Eye lens replacement
#11
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Granted I'm also the guy that had to take my glasses off when I first got them and turned my head. I could see the objects moving faster traversing across the lenses and it would impact my balance and trigger some queasiness. Yeah, that was nuts.
Going down any steps, with even normal glasses, took awhile to adjust to. With all the motion sensitivity and depth percention issues I was thinking "how does the FAA allow anyone to fly with glasses!?!?" It's no big deal now but each transition to cheaters, glasses, bifocals, transitions, trifocals took awhile to become normal.
Having the blurriness/lack of clarity off center used to bug me. Now it's no big deal.
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#12
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No desire whatsoever to do progressives. I have to turn my head to look at something; with the bifocal and a constant focus wide lens, I can keep my head position constant and move my eyes and get the same vision correction for the full azimuth of the lens. The day I took the progressives back and came away with bifocals, it was a quantum improvement. I'm fine with Grandpa glasses.
Of curiosity; what are you hoping to get from the FSDO? That's flight standards; nothing to do with medical.
Of curiosity; what are you hoping to get from the FSDO? That's flight standards; nothing to do with medical.
#14
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#15
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Do not do