/ Monovision laser eye surgery for presbyopia

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john arran - on 11 Jan 2013
I've been reading about options for getting rid of the reading glasses which have become increasingly necessary in recent years and the Monovision treatment sounds like it has a lot of potential so I'm looking for advice from people who have had this type of treatment or decided against it for good reasons.

I've read that it can take a while to get used to so a couple of days ago I took one lens out of a cheap pair of glasses and I've been wearing them almost all the time when indoors, finding it remarkably easy to adapt and quite impressive how I'm already no longer aware which eye is doing the work when looking at near or far objects.

Also does anyone have any recommendation for where would be best to have this done or for which company to go with?
Neil Williams - on 11 Jan 2013
In reply to john arran:

I reckon I would find the loss of 3D vision (perspective) quite annoying. Though I have heard of people who have done quite well out of this, so if that doesn't bother you...

Neil
Rob Exile Ward on 11 Jan 2013
In reply to john arran: Have you given bifocal contacts a try? Laser is a bit irreversible if you don't like the outcome and there are complications in a significant (5%?) proportion of cases.
colina - on 11 Jan 2013
In reply to john arran: .
if its only reading glasses u need ,not sure whether id bother taking the risk of eye surgery .if it was for general everyday use then that's another scenario I guess, and worth more investigation, and weighing up the risk.
john arran - on 11 Jan 2013
In reply to Rob Exile Ward:

I haven't tried any contacts and for some reason I really don't fancy the idea but I agree it is another option worth considering. I haven't read anywhere about complications in 5% of cases - mostly people who haven't adapted to them well, which is why I've been running my own little personal experiment! Links to helpful papers or studies very much appreciated if anyone knows of any - google's better at finding places that want to flog you the treatment although I have also found some apparently impartial opinion.
Neil Williams - on 11 Jan 2013
In reply to john arran:

You can do monovision with contacts by only putting one in or by putting a different strength in each eye.

A thought - might this (assuming you drive) have car insurance implications because loss of depth perception may make you more likely to be involved in a car accident?

Neil
Fraser on 11 Jan 2013
In reply to colina:
> (In reply to john arran) .
> if its only reading glasses u need ,not sure whether id bother taking the risk of eye surgery .

Agreed, I'm sure I wouldn't.
Neil Williams - on 11 Jan 2013
In reply to Fraser:

While I know people who have had it entirely successfully for short-sightedness, I stick with glasses (don't get on with contacts) because the possibility of it going wrong is to me too bad to contemplate where there is a decent alternative of glasses, IYSWIM.

A secondary point is that my glasses have prisms for computer use, so I'd still need to wear glasses on the computer, as you can't replicate this in the same way using laser surgery or contacts.

Neil
Postmanpat on 11 Jan 2013
In reply to john arran:
>
> Also does anyone have any recommendation for where would be best to have this done or for which company to go with?

I recently had my eyes lasered for short sightedness and as result need reading glasses much more.

The consultant I spoke to was not that keen on monovision although he said most of his colleagues were more enthusiastic.

He said monovision is generally fine but you would probably still need reading glasses for reading a book for a long period of time or in weak light and that distant vision .eg. a football match, may be a little fuzzy.

I am still not sure in my own mind whether I should have gone for monovision. Reading glasses are nuisance but if you cannot dispose of them entirely is it worth it?

Jonathan - on 11 Jan 2013
In reply to john arran: Monovision does not cause loss of 3D vision. There are multiple cues to depth and disparity between the two eyes is only one of them, often a fairly minor player. You can test this my closing one eye and observing that the world does not become 2D! Lots of people have amblyopia or a squint meaning they never have stereoscopic vision -they can still drive etc fine (that's not to say it won't take a little getting used to).

It's good that you've tried monovision with your glasses. I would advise visiting an optometrist and trying out wearing a contact lens in just one eye as an alternative. This is advantageous as you have less of a difference in image magnification between the two eyes with contacts than with your present system. You also have the option of picking and choosing when you use the lens, which is often good for people with a varied lifestyle who may not need to read much on some days, or read a lot on others.

