John C Hagan III, MD, FACS, FAAO  
Kansas City, MO

Specialties: Ophthalmology

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New Article on Multifocal IOL vs "Mini-monofocal" 2015

May 21, 2015 - 42 comments

Mini-monovision Versus Multifocal Intraocular Lens Implantation

Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, Kozobolis VP

J Cataract Refract Surg. 2015;41:53-57

Study Summary

This study was performed by a team of investigators from Alexandroupolis, Greece, who compared levels of spectacle independence and visual symptoms in cataract surgical patients.

Two groups of age-matched patients with no ocular abnormality underwent cataract surgery performed by the same surgeon. One group received a refractive multifocal IOL (Isert PY60MV; Hoya Surgical Optics, Inc.) with both eyes targeted for plano, whereas the other comparative mini-monovision group received a monofocal aspheric IOL (SN60WF; Alcon Laboratories, Inc.) targeted for -0.50 D in the dominant eye and for -1.25 D in the other eye.

Pre- and postoperative evaluations were obtained with the Visual Function Index-14 (VF-14) to determine visual symptoms and general visual functionality. Uncorrected binocular near and distance vision were assessed, as well as the proportion of patients who were spectacle-dependent for near and distance vision.

Both the multifocal and mini-monovision groups achieved good binocular uncorrected distance vision. The multifocal lens provided better overall near vision than the -1.25 D target for mini-monovision. There were no differences between the two groups in contrast sensitivity, stereopsis, or VF-14 items pertaining to distance or near vision.

Approximately twice as many multifocal patients (66%) reported being spectacle free compared with mini-monovision patients (34%). However, dysphotopsia (shadows and glare) occurred much more frequently in multifocal patients than in mini-monovision patients.

COMMENTS: William Cuthbertson MD
Although two thirds of the multifocal group was "spectacle-free" in this study, spectacles are not expected to provide relief from dysphotopsias in multifocal emmetropic patients; therefore, patients would be "spectacle-free" no matter what their visual function.

An additional question that could be posed in these studies comparing multifocal IOLs with monovision would be, "Is your vision adequate to do everything that you want to do with ease, including if you wore glasses when you need to?" If the occasional need to wear glasses is included, the excellent vision without dysphotopsias afforded by monofocal monovision would reflect a very high level of visual satisfaction in virtually all patients.

In conclusion, although the term "mini-monovision" could be better defined for study purposes, the concept of providing proximal-range, convenient, and usually spectacle-free vision with simple monofocal IOLs is very appealing. It maintains justifiable advantages over more expensive, and sometimes problematic, multifocal IOLs.

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Avatar universal
by Wolfhall, Aug 01, 2015
May I ask a question?  If the non-dominant eye has already been fitted with a mono-focal IOL would monovision still be achievable with a monofocal lens adjusted for near vision in the other eye, where a cataract is well developed ?  A multifocal lens has been considered but in this situation it seems unlikely to me that even a top range multi-focal lens such as symphony would be a good solution.  The patient reads and works on a computer a great deal and has accepted that driving at night is becoming increasingly hazardous.  Distance vision in the operated eye is good if partially obscured by new floaters.  Before the floaters they were no haloes or light distortion in the operated eye. Crucially, I suppose I am asking if a non dominant eye is corrected for distance vision only, is there really any choice for the other eye except the same thing, without taking a bit of a gamble?

Avatar universal
by Wolfhall, Aug 01, 2015
May I ask a question?  If the non-dominant eye has already been fitted with a mono-focal IOL would monovision still be achievable with a monofocal lens adjusted for near vision in the other eye, where a cataract is well developed ?  A multifocal lens has been considered but in this situation it seems unlikely to me that even a top range multi-focal lens such as symphony would be a good solution.  The patient reads and works on a computer a great deal and has accepted that driving at night is becoming increasingly hazardous.  Distance vision in the operated eye is good if partially obscured by new floaters.  Before the floaters they were no haloes or light distortion in the operated eye. Crucially, I suppose I am asking if a non dominant eye is corrected for distance vision only, is there really any choice for the other eye except the same thing, without taking a bit of a gamble?

Avatar universal
by wanlien3, Aug 02, 2015
I guess your (Wolfhall) question would be-is it advisable to have monovision where the non dominant eye is corrected for distance and the dominant eye is corrected for near?

The important thing to bear in mind is that there is no 'right' or 'wrong' answer.

