Cataract Surgery - Monovision vs Multifocal Lenses

I’ve hit the point where I’m ready for cataract surgery and prescriptive lens implants. Historically, for many years I wore multifocal contact lenses but was dissatisfied with my visual acuity and for the last few years have worn monofocal lenses - 1 for distance and 1 for reading - to create monovision. The monovision appears to be working as well as the prior multifocal contacts.

So I now need to make a choice of whether to go with monovision or multifocal lenses as part of my cataract surgery. From what I can gather from scientific littersture online, the differences are:

  1. Multifocal will provide superior close up vision while monovision may require reading glasses for fine print. Multifocal may also provide very slightly better distance vision.
  2. There is a much higher incident rate of glare and halos with multifocal lenses.
  3. Monovision is fully covered by my insurance but multifocal will cost me $2500 per eye.

Anyone familiar with the literature? Any eye doctors out there who can offer an opinion?

I am not an eye doctor but I have multifocal lens implants. My Dr. used ORA, a laser measuring gadget, during the surgery to determine exactly which lens would work best. I also wore mono vision contact lenses before this.

I chose the multifocal so I would be free of glasses. My Dr. said that overall vision with multifocals may be slightly less sharp than other options. I was also warned about glare and halos, which I already had. My glare and halos are slightly better than they were before the new implants. My close up and distance vision are both fine for me. My H needs very sharp close up vision for a hobby and chose not to get multifocals because he was not willing to give up any acuity there. It all depends on exactly what your needs and wants are.

I find that I now need more light for close up work. It took me awhile to realize this, but I can read the tiniest of print but only with very bright light. I use a clip on book light when I read in the evening.

Mono contacts were OK but I was pretty sure I didn’t want to spend the rest of my life squinting with one eye for certain tasks. My sister chose that option for her implants and regrets it for exactly that reason. She had not worn the contacts before her surgery.

My implants cost about $7,000 extra. I was charged around $800/eye for the laser measurement. I have no idea if that is a money maker for the Dr. or actually improves outcomes. He will not implant multifocal without it so I had no choice.

I hope you find all the info you need to make the right decision for YOU. Good luck!

What if your vision changes as you age?

According to my Dr. changes should be minimal unless eye diseases crop up. I was told I have corneal dystrophy, a genetic eye problem, but it may or may not progress as I age. Meanwhile, I am enjoying my glasses-free life.

I had cataract surgery ten years ago at age 46. My doc recommended mono lenses – he said many of his patients were unhappy with the multifocal lenses, esp. those who thought they’d be able to ditch the glasses. Sounds like not much has changed in the past ten years. I also had a significant difference in my copay if I went multifocal. I chose to correct for distance and have not been sorry. I have astigmatism and my prescription has prisms to correct that, so I knew going in I was still going to need glasses, esp since I do a lot of close work.

I can watch TV without glasses, and I could drive without them as well, but my driver’s license requires them. No big deal. My prescription has changed slightly since the surgery, but nothing near the significant diopter changes I experienced before the procedure.

I had cataract surgery about 5 years ago. My surgeon was very confident that multifocal lens would give me 20/20 vision and no reading glasses. Cost me thousands.

He was wrong. I need reading glasses and my close visions is not good. I did all the exercises recommended and still had this result. I also had to have a laser treatment 6 months later to address an issue.

I really regret getting the multifocal.

I got monovision. Eye doctor recommended it because of my job and astigmatism. I have to wear glasses for closeup, but I can watch TV and drive without glasses. I don’t do either, because it is just easier to always wear my glasses. My astigmatism returned without 2 years of the cataract surgery.

I’ll be having cateract surgery sometime after my next appointment in July. My doc said…any time I’m ready, I can have it done.

He says, I’m an excellent candidate…no astigmatism, and my near point vision is actually good. I will get monovision.

My only concern…I have exfoliation syndrome in one eye…and sometimes that can cause complications in terms of the lens insertion. My doc didn’t say anything to ME about that…but a friend was told that.

I also have glaucoma…so apparently multivision are not recommended.

I’m book marking this thread!

Thank you everyone for your input. I’m strongly leaning towards monovision particularly since I’ve worn both multifocal and monovision contacts with good results with the latter and dissatisfaction with the former. Plus it’s nothing to sneeze at that the monovision is fully covered by my insurance. I think I’ll pull the trigger after The first week of June to allow me to train for a 4 day bike event I’m riding June 1-4.