Laser is an option if you are sure you like the monovision, but as others said it is irreversible so you need to be sure. If you did have the laser and didn't like the monovision, you could have the other eye treated as well, but this would leave you needing distance glasses (but not reading glasses) assuming two successful surgeries. Again, a good long test of monovision contact lenses (or one lens) would be a good idea before considering surgery. You may then even decide just to stick with contacts, as most people adapt to them very well and quickly find they become unaware of the sensation of wearing them.

Hope that helps.
Jon Stewart - on 11 Jan 2013
In reply to Neil Williams:
> (In reply to john arran)
>

> A thought - might this (assuming you drive) have car insurance implications because loss of depth perception may make you more likely to be involved in a car accident?


Don't think so. Loads of people can't really see with both eyes at the same time but aren't even aware of it. For driving you just need reasonable acuity (reading the number plate test) and no massive gaps in your visual field (as happens with glaucoma).
Postmanpat on 11 Jan 2013
In reply to Postmanpat:

I had it done at Moorfields in London. Probably too distant for you and it's very expensive. I just wanted the security of knowing it would be done right and I'd get all the follow up etc.
john arran - on 11 Jan 2013
Thanks everyone so far for valuable advice and info. Any further suggestions for treatment or clinic would be very appreciated.
jon on 11 Jan 2013
In reply to john arran:
> Any further suggestions for treatment or clinic would be very appreciated.

Are you not considering having it done in France?
john arran - on 11 Jan 2013
In reply to jon:

I haven't yet got around to researching France options and I'm not yet registered for French medical care. Do you have any good suggestions as to where best to look?
Rich D - on 11 Jan 2013
In reply to john arran: hi John, have you got any distance prescription at all? If you have no distance prescription no one reputable will treat you to make one eye worse - mono laser is usually done by removing the prescription in one eye ad leaving the other eye under corrected.
Also how old are you? If your near vision is still getting worse and you still have accommodation left then laser will leave you corrected OK now but not in the future as your reading gets worse.
A decent provider will trial you with monovision contact lenses first to make sure they're suitable and you can get on with them - not everyone can.
You'd have no problems with driving standard with one eye for distance. Laser is safer than wearing contact lenses for infection rates and complications - but has quite stringent guidelines to make sure that only suitable patients are treated.
Cheers Rich
jon on 11 Jan 2013
In reply to john arran:

Ah, well that might change things a bit. I'm a veteran of three operations in France and it hasn't really cost me a penny (cent?) and you just choose your date. I think it's a fabulous health system and very worth while getting into. All(!) my ops have been mechanical ones, so I can't comment about eyes. Lyon seems to be very well thought of and is in fact where I had my hip done.
john arran - on 11 Jan 2013
In reply to Rich D:

I've never had a prescription and haven't had my eyes tested in decades. Both eyes seem completely fine for distance vision and down to about 1m or so before struggling. I've just been wearing off-the-shelf +1s and more recently +1.5s for reading. I'm 49 now.
I know I need to have a proper consultation and test if I'm considering laser treatment but I'm trying to find out as much as possible about the options first so at least I can ask the right questions when I do so.

Thanks for the advice.
tmawer - on 11 Jan 2013
I asked a related, but not identical question, regarding "normal" eye surgery for a younger person with myopia, so not certain how much of this is completely relevant. This is the reply from a friend of mine who is an optician and it may be of interest.




Laser eye surgery is very big business and very profitable so many of the companies go in for hard sell in the sense that they completely cover up the possible pit falls
Having said that I would not say that itís a bad idea, itís the most widely carried out cosmetic procedure now worldwide and the safety record is very good in relative terms
As you may know the procedure involves using a laser to cut a flap of cornea, folding that back ,then using the laser on the the exposed corneal surface to change its shape and then putting the flap back down and leaving it to heal
Itís generally agreed that the chance of having a complication that will cause weeks for months of discomfort and possible short term reduced vision is statistically about 1 in 250
The chance of having long term reduced vision significant enough to cause detrimental effects to a personís life is about 1 in 1000
The chance of blindness in one or both eyes following catastrophic infection is very rare indeed maybe 1 in 1 million or even less
The minor complications can be
1/ Mild infection Ė general treated with antibiotics (at least at the present time)
2/ wrinkles in the flap surface once the flap has been replaced or growth of epithelial cells under the flap during the healing process. Both will cause distorted vision but can be corrected by a repeat of the procedure which will usually be done free of further charge
3/Dry eye symptoms following the surgery Ė The cutting of the flap cut through nerve fibres that take a long time (up to a year) to recover. This means that the cornea loses some of its sensitivity for some time
The main thing that drives the blink reflex is the very high sensitivity of the cornea so there is a reduced blink rate in many people following the surgery
This can caused increase tear evaporation and dryness of the front of the eyes
In a small percentage of people that will cause slightly sore eyes for a few months but in most people the effect too same to matter
4/ A persistent long term immune response causing a non-infection inflammation, called Diffuse lamellar Keratits .This causes a persistent haze in the cornea producing reduced vision and glare symptoms. It can significantly reduce vision for a long time even years but it is fairly rare at about 1 in 1000