Usually, for refractive patients I do a trial of monovision with contact lenses, but this is obviously not so straightforward for patients with cataract, since the cataract also affects vision and would not give a good representation of the situation post -operatively.

So yes, it is a bit of a gamble if you operate on the other (dominant) eye and aim for myopia to achieve monovision. However
1. If prior to the cataract affecting your vision you already had monovision, and found it acceptable, then it would probably be OK to aim for this postoperatively as well.
2. If you aimed for monovision with the dominant eye for near, and did not like it, it is a fairly simple matter to make a pair of glasses and wear them. ie the stakes are lower with monovision compared with multifocal lenses where, if you could not stand the halos and other visual side effects, you may have to consider a lens exchange

Each lens has its pros and cons, benefits and limitations.

If you are talking about the Tecnis Symfony:
It extends your range of clear vision while avoiding most of the issues seen with traditional multifocals such as halos and reduced contrast.
But, clear vision with the Symfony, without glasses, is only from far to about arm's length (intermediate range). As long as you know what to expect, and are prepared for it, it is OK to have a monofocal in one eye and a Symfony in the other. In this situation, your distance will be pretty good in both eyes, and the Symfony in one eye will help you for intermediate vision so that you don't always have to look for your reading glasses. However, during periods where you have to do prolonged reading or computer work, reading glasses will probably still be necessary.

177275 tn?1511755244
by JohnHaganMD, Aug 02, 2015

Avatar universal
by Wolfhall, Aug 04, 2015
Thank.you so much for these answers.  After reading the first post and found it extremely helpful I have also consulted the referenced document and spent several hours reading associated posts and questions.  I am so grateful to have discovered a place on the net where it is possible to access help for such an important medical decision. I will now make sure I understand the exact, current 'readings' for each eye before taking any action and have delayed surgery on my second eye. Once again, much thanks.

177275 tn?1511755244
by JohnHaganMD, Aug 04, 2015
you're welcome

Avatar universal
by ankp2013, Oct 05, 2015
hello..my question is related to cataracts.my mother is scheduled for a cataract surgery.she has had a pdp (hair color) allergy 6months back.with severe swelling..we did not visit a doctor then .the swelling went away in 4 days after taking antihistamines 3 times daily and apllication of hydrocortisol cream..and washing the hair with hydrogen peroxide solution..i can she go for cataract surgery now.would it be harmful?

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by JohnHaganMD, Oct 05, 2015
Only a physician that can actually examine her can tell you if there are any problems that might develop. However the circumstances you describe are not likely to leave any lasting effects.


Avatar universal
by caren123, Jan 15, 2016
I believe this study was sorely missing and I am very pleased that it was done!

Avatar universal
by dorcasapeke, Feb 24, 2016
Hi Doc, please can you help me with this issue, on 30th Jan. 2016, I had a MC and on the same day I had a d&c, after which I bled for about 1 week, so on 8th Feb, I had an unprotected sex with my husband and 2times again thereafter, then a week after we had the last sex, I began to feel another early pregnancy symptoms, I got a urine ptest and was still tested negative... pls I want u to tell me if am pregnant or not so that I will know how I would be able to take good care of my self because I don't want to have another mc. Thanks

177275 tn?1511755244
by JohnHaganMD, Feb 24, 2016
This is an eye forum.

Avatar universal
by CooperSky, Apr 24, 2016
I had cataract surgery L eye 2/28/14 as a combo surgery with glaucoma surgery. I had just cataract surgery on R eye 5/2014. Starr mono vision IOLs. In the fall of 2014 I had the Yag procedure done in L eye and it caused the IOL to move off center and cause bright lines or reflexions  in vision as well as slight blurring of vision. Yag on R eye followed month later with no problems.
I reported several times to ophthalmologist that L eye Yag procedure seemed much more traumatic than R eye Yag and L eye did not feel right and continued to feel badly after a year.
My L eye vision has continued to deteriorate and now near and far vision is much worse than before any surgery was done.
My cataract specialist did a 2nd L eye Yag procedure most likely not needed and further blurring occurred. Now I am told IOL is centered but could be moved slightly forward or backward causing bad focus and I could consider a piggyback IOL or wear glasses. I get migraines and dizziness when wearing glasses or contacts.
Do you have a suggestion for me and is a multifocal piggyback an option if I choose to take this route of correction?
FYI ... L eye Yag done by glaucoma specialist. R eye Yag done by cataract specialist. Both are in same practice together.