For those who have had cataract surgery, how long does it take for your vision to “settle down” to the point that new glasses can be prescribed? I’m at that “whenever you’re ready” stage. I have a 5 day vacation planned for late June, and a 11 day trip to Europe in September. If I wait until July for the surgery, will everything we good to go in September?

ALSO, while I have CC’s ear, I have one eye whose cataract is much worse than the other. Will having one done cause a situation where one really good eye + one so-so eye will cause frustration?

MADad, I went nuts when I had one eye done and not the other. Cheapo reading glasses gave me headaches. I had my eyes done three weeks apart, and got new glasses about three weeks after the second eye. YMMV, but mid-July and travel in September should probably be ok. Check with your doc about travel – because airplane cabins are pressurized, some docs recommend you wait a bit before flying. DH had to travel not long after his procedure, and IIRC, the doc told him a week.

I have a friend who had one eye corrected for near, and one eye for distance. No way could I do that!

Do they ever go back in and change the lenses?

I asked the my ophthalmologist that very question for 2 reasons : 1) if I didn’t like monovision or multifocal and wanted to switch to the other and 2) what if my vision changes again a few years down the road. His response was that it depends on how much time has passed since the surgery. He stated that taking out existing implants and putting in new ones is much more difficult and complicated than the original surgery. If it’s a matter of a couple of months, then perhaps. If it’s a couple of years, then no. If your vision changes a couple of years down the road, he stated that LASIK, contact lenses or glasses would be the solutions.

I did not realize you could wear contacts after the cataract surgery. Did the ophthalmologist say anything about soft or hard lenses were OK?

I have mono vision soft lenses now. If I would need surgery my optometrist recommended mono or corrective to close. I really think that I would get corrective to distant (I would rather wear readers than eyeglasses to see anything). My diopter is -5 for distant. I think that mono vision while it has been good is not ideal and what if one eye goes sour? I guess the multifocal would be the best option but I have astigmatisms and maybe that would not be an option.

Would it be correct to assume that you prefer not to wear glasses (or contacts) on a regular basis?

If you are willing to wear glasses on a regular basis, it would seem like monovision would be fine. You could wear glasses (single vision or bifocal) on a regular basis, but you would still have some near and far visual function if you do not have your glasses on.

My goal is to not wear glasses. I am a competitive athlete so glasses for mid-distance vision is not compatible with my lifestyle. When I food shop, reading food labels is important to me and carrying glasses for that purpose would be very inconvenient. I also spend a lot of time engaged in activities that require instantaneous shifts from mid-distance to reading and back. Again, glasses would be a major inconvenience. That’s why I’m leaning towards monovision (one eyed corrected for distance and one for near).

One thought about monovision correction:

I wear hard contact lenses. I have monovision with the under-corrected lens not fully under-corrected. The advantage is that it’s easier to focus mid-range, say at arms length, like a computer monitor or car dashboard. For the occasional very miniscule print I use otc reading glasses (1.0).

(I have a hard time adjusting to a greater discrepancy between the two prescriptions.)

As for “do over” cataract surgery, a friend had to have one of hers corrected within a month of the original surgery because of the surgeon’s error. All’s fine.

If you do a search for dentmom4, you can read all about my cataract surgeries on several threads. I had a few setbacks, but now all I have are floaters and dry eyes.

Looking back, I wish the doc had told me that I MUST do both eyes, 2 weeks apart. He only suggested it. My eyes were too different and I had to wear a patch to be able to see out of my eye with the new lens as my glasses didn’t work, even with a different Rx. I was unable to pick up a dental drill for 6 weeks. I also went through 3 different prescriptions for my glasses before my optometrist told me I had grown a film on the new lens. I also grew a film on the second lens. I had those lasered off at separate appts. I had the flashing white lights on the edge of both eyes, but that has settled down. I developed major floaters in both eyes; better now, but sometimes I think I am seeing a small bug and that’s distracting.

I am a major eye phobic. I hate eye drops so I live with dry eyes. I developed almost every consequence of cataract surgery except needing replacement.

It’s fundamental to mono-vision that you lose some depth perception. Stereo vision is impossible without two sensors, which in this case would be eyes. However, if you’ve had mono-vision for years and that hasn’t bothered you, I wouldn’t start worrying about it now.

I didn’t have to miss any running days after my cataract surgery, Michael. (Per the doctor). I just had the ne eye done that developed the cataract after my emergency retina surgery. I had that eye done for near vision and the other eye is my distance eye. I wear a low powered contact lens on the cataract surgery eye. I could wear any type of lenses (I’ve always used extended wear) but now use daily lenses.