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Range of vision for plano or distant monofocal IOL
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MedHelp Member's Question

Range of vision for plano or distant monofocal IOL

by ddtla, Jan 26, 2007 12:00AM
I had bilateral rezoom placed about 5 and 6 weeks ago. I see constant ghosting image with the rezoom and I am unhappy with the result. I am thinking about having them explant and placing bilateral monofocal lense set for plano or distant vision.



My question is with the monofocal lense set for distant, what is the range of vision that I can expect to see clearly without wearing glasses?

Will I be able to see clearly from 4 or 5 feet and beyond without glasses? Will I be able to see the face of the person sitting across the dinner table clearly without glasses?



I know that I will need glasses for reading but I would like to know what is the range or limit that I can see clearly without glasses?









Doctor's Answer

by Forum-OD-MP, Jan 26, 2007 12:00AM
"My question is with the monofocal lense set for distant, what is the range of vision that I can expect to see clearly without wearing glasses?"



assuming they actually REACH exactly plano (big assumption)...10 feet and farther: clear.  9 feet and closer: blurry.  NO READING.  NO COMPUTER.



"Will I be able to see clearly from 4 or 5 feet and beyond without glasses?"



10 feet and farther...clear.  anything closer...NO not clear.  the closer it is, the blurrier it will be.



"Will I be able to see the face of the person sitting across the dinner table clearly without glasses?"



you will be able to physically see them, yes.  but they will not be clear.
Member Comments (41)

by ddtla, Jan 26, 2007 12:00AM
Thank you for your quick respond.

I heard that you can wear bilateral multifocal contacts and this will allow you to see near, intermediate, and far with the monofocal IOL(set for distant). Is this true?



What other options do I have with the monofocal lense set for distant?

If I wear bifocal glasses, what is the range of vision that I can expect to see clearly? Will I be able to see sharply and clearly at all distances ( near, intermediate, and far) with the bifocal glasses?



Any comments or personal experiences will be greatly appreciated and will help me to make my decision.

by Ag-i-doc, Jan 26, 2007 12:00AM
"I heard that you can wear bilateral multifocal contacts and this will allow you to see near, intermediate, and far with the monofocal IOL(set for distant). Is this true?"



well this is a trick question.  you stated that you already HAVE bilateral multifocal IOLs and you're not happy.  those IOLs have the same optics (or very similar) as bilateral multifocal contacts.  in fact, the optics design for the IOL's is based on and very similar to the design of the multifocal contacts.  so NO.  for you that would likely be untrue.  you'll be just as unhappy with multifocal contacts with your monofocal IOL set at distance as you are with multifocal implants.



"What other options do I have with the monofocal lense set for distant?"



bifocal glasses, multifocal glasses, monovision contacts, multifocal contacts (although already discussed that probably wouldnt work)...



"If I wear bifocal glasses, what is the range of vision that I can expect to see clearly? Will I be able to see sharply and clearly at all distances ( near, intermediate, and far) with the bifocal glasses?"



if you are talking about bifocals WITH A LINE ("flat top bifocals")...the top is 10 feet and farther.  the bottom is say 1.5 to 2 feet and closer.  no "intermediate" distance.  multifocal glasses ("progressives")...yes in theory for every conceivable distance there would be a spot in the glasses that you could see clearly.  you'd just have to learn to "find the spot"

by JodieJ, Jan 26, 2007 12:00AM
To: ddtla
I have monofocal aspheric lenses set to plano in both eyes, which give me excellent distance vision in all lighting situations, with no ghosting, glare, halos or other aberrations.  And there was no lengthy adjustment period to a new visual system; I was driving at night the day after surgery without problems.  But my near and intermediate vision are poor, IMO.  Anything within arm's length is noticeably blurry, although I don't have a problem seeing somebody's face across a table.  I wear bifocal contacts (or, occasionally, progressive glasses) most of the time, because I'm very fussy about my vision and hate blur.  (Other people with two IOLs at plano only wear readers occasionally--e.g., for menus, the newspaper and the computer.)  



With both eyes at plano, you could also get good near/intermediate vision by wearing a contact lens in one eye (reversible monovision).  Another alternative would be setting one eye at plano and leaving the other a little nearsighted (sort of a modified monovision).  This would give you good distance and intermediate vision; you'd probably only need readers for small print.



I've read your posts about your multifocal problems.  If you can safely explant your multifocals, I think that you'd be much happier with monofocal lenses.  I've found them to be problem-free.

by Jmadison, Jan 27, 2007 12:00AM
I am 10 weeks post-surgery for my aspheric monofocal and the only noticeable visual deficit I have is reading newspaper print closer than about 18-24 inches (I'm able to use the computer as most print is large enough).  My current correction is -0.5, so I am slightly near-sighted.  It is a decent range of vision.  About six weeks ago, my correction was -1.0 and I was able to read the newspaper at a closer distance, but I did need driving glasses. All in all, I am happier at -0.5 than I was at -1.0, because now I only need some low-powered drug store readers for extended reading or for fine print.