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by JohnHaganMD, Apr 24, 2016
Yes I would strongly suggest you get a couple of second opinions from surgeons outside the group you go to now. You want  to check around for surgeons that handle post operative complications. Since you had glaucoma surgery that might complicate your options of a trabeculectomy was done. If you had a small valve like iStent put in it might not make much difference. I'm a big believer in second opinions. Get them often myself in my practice.

Avatar universal
by jebvl, May 01, 2016
Thanks for all this information! I have had both eyes operated on with mono-focal lenses, and I am corrected for near vision. So I still need my glasses for distance (driving & tv), and I need magnification for very close vision. I am not unhappy with this, but I wish I had more information before being asked whether I wanted distance or near correction. What I felt I should have asked, was, "what do most people choose, and why?"

As for multi-focal lenses, the fact that my health insurance would not cover them made them not even a consideration. Interestingly, even with what is considered really good health insurance through my husband's employer, it still cost me nearly $1000 per eye. (Compared to the $50 copay my Medicare-eligible relative had to contribute.)

Still, I will be forever grateful for the surgery that has given me improved vision, and I sure do appreciate the superiority of our "original equipment"!

177275 tn?1511755244
by JohnHaganMD, May 01, 2016
If you were totally unhappy you could have lasik on your dominant eye and correct it to distance and you would have mini-monofocal distance bias.

Avatar universal
by smakcanada, May 01, 2016
This is an interesting site.
I have worn glasses since age 2. I am 58 now. I wore soft contact lenses from age 1 until about 10 years ago. Now I only wear glasses because the contacts became useless. I tried hard lenses but discomfort, redness meant I couldn't wear them. Tried gas permeable: they hurt, red eyes just like hard. I was wearing soft contacts WITH glasses for most things so I just gave up on contacts.
I HATE wearing gasses even though I have really cool,stylish frames, ultrathin lenses, low glare etc. I pay between $1000. and  $1200 for glasses - most of that because of my prescription. I also seem to be seeing 'worse' even though my prescription is only changing slightly over the last few years.
I would like to get surgery on my eyes but my ophthalmologist has always advised against it. He is conservative and I understand that if something went wrong with my right eye I would likely be unable to drive - and that is just NOT an option. I need to drive for my sales-related job and I could not afford not to work. I know there are different surgeries now but is there something that I could be 'guaranteed' the following: 1. my vision wouldn't be lost, 2. My eyesight wouldn' t be worse, 3. I could live without glasses.
I wouldn't mind if I occasionally had to use reading glasses, i.e. like in a dark restaurant with tiny writing on the menu.
But if there's a big risk of loss of sight, or the 'glare', & lack of contrast is too big a pricevto pay, or only a minor improvement would be gained then i think I'd suffer with the trifocals every waking hour. I just wouldnt be interested in paying that kind of money for little gain. I live in Ontario, Canada.
My Prescription (this isnt the latest but its the only one I could find right now)
ADD: +275
Thank you

177275 tn?1511755244
by JohnHaganMD, May 02, 2016
No there is nothing that is guaranteed in medicine especially surgery. Your eye shape is extremely difficult to fix, you are farsighted and lasik not work well for that. If you develop cataracts on down the line your glasses can be made much thinner and likely some things you can do without glasses but refractive surgery will always involve some risk and yours is tough.

Avatar universal
by Kamalakar, May 23, 2016
Hello Doctor,
I am 61 years old  and diabetic.I lost my left eye in an accident at the age of 3 years while playing bow and arrow game with my brother.Then onwards, my eye  vision has gone. Now, I am with glasses for shortsight. I am doing 4miles walk for one hour 30 minutes. Controlling my sugar levels  and checking BP, and consuming low calories are my aim. Is this sufficient to maintain good vision. I will be visiting the eye doctor once in a year for my vision testing. for the last few years.Please suggest me if any thing I am not caring. My blood sugar A1C is below 9 and I am trying to bring it to  8 or 7 within a couple of months. Thanks in advance.

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by JohnHaganMD, May 24, 2016
You need to discuss the A1C test with your physicians.  If that is the standard test normal is 5.7 or less. Ideal place for a diabetic to be is low 6's   e.g. 6.1  an A1C of 7 is NOT GOOD and higher than 7 is really bad.   So the #1 thing would be to get your A1C down to a much better level.  Discuss with your physician and read on the internet about the A1C test.

