Choice of intraocular lens or lenses during cataract surgery

[Astigmatism]

I have an MD degree, but not smart enough to be in the optical field. My sister posed questions to me, but I can't answer them. Was hoping you could help here. The following is what she wrote:

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I seek monovision with cataract surgery. My goal: to see distance clearly but to not have to wear reading glasses for reading ingredient labels or other small print.
1. Can I use a Vivity lens in one eye for best distance and a non-Vivity lens (the "regular" kind) for close-up in the other eye?


2. If the answer to the above is yes, then:
What is most likely to give me, with monovision, the clearest possible vision at all or most distances:
a. two Vivity lenses
b. Vivity for distance, "regular" for close-up


3. If I seek monovision, is there any reason to NOT choose a Vivity lens, even for distance?


ASKED DIFFERENTLY:
4. What lenses or combination of lenses are recommended for best monovision with clear distance vision and clear closest-up vision.


5. What are the downsides of having both eyes done at the same time? (Why space the two surgeries?)

[optical24/7]

Don’t, I repeat don’t even think about mono IOL’s till you’ve tried it ( for at least weeks ) of CL wear in mono. IOL’s are for the rest of your life and there is no “do over”!

[Barry Santini]

“Freedom from spectacle dependence” is a false premise and promise.

[Robert Martellaro]

The lowest risk (best possible visual outcome) is with monofocal implants without monovision.

The question that needs to be answered before all others is how much risk are you willing to accept (poor visual outcomes and/or continued dependence on eyewear) in exchange for an unknown degree of dependance on distance and/or reading eyeglasses.

Best regards,

Robert Martellaro

[finefocus]

Years ago, knowing that IOL's were in my future, I tried (for a reasonable period, not just a day or two) both monovision contacts and multifocal (simultaneous vision) contacts. I had had patients who adapted to and endorsed both modalities. I was never able to see a pattern explaining who was successful and who wasn't. My brain was one of those that just didn't like it. I understood the principles, I gave it enough time, I seriously tried with the foreknowledge of a professional. Still, these analogues of fancy IOL's were unacceptable. No problem, I just stopped using them. That option just isn't available to a post-op patient. Will it be great? Will it be awful? Whatever, it's over. Although it's theoretically possible, your doctor just won't go back in to swap out an IOL that you don't like. You should listen to optical 24/7 and Robert

[Lensman11]

Mono vision is a compromise if you want not the best acuity in distance or near that is the way to go. Try driving a car with one eye clear and the other blurry not a good idea.

[Michael Davis]

The problem with trialing contact lenses before cataract surgery is the the vision is not that good if the cataract is dense enough for the surgery. If I have a patient that has been happy in monovision prior to cataract development then this would be an option in IOLs otherwise, multifocal IOLs if the patient is tolerant of mild blur

[finefocus]

The problem with trialing contact lenses before cataract surgery is the the vision is not that good if the cataract is dense enough for the surgery. If I have a patient that has been happy in monovision prior to cataract development then this would be an option in IOLs otherwise, multifocal IOLs if the patient is tolerant of mild blur

I agree, once surgery becomes indicated, it's too late to use contacts to experiment and choose an IOL.
Has anyone here had patients who were successful with monovision contacts but not monovision implants?

[drk]

The problem with trialing contact lenses before cataract surgery is the the vision is not that good if the cataract is dense enough for the surgery. If I have a patient that has been happy in monovision prior to cataract development then this would be an option in IOLs otherwise, multifocal IOLs if the patient is tolerant of mild blur

This^^^. Listen to Dr. Mike. Be like Mike. GOAT post.

[drk]

Now for the REAL POOP.

YOU ARE POOP for posting this poop question on a board with a lot of opticians and a few hack optometrists, like me.

How about your overweening sister gets a referral to a kick-@$$ cataract surgeon and let him/her make these kinds of decisions?

What kind of world are we living in, here? Cybersurgery?

[CCGREEN]

Before a decision can realistically be made it has to be determined if the pt's expectations are realistic. If your 70 you are not going to see the same as you did at 20 there are to many other health issues that affect your vision and also have to take into account the HEALTH of the eye itself. It sounds like the above mentioned patient wants youthful vision, well hell don't we all?
Next, the surgeons skills set is but only so good and then then rest of it is up to nature and how the eye heals itself which we know we have no control over AND read all the fine print of the surgery papers and you will find that the Dr is not promising you anything but to do the best he can.
Personally myself, spending more then half my career working with MD's I am going to go with SV dist IOL's and continue using multifocals. I want to get as close to 20/20 distance as I can and call it good.