My target was plano, but my result of being slightly near-sighted does have its benefits (I was told the final result would likely be +/- 1.0 diopter different than what was planned). Right now, I am able to use my surgical eye for distance.  My non-surgical eye has a multi-focal contact lens that on purpose under-corrects my myopia to about 20/50 so I use that eye for near.

by JodieJ, Jan 27, 2007 12:00AM
I didn't mention that there are several designs for bifocal/multifocal contacts.  The ones I have (Triton soft bifocal contacts/www.gelflex.com/1-866-GELFLEX) use a translating design, which is totally different from the optics of a multifocal IOL.  They're sort of like bifocal glasses, with the top part of the lens for distance and the bottom for near/intermediate vision.  The prescription in the near/intermediate section can be a little different in each eye (if desired) for a slight monovision effect to improve intermediate vision.  (Mine don't do this, and I can still use the computer without problems.)  I think the Tritons are excellent contacts.  My optometrist charged me $300 for lenses that should last a year.  (These contacts can also correct astigmatism, if necessary.)



I also tried soft disposable multifocal contacts, which have optics similar to an IOL.  I didn't like them as well, although I didn't experience ghosting or halos.  I wore C-Vues for a couple of weeks (plano with a high add).  When you have 20/20 vision uncorrected, it's obvious that your distance vision isn't quite as good when wearing these contacts.  My near vision was barely adequate.



I've never worn gas permeable multifocals, but I know people who are very happy with them.  And another alternative for post-cataract surgery would be to wear a contact in one eye for reversible monovision.

by Susan12345, Jan 28, 2007 12:00AM
To: JodieJ
Well, they closed our last thread where you wrote about your letter to Dr. Christenbury. I'm not surprised that he said have the other Restor put in, because that's exactly what my doctor said, that's what the Alcon Co. tells them, that the Restors are designed to work together and won't work with only one, which is why Dr. C told the one-eyed man to have the monofocal.  I go back and try to analyse what I should have done.  Obviously the Restor on the one eye was doing nothing for reading vision.  I told my doctor that and he said it would work when I had the other one done.  He KNEW I was using OTC reading glasses, he told me to.   I couldn't stand having one eye for distance and one for near, though I know many people do.  So in retrospect,  my only other alternative at that point was to have the Restor taken out and replaced by a monofocal of approximately the same degree of nearsightedness as my other eye, but I doubt my doctor would have done that even if I'd asked, and I was still naively hoping he was right, that the Restors would work.   The Alcon people have a good deal going, once you get one you're pretty much committed to the second.  But still, the 5 weeks between my 1st Restor and my 2nd, while my vision was confused with clear glass over the Restor eye and OTC reading glasses for reading, I didn't seem to have as much of the annoying fluttering as my eyes tried to adapt from near to far. Maybe because I was mainly just using the non-Restor eye.  Still, it makes make me wonder if only one IOl exchange MIGHT work if I had it set for -200.   Before surgery I was -400 in the right eye and -525 in the left.  If I couldn't adjust to bifocals I certainly could never adjust to monovision.  Anyway, if Dr. C has really done 5000 Restors, he MUST have had some that didn't work.  I'm curious what he tells them, he can censor his letters, but he has to see them face to face in his office.  I suppose, he tells them what my doctor told me, that my fluttering was due to being tired, I would read better if I didn't hold my books too close, and everybody else LOVES their Restors.  Susan12345 (the freak who doesn't love her Restors)

by JodieJ, Jan 28, 2007 12:00AM
To: Susan
Any reader of this forum knows that many people are very unhappy with their ReStors.  In a perfect world (for consumers), there'd be some objective research available about patient satisfaction with their multifocals at various points in time post-cataract surgery.  This type of information would help patients and their doctors make better decisions about who should (or shouldn't) get multifocals and which lens (or combination) might work best in particular situations.  Unfortunately, this data doesn't exist.  I've said before that the field of cataract surgery seems to be dominated by corporate rivalry, and the major corporate players probably wouldn't benefit from having this information available.



Susan, it is not your fault that your ReStors don't work for you.  Possibly your topography findings will help your new doctor determine why they don't.  I'm sure that he can make recommendations about what you might do at this point.  As for Dr. Christenbury, you'll probably enjoy reading the comments by his patients (http://ratemds.com then click North Carolina).



by Susan12345, Jan 28, 2007 12:00AM
To: JodieJ.
Interesting comments