Avatar universal
by Kamalakar, May 24, 2016
I appreciate your very speedy reply.  Thank you Doctor

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by JohnHaganMD, May 24, 2016
Yes other things: don't smoke or use nicotine products, don't use cannabis. exercise regularly, watch your diet very carefully, watch your weight.  Keep your blood pressure and cholesterol under good control. Don't drink alcohol excessively. Practice relaxation and controlling your anxiety and depression. Have many friends and socialize. Have a philosophy or life or religious system that gives you inner peace and tranquility.

Avatar universal
by epoints, Jul 19, 2016
To Kamalakar,

have you consider implementable Contact Lense (ICL)?  i too suffer from inconvenience of  glasses and discomfort of contact lens.  I went with ICL when I was 45 knowing that I might need reading glasses when I get old.  I got good 7 years of clear vision and my life took an exciting turn.  hiking, swimming, scuba, fishing and partying.  I wish I would have done it earlier.
To Dr. Hagan,

Now I am 52 and have minor cataract on my right eye.  I currently have ICL with right eye set for monovision.  I am looking into Crystalens and Softec HD.  My doctor is recommending Softec and setting it for distance.  What is your opinions between these two lenses, and should I go with distance or monovision on my right eye?

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by JohnHaganMD, Jul 19, 2016
First read this article carefully, then read it again:  http://www.medhelp.org/user_journals/show/1648102/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You  ;

Do you realize that cataract are a known complication of ICL?

If you have a "minor cataract" you don't need cataract surgery. Cataracts only need to be removed if they are moderate or large in size and causing moderate or large disability. The surgery while common and low complication is not NO complication as a quick review of the many patients posting on the eye forum with problem related to cataract surgery.

Avatar universal
by claudiafeige, Sep 25, 2016
Hi Dr John. I have what feels like pressure around my right eye and blurry vision in that eye.Also the feeling of the eyelid being heavier (although both eyelids are equally open). No trauma. I don't spend more than an hour in front of a screen most days. I can't pinpoint the exact day that it started, but approxmately 9 months ago. I am a healthy 48 year old female on no meds and enough excercise. I had a thorough check up at the opthalmologist 2 months ago and he couldn't tell me what the issue could be: I have small cataracts that are apparently normal; Interoccular pressure normal; my left eye 0.75 and the right 0.5 (although when I close my left eye, close up writing is more blurry); no glasses ever.

I have consulted Dr Google and came across a forum where someone had a similar issue and mentioned blocked sinuses that cause pressure on the optic nerve. I do need to use a handkerchief from time to time. I'm not sure if it's my imagination, but it feels more comfortable to keep my right eye at "half mast" when in the sun. It seems like there is still that "pressure"on my right eye when lying in a dark room.

Please advise if I should go to an ear nose and throat surgeon to check out my sinuses or even do a CT scan?  

177275 tn?1511755244
by JohnHaganMD, Sep 25, 2016
This does not belong in this discussion thread. Please cut and paste it into the Eye Forum and I'll be happy to answer.

Avatar universal
by jrsdreece, Dec 13, 2016
  I am very happy to have found this sight. I had cataract surgery on my left (dominant) eye and a Toric MFL was put in.last April. I also had lasik performed to correct astigmatism. From the first day when I came back for my follow up I told the Dr. that the lights looked like Christmas bell ornaments. That went in one year and out the other. He checked my eye and said it looked "OK". come back in a couple of weeks . It needs time to heal and the swelling to go down. I did not seem  to have a swelling issue and by the next appointment nothing had changed. I did not know what to call my problem so I said I have double vision but that was not the right description so the next appointment I was calling it a ghost image. The truth is I have 3 dominant images that have 3 or 4  more riding on them also. Then as I was "healing" it became more evident that I had an abnormal amount of glare, most evident with bright light like headlights. This starburst is like a dandelion with bright lights at the edge of the ghost which gives off more star glare and makes the light look like it is incased like a bagworm nest in a tree. This makes driving quite dangerous and (I make amateur  videos) makes focusing a camera quite difficult. I am a Metrology engineer and perform repair on electronic test equipment. These conditions make tracing and following wiring and  reading schematics very difficult. I have not had anything done to my right eye yet am waiting to see if my left eye can be fixed. The Dr. said he could put in a "piggy back " lens in but changed his mind and did a lasik procedure to correct the alignment of the lens that he said was 1.5 off center and should have been less than .5 off center. I expected this to correct my problems with this lens but after 5 months I still have the starburst and ghost images. My question is does this ring a bell (no pun intended) and can this be corrected?  Do I need to see a cornea specialist? Am I going to be disabled in this eye and should I have a non multifocal lens put in my right eye? Is the ghost image caused by a distorted surface of my cornea causing it to act like a prism? What are my options?