[CCGREEN]

now for the real poop.

You are poop for posting this poop question on a board with a lot of opticians and a few hack optometrists, like me.

How about your overweening sister gets a referral to a kick-@$$ cataract surgeon and let him/her make these kinds of decisions?

What kind of world are we living in, here? Cybersurgery?

awesome drk........just awesome! Makes you have to wonder just what his MD degree really stands for. Something just kinda smells here.

[drk]

It's the poop?

[Astigmatism]

Before a decision can realistically be made it has to be determined if the pt's expectations are realistic. If your 70 you are not going to see the same as you did at 20 there are to many other health issues that affect your vision and also have to take into account the HEALTH of the eye itself. It sounds like the above mentioned patient wants youthful vision, well hell don't we all?
Next, the surgeons skills set is but only so good and then then rest of it is up to nature and how the eye heals itself which we know we have no control over AND read all the fine print of the surgery papers and you will find that the Dr is not promising you anything but to do the best he can.
Personally myself, spending more then half my career working with MD's I am going to go with SV dist IOL's and continue using multifocals. I want to get as close to 20/20 distance as I can and call it good.

Thanks to everyone who answered. Guess I wasn't clear enough earlier. My sister has had monovision for over 50 years and has been very happy with it. So we are not seeking advice on the pros and cons of monovision.
She knows she has to wear glasses most of the time for best vision and is glad to do that (especially for driving and reading), but wants the option of being able to glance near or far, see clearly at a social gathering or when she gets out of bed in the morning, but also able to read her text messages, ingredients on a food label, etc. without always having to put glasses on.
The question is: Is it best to stick with the same brand/kind of lens for each eye? If she uses a Vivity for distance, does she need to use a Vivity for the close-up eye also -- or can the close-up one be a regular single-focus iol for reading?

[drk]

As an MD, don't you have an OMD friend who can answer these questions? Why should we assume you're an MD and not just some guy looking for surgical advice on an optician's chat room?

As an MD, is this the way you get information about specialist care for YOUR patients?

I find this all a little incredible.

[Astigmatism]

As an MD, don't you have an OMD friend who can answer these questions? Why should we assume you're an MD and not just some guy looking for surgical advice on an optician's chat room?

As an MD, is this the way you get information about specialist care for YOUR patients?

I find this all a little incredible.

Wow! Sorry, I thought forums were for sharing useful information with healthy input from a variety of educated opinions. I did not want opinions from just one professional. What do you want me to do about this? Terminate this discussion?

[drk]

Answer this question: does she have a surgeon or not? Why are you asking randos instead of him/her?

[KrystleClear]

Our MD does cataract surgery. He will do monovision iols if someone is dead set on it, but will try to talk them out of it, especially if they have never worn monovision cls. We had a patient a few years ago who was absolutely dead set on it. We did it. She was not happy with her vision after the surgery, of course, as monovision is essentially a compromise. I highly recommend just spending the extra money on premium implants like Crystalens or Panoptix if you want the best possible vision post-cataract surgery. We have a lot of happy patients who opted for Panoptix implants.

[Astigmatism]

Our MD does cataract surgery. He will do monovision iols if someone is dead set on it, but will try to talk them out of it, especially if they have never worn monovision cls. We had a patient a few years ago who was absolutely dead set on it. We did it. She was not happy with her vision after the surgery, of course, as monovision is essentially a compromise. I highly recommend just spending the extra money on premium implants like Crystalens or Panoptix if you want the best possible vision post-cataract surgery. We have a lot of happy patients who opted for Panoptix implants.

Thank you soooooooo much for this excellent on-point reply!

[Astigmatism]

Our MD does cataract surgery. He will do monovision iols if someone is dead set on it, but will try to talk them out of it, especially if they have never worn monovision cls. We had a patient a few years ago who was absolutely dead set on it. We did it. She was not happy with her vision after the surgery, of course, as monovision is essentially a compromise. I highly recommend just spending the extra money on premium implants like Crystalens or Panoptix if you want the best possible vision post-cataract surgery. We have a lot of happy patients who opted for Panoptix implants.

Sorry, but your fine post brought two more good questions from her:

With Panoptix:
1. Is there increased glare sensitivity?
2. Can one read without reading glasses?