actually working pretty well for all purposes (distance/mid/close) it is just the bit of blurriness (or lack of sharpness) in certain instances that i was hoping would improve as time goes on...

Until i get back here with an update, i thought you (and everyone here) might find the excerpt from a medical article i read yesterday online about what to expect after cataract surgery when having either monovision or min-monovision done. (reading articles like this gave me encouragement that i might yet see a further improvement that will leave me even more satisfied)....here it is:

After a week of taking it easy, your doctor will probably tell you to do as much as possible to challenge your eyes and brain to work together at all distances with your new lens. You will be adjusting for a while and may feel a little frustrated at times. This is normal.
Two weeks after surgery, if you are like most who have lens replacement surgery, you will be delighted at the great improvement in your vision. However, when any part of the eye undergoes a change, the brain needs to adjust to help us obtain our optimal vision.
After two months, your brain and eyes will have largely learned how to work together, and between two to four months after surgery, your vision should be nearly optimal.
During the first few months, continue to challenge your vision. Check with your doctor if you have any questions about whether what you are experiencing is normal.

[JodieJ]

There is one additional point that might help you understand why you are having the vision problems you describe.  IOL power predictions are based on formulas derived from averages, and the results aren't always consistent with the predictions.  Although your doctor targeted plano (20/20) for your right eye and -1.25 for your left eye, your post-surgery acuity might end up off-target.  Even the most skilled surgeon doesn't always hit the target.  Please re-read the quote you posted above from Dr. Kutryb's blog about mini-monovision. ("There is one caveat with this technique and that is that it is crucial to get the first or distance eye as clear as possible for distance.  If it is a little off for distance, then I am occasionally forced to make the second eye for distance as well since these patients usually have distance vision as a main priority.")

I strongly suspect that your right eye is a little off target.  If this were the case, you could either wear progressive glasses or consider having a LASIK touch-up (either to achieve a good mini-monovision result or to correct your left eye for distance.)  Possibly an IOL exchange would also be an option.  

Keep us posted.

[Craig10x]

JodieJ....The opthomologist in his office that does the follow up eye exam for him (which he reviews and does some checking himself right after it with me) told me that last time...I was supposed to do my 1 week follow up last week but was unable to... however i will be seeing them this coming tuesday, and hope to get clarification on that as well as my overall view on the results so far...

I will post back here after i see him with a hopefully better "picture" of the situation...

By the way, i really appreciate your feedback as well as the others here...

[JodieJ]

Craig, in a previous post you stated that your acuity in your right (dominant) eye is 20/25.  Is this really the case?  If so, then your doctor did NOT get optimal vision in your dominant eye.  (I suspect that this is the real basis for your dissatisfaction.  Possibly your right eye is a little farsighted.)

You also stated that your acuity with both eyes is 20/20.  This is what excellent mini-monovision results should be, but it does not seem to the case for you based on your complaints.  What is your acuity with both eyes?  20/25?  20/30?

Keep in mind that with mini-monovision, neither eye is set for good near vision.

  

[Craig10x]

Also, this article i read right here on Med Help:
It seems what i got is known as Mini-Monovison....and based on what i read here, if the doctor gets optimum distance in the dominant eye that is corrected as such, then distance vision should still be quite sharp in the blended vision of the two eyes...And my doctor did get me optimum in my distance eye...Along with a useful (but not perfect) amount of mid and close as well (which is what i am getting)...
So, this is why i thought that especially the distance should get sharper as time goes by (see excerpt below)...

Mini-Monovision is a very desirable result for many patients and usually provides excellent distance vision and some useful near vision for computer work, and light reading like price tags and menus.  It is my favorite technique.  For example, after determining the dominant, I would aim for 20/20 distance vision (as close as possible) in that eye and then aim for something like 20/50 in the non-dominant eye with about -1.25 of myopia or nearsightedness in that eye - just enough to support a small to medium amount of intermediate and near vision.  It is such a small difference between the eyes that a great many patients can adjust to it quite well. These patients already can see almost perfectly for distance with one eye so that the non-dominant eye is freed up somewhat to be a little less sharp for distance and a little better up close.  There is one caveat with this technique and that is that it is crucial to get the first or distance eye as clear as possible for distance.  It it is a little off for distance, then I am occasionally forced to make the second eye for distance as well since these patients usually have distance vision as the main priority.

[Craig10x]

Thank you all for your feedback....though my concern is whether my blended vision will improve more in terms of sharpness as i continue to recover from the surgery and my eyes heal...which i understand can take a month or even several months to reach the optimal vision...

This is what i have read in many articles...yet i seem to get the impression from the feedback here, that this is not usually the case and that basically what i saw within my first few days is as good as it gets..So now i am confused on what i might expect in the long run...

Take for example this small excerpt from a medical article i read:

After cataract surgery, it is common that there will be blurred vision, which may last for a number of days or some weeks, while the eye heals.  

[JodieJ]

I agree with the response above.  Your non-dominant eye is set for intermediate rather than near vision.  Most people need -2.0 or stronger for prolonged reading.  Your need for reading glasses depends a lot on your lifestyle.  If you don't enjoy reading or have hobbies that require good near vision, then you probably could do without glasses 95% of the time.  I'd suggest that you get some prescription progressive glasses.  In addition to reading, you could wear them when you wanted to give your distance vision a little boost (night driving, etc.)

[es98]

-1.25 is almost, but not quite, good enough for reading comfortably.  -1.5 to -2.0 would have been better.  I think you will have to accept what you have there.