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by JohnHaganMD, Dec 13, 2016
JRSDREECE: your posting would be good for the eye community and others can read and learn. Also we have many very accurate and precise posters who have had this type of surgery who often offer their experience. So please cut and paste into the eye forum and I will be happy to answer.  JHaganMD FACS FAAO

Avatar universal
by choc2016, Dec 24, 2016
Dear Dr. John,  I had cataract surgery in my left eye in May 2016 . Six weeks later I had a detached retina in that eye.  Then five months later (Oct 2016)  was told my lens had rotated.  Dr now says he can go back in to correct that and then do a PRK to help my vision.  I am so afraid of having another surgery because of the risks involved.  I was told that the capsule surrounding the lens could be punctured,  In researching, I found other risks of infection or another detached retina.  I went for two other opinions.  One said he would not advise it.  Another gave me two options 1) take the risks, then do a YAG procedure, then do PRK if needed for better visual outcome.  Option 2) Only do the YAG and then PRK.
I am a healthy 73 yr old.  I had cataract surgery 10 yrs ago in my right eye with no problems but could use a touch up PRK now for that eye.  Also 12 yrs ago I had monovision lasic done, left eye for reading, right for distance and had no problems.  One question, can myopic vision in my left eye cause a detached retina?   What are the chances of puncturing the capsule after this length of time?  What are the chances of another detached retina?  My retina has healed well from the previous surgery.  I cannot drive at night now because of the halos and starburst but do fine with glasses during the day to drive.  Your thoughts would be appreciated.

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by JohnHaganMD, Dec 24, 2016
If you have seen the retina surgeon on numerous occasions, as I know you have, and they have not noted any problems in RE (such as holes, tears, lattice-thin areas) and not recommended any preventive treatment such as laser or cold treatment (cryotherapy)  then the risk of a RD in your RE is probably around 5-10% maybe better depending on what your retina looks like and your refractive error prior to surgery (higher if you were a high myopic). Myopia does not cause RD but its a risk factor if especially if greater than -6.00 diopters of myopia. Cataract surgery increases risk of RD even small incision, no stitch but much lower than it used to be with big incision and stitches.

If your retina Eye MD would sign off on getting a Yag laser capsulotomy then that would be an acceptable risk and might make a huge improvement in your vision.  Opening eye and rotating IOL is a much bigger operation than Yag cap followed by PRK. If the IOL is not severely rotated then optical problems can usually be corrected with glasses, contacts or refractive cornea surgery.  I would strongly suggest you run these options by your retina surgeon and if he/she signs off maybe get a third opinion as if a Yag and PRK will do as well as opening eye and doing an intraoperative procedure you likely will be better off with less usrgery.

Avatar universal
by choc2016, Dec 25, 2016
Thank you for your timely response.