The biggest factor as you will realise yourself is continued Myopic regression after the surgery .in maybe 1 in 8 people there is some regression of the previous myopic over the first few months so that you end up still slightly myopic .The more myopic you are to start with the more likely that is
The procedure can be carried out again but itís important to check if the company will do that without further charge
Another important point is that the procedure turns the clock back to zero hopefully but does not off course stop further myopic change
If Ashley has it done now it is very likely indeed if not inevitable that be will over years go more short sighted to the point where he will at least have to wear glasses for driving
He would maybe have to leave it about 10 years to be fairly certain of his myopia not changing any more, even then there is no complete certainty
The most important thing to accept is that this is not a lifelong fix and he will almost certainly have to either have it done again at full cost or wear glasses at least for driving
The big danger is that people refuse to wear glasses later on for driving when they should because they were encouraged to form the mind-set that they will never need glasses again
I donít know much about any of the providers and in the end it all depends on the surgeon doing it rather than the company but all I would say is avoid Optical Express .I worked for them for a while and like many other people I have spoken to how have worked for them they I think that the whole ethos of the company, driven by its owner, is very unethical

Nigel Modern on 11 Jan 2013
In reply to john arran: Varifocals or just reading glasses if you have OK distance vision - risks are low with eye surgery but I wouldn't personally take the risk.
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john arran - on 11 Jan 2013
In reply to tmawer:

Very kind of you to share that - it certainly helps.
john arran - on 11 Jan 2013
In reply to Nigel Modern and others:

I'm not a very conservative person in general and will always be looking for a best option rather than settling for continued inconvenience. That said I'll certainly need to be very convinced it's worth it even if any risk is very small as I agree it's a very important part of the body to be messing with unnecessarily.

Thanks for everyone's comments.
Jon Stewart - on 11 Jan 2013
In reply to tmawer:

Great post. Interesting opinion on Optical Express.
veteye - on 11 Jan 2013
In reply to john arran:
I have been myopic for a long time,but latterly needed to use the cheapo reading glasses.More recently I have moved to varifocal contact lenses(I have worn contact lenses since 1977), and for a myope such as myself, they are great.I would not do anything though until you have been and had eye testing and discussed it all with an optometrist.
Rob
Jim Fraser - on 12 Jan 2013
In reply to john arran:
>
>
> I've read that it can take a while to get used to so a couple of days ago I took one lens out of a cheap pair of glasses and I've been wearing them almost all the time when indoors, finding it remarkably easy to adapt and quite impressive how I'm already no longer aware which eye is doing the work when looking at near or far objects.


My eyes are showing signs of age but relatively little compared to most folk. I do the same trick with my choice of contact lenses and it's really effective. A drop of 0.5 diopter on one eye works a treat for me. Others may need more.

Jonathan - on 12 Jan 2013
In reply to john arran: If you are thinking of having it done in the UK I would always suggest seeing someone who is a cornea sub-specialist consultant ophthalmologist with an NHS practice. There are plenty of doctors about who only do laser and, whilst some are very good,some are not trained to the same high standards that an NHS consultant will be. That might be fine if all goes well, but if the shit hits the fan you might be shipped off for the NHS consultant to fix it! Better to see him/her in the first place I say!

If I was having it done I would pay a bit extra to have it done in the private bit of a major eye hospital -moorfields in london, or manchester royal eye hospital are both excellent. Optical Express have recently closed a lot of practices.

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