[Craig10x]

Yes...JodiJ i think he meant -1.25D (sorry, didn't explain that part of it properly) in the left (non-dominant eye)....Things are fuzzy when i look only through that eye...and that is the eye that is enabling me to see mid to close which i wouldn't be able to see clearly without glasses had he corrected both eyes to distance...

I guess i thought that things would be a bit sharper (distance/mid/close) because i thought that the brain would automatically pull in the sharpest vision in whatever range you were viewing at the time (through combining the best of the two eyes together)...

After just two weeks, that doesn't appear to be quite the case....
I was told by the surgery coordinator at his place that my vision would improve even more as my eyes settled in and stabilized....that's why i thought it would get better as the eyes healed...are you saying i shouldn't expect any further improvements in the coming weeks?
And this is as good as it gets?

As far as seeing...i can see quite clearly in distance....also mid range like when doing the computer and as far as reading...at this point, as long as i keep the reading material about 12 inches away i can read whatever it is...

It's the slight lack of extra crispness/sharpness that i am concerned about...
They did tell me originally that i might need readers to read extremely fine print but otherwise should be able to do without glasses about 95% of the time...

[JodieJ]

After re-reading all the info you've posted, I'm a little confused.  You say that your vision in each eye is 20/25, and 20/20 using both eyes.  Yet the TV that is about 6-7 feet away (distance vision) is crisper with your right eye than with both eyes.

I think that your surgeon was targeting -1.25 D (not 20/125) in your non-dominant eye (i.e., good intermediate vision).  But if you ended up with 20/25 acuity in that eye, that's pretty far from -1.25 diopters.  I assume that your intermediate and near vision are not too good.

Mini-monovision involves distance vision in your dominant eye and intermediate vision in your non-dominant eye.  You will not have good uncorrected near vision with mini-monovision.  You'll probably be able to read most restaurant menus, but you'll need glasses for prolonged reading.  This is as good as mini-monovision gets, even with a LASIK touch-up.  By contrast, full monovision involves distance vision in the dominant eye and near vision in the non-dominant eye.  You might be able to lose the reading glasses with full monovision, but many people cannot adjust to this type of correction.

[Craig10x]

Thank you for the feedback, JodieJ...i have noticed that you have contributing many posts to this forum on the subject...

Well, yeah that is because i am able to read all the identical lines with both eyes, but what isn't taken into account is that the left eye (one that is set for mid to close range) sees the lines with more fuzziness...sure, i can SEE the letters to read them but they are not as crisp_...

It looks sharper when i read the chart with both eyes of course, but not as sharp as just looking through the right (distance eye)...

I will check with the doctor next week but i believe he said (before the operation) he would be setting the left eye at about 20/125 or so...

By the way, that left eye had the worse of the two cataracts...it was probably pretty "ripe' already (it use to look like looking through wax paper even with my glasses on...but right eye was still fairly good)...

I did read online that in such a case, since they have to use a higher amount of ultrasound to remove the cataract, that could cause some temporary swelling which might take a while to resolve...i wonder if that could be having some effect?...

I would prefer to avoid the glasses if possible...what would a lasik touch up do?

And as i mentioned, it's only been about 2 weeks since both were done...so i wonder if i just need to give it more time..

[JodieJ]

You say that both eyes are 20/25 for distance, and 20/20 with both eyes.  This does not sound like any form of monovision.  Are both eyes slightly nearsighted?  One eye slightly farsighted?  I'd expect that your dominant eye would be 20/20 for distance, and your non-dominant eye would be slightly nearsighted.

Perhaps your surgeon didn't quite achieve the refractive targets that he was aiming for.  In this case, you could get excellent vision at all distances with progressive glasses.  Or you could consider having a LASIK touch-up.

[cwatt1]

Try searching for "monovison" or mini-monovision" in the Search box (top center of the page).  There's quite a bit of discussion about it in the forum archives.  JodieJ, in particular, has posted about this a number of times -- it seems to have worked out quite well for her.

[Craig10x]

No one else has any feedback on this? I'm going to ask my doctor when i see him at my next follow up next week, but i would welcome feedback from those that have had it or know someone who did....

Thanks...

[John C Hagan III, MD, FACS, FAAO]

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[Craig10x]

Thanks for your input, Dr Hagan...that sounds a bit discouraging...my doctor gave the impression that except for reading very fine print which might require reading glasses, that i would have very good vision, distance, medium and close...that is why i went for the modified monovision instead of having both iols set to distance...

Actually, although the tv is about 6 to 7 ft away...when i look through just my right (dominant eye which is set for distance) it is very clear and CRISP...so no problem with the distance eye...but when viewed with BOTH eyes it is still very clear but lacks the "crispness"...

I though that perhaps it was due to being such a short time after the surgery and that perhaps my brain had not fully adjusted to make the full changes...or possible slight swelling or other typical things that usually happen right after the surgery that take some time to resolve...

My doctor did mention it would probably take about 2 months for everything to stabilize properly...When i do the eye tests in my follow ups, they say i am showing 20/25 in each eye and 20/20 combined!

Yet, things generally aren't as sharp as i was hoping for...of course it has only been about barely 2 weeks since i got both eyes done..if that makes a difference...

I'd also appreciate feedback from others who have had (modified monovision) or have experience with people who have had it...

Were (you/they) able to eventually get pretty sharp (crisp) vision in the distance/mid/near ranges?