177275 tn?1511755244
by JohnHaganMD, Dec 25, 2016
you are welcome

Avatar universal
by judyjla, Mar 04, 2017
I  know  I  should   provide  numbers  here,  but  at moment   can't  find,
I  am   a   young  70.    Have  had  cataracts   number of years  (seemed  way too  early,   don't  think   my  progenitors  had,   but who  knows).
I  use  progressive  lenses,   a  top  brand  it  seems.
Need for  glasses   started at  age   16  in  college,   I  am not unhappy  wearing  glasses.   over the  years I  had to  get progressives,   still not  unhappy.   Right  eye  was  always  far  better,   but   cataracts  in both,  and the one in right  eye,   is  larger?   and  in  any  case,   right in  center,  such  that  night  driving,  with  oncoming  lights,   is  a  killer,
On  dark   country  roads,  no   problems.   Cataract  md  who   haven't seen  in   3  years,  told  me,  "you will know  when you  need  surgery"..   Been  seeing  someone  else  since   cataract  guy's   staff    refused to  give  me  appt  at  NY  Eye and Ear,   told me  that  a different   problem  that i  thought i  might have  (after  head  blow,   and yes,    blood   red   down,   and   healed).   They  said  he is  only  cataracts.    well,   WOW   WOW.    i  had  seen  him   couple of  years,
So  i've  been  seeing  someone  else   last   2  years. She  agrees   that  it's up  to  me.   it  seems that   changes  have  slowed down.  (and I   actually  like  wearing  glasses).  
OK,   got to  stop  going on and  on.    I  am  not  unhappy  with the  vision I  have with the  progressives.  
although  i  find  myself  closing  right  eye  when i   read,   (unconsciously).
I  am  planning   appt  with the  non  cataract  person   in  few months, she   has  no  opinion  re  surgery,
So:  after   all of this: HERE IS  THE  QUESTION.  if I  am  not  unhappy with   progressive   eyeglasses  and their  level of  correction,   after   reading  about all sorts of possible  issues  from   cataract  surgery,  (yes,  possible)  I  am a  non-interventionist  person.
Would  I be  crazy to have   cataract  surgery on the  right eye   the  one with the larger  cataract,  smack in  middle,??  making  nighttime  driving  scary  (hey,  those  huge  overhead signs,   green  with  ,   not sure,  lights?   but on  major  highways  that i  am  not  familiar  with,  scary).
Would i  have  to be   crazy  to  risk  any of  possible    side  effects.  ,   glare  (hey,   that  is  the  problem),  as   side  effect,  that would  be  crazy,    INSANE     to have  side  effect  identical to  original   complaint???
I  would  like to  feel   free to  drive  summer  vacations  at night.    otherwise,  the level of  correction,   sheesh,  i  can  find  the  rx  for  computer  glasses,  which i   never  got,   but  not  total  RX),   is  sufficient for me.
Strange that the  far  better  right  eye,  re   long  distance,  is  no longer   the  better one  due to the  larger  cataract,  very very  central,   affecting  nighttime  driving,

With  all of  the  possible   side  effects,   yes,  i  know,   Possible,     halos,   omg,   that is what i  have  at  night,
would i  have  to  be  crazy  to  consider   cataract  surgery?     i  think   they are  not  growing,  but do not  know  re   age  effects,   i.e.   at   70?   will  that  create   problems?   could  they   harden,   if they  do not increase in size   anymore,   would that  be  an  issue????
I  am  non   interventionist  person,   natural  childbirth,    is  one  example.   others,  
Also,    it  seems  that the  number of  options  re  lens  replacement  is  extraordinary,   too complex  for my  mensa  brain,
and if I  did   right  eye,    would  I   be  compelled to do    left  afterwords,
I  know i  am  not giving   numbers  here,  (can't  find  script, and  ;perhaps  not  relevant?)/
Should i   stay  with my  lifetime   motto,    less is  better?
What  is  percent  of  problems  (OF  ANY  KIND  WHATSOEVER)     after  cataract  surgery?    Is  this a  gamble  worth  taking?   was  totally  stressed   out   driving  back  to  NY  from  Mass.  after  visiting   progeny
yup,  can   avoid  nighttime  driving,      are the  cataracts  only  cause of  difficulties in  nighttime  driving for a  young   70  year  old???
Too many   questions,  but in  final   analysis,  it is  really  only  one.
Thank you  for  any  input,  or  even  suggestions   re   reading.

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by JohnHaganMD, Mar 04, 2017
I will make one posting here but if you need follow up please post this to the general clinic so the discussion can be viewed by a larger number of people.

You will not get the reassurances you want in a less than perfect world and especially in medicine. I can understand the reluctance of your physicians to do surgery until you say "I understand the risks and I want the surgery"

With an experienced surgeon and a normal risk patient the operation will be complication free 97-99% of the time. That does not mean the person is happy or can see 20/20.  Some people have multiple eye problems and when the cataract is removed do not have an eye capable of seeing 20/20.  Some people hate glasses and want to see like they saw when they were 12 years old. You get a new lens but not a new eye.

Basically I ask a my patients:  For everything you need to do and want to do visually over the last 6 months tell me how big of a problem is it for you:  No problem? Small Problem? Medium Problem, Big Problem.  If the answer is no or small I tell them we won't do the surgery until they believe it a medium or big problem. IF they commit they must understand the risks. We take risks all the time.  Getting in an automobile is one of the riskiest things we do. When you feel your vision is a medium or big problem then find a surgeon you trust and can communicate with and work through all your other reservations and concerns.  Remember cataract/IOL surgery is the most common and successful operation done on adults.

177275 tn?1511755244
by JohnHaganMD, Aug 26, 2017

Avatar universal
by Tweets1964, Feb 21, 2019
Dear Sir
I would greatly appreciate some advice, if you have the time. please..
I am a 54 year old female, who had no eye problems and no cataracts, prior to lens exchange 2 years ago. I wanted to be free of having to use 2 pairs of glasses - close up and intermediate.
I had Zeiss AT Lisa tri focal lenses implanted in 2016.
Due to all the problems with tri focals (multi focals), glare, halos, misty vision, low light problems, plus postule opacification in the right eye, I sought to find a solution.
I had the dominant eye lens explanted 3 weeks ago and replaced with a monofocal lens, Clareon +22.5D. The right eye was "cleaned and polished", however, the misty vision at intermediate is worse than previous.

I intend to have the other tri focal lens explanted and replaced with a monofocal, set for close up, but I am uncertain what "strength" to go for. I am looking to achieve mini monovision.

At present, I am better than 20/20 with both eyes for distance. I am using +2 for reading. I cannot read anything with the monofocal eye on its own.

I would like to be able to read a menu, for example, but still have clarity at intermediate and distance. Do you think this would be achievable with mini monovision? Looking at the lens strength I currently have for the dominant eye, set for distance, what would you suggest for the other eye please?

177275 tn?1511755244
by JohnHaganMD, Feb 21, 2019
Be sure you have read this completely:  https://www.medhelp.org/user_journals/show/841991/Consider-ALL-the-Options-Before-Your-Cataract-Surgery-Working-Through-Whats-Best-For-You      Your problem is an example of why I have never recommended "clear lens" or "refractive lens" exchange.   If the eye you just had surgery on is clear at distance (20 feet away or further) and is monofocal you would expect your intermediate and near vision to be blurry.  If you set the other one for reading  that is NOT mini-monofocal but full mono-vision.  It is deeply disturbing to many people. One eye is always out of focus. Glasses are difficult to wear and adjust to because of the big difference in the strength of each lens and intermediate  3-15 feet is going to be out of focus. You might want to get a second or third opinion before you end up going from the frying pan to the fire.  You WILL NOT have good vision distance, intermediate, near with monofocal lens.

177275 tn?1511755244
by JohnHaganMD, Feb 21, 2019
The last sentence should be (without glasses).   I saw a person in consultation a month or two ago in a situation like this. He has spent $12,000 out of pocket for several surgeries on both eyes and was still dependent on glasses for many things and very unhappy and very much poorer.  Nothing we could do to help him.

Avatar universal
by Tweets1964, Feb 22, 2019
Dear Doctor Hagan

Thank you very much for your super-quick reply.  I was not aware that the monofocal set for distance would impact my intermediate vision...

Knowing that I now have good distance vision in my monofocal dominant left eye, please could you "loosely" recommend what strength of monofocal lens I have put into my right eye, to achieve mini monovision?  

I am looking to achieve improved intermediate and close up, but I do understand that with monofocal lenses, you cannot have clarity at all 3 distances. I saw on another thread that mini monovision is a good outcome.

177275 tn?1511755244
by JohnHaganMD, Feb 22, 2019
Monofocal means 'focused at one distance and one distance only'.   Anything further, nearer will be out of focus. There is a physics formula for the focal length of any lens system and its extremely accurate.  There is a "depth of focus" that is variable and depends mainly on the size of the pupil and how reactive it is.  Within this depth of focus thing seem relatively clear.   At distances further than 20 ft/6 meter the light enters the eye parallel and if the distance post op RX is 0.00 (called plano) then distance further than 20 ft is clear. Now at some distance the objects become too small to clearly make out.      And NO I cannot loosely recommend any IOL power. It is a complex formula based on length of eye, radius of curvature of the cornea, a K constant unique to each IOL and modified by regressive analysis of the surgeon's previous post op results.  It is unlikely you are going to be happy with any of your choices and your post op results. My final recommendation would be to get a second opinion before you have surgery.

Avatar universal
by Tweets1964, Feb 28, 2019
Sorry for the late respnse, but thank you again for taking the time to respond.

177275 tn?1511755244
by JohnHaganMD, Feb 28, 2019
Best of luck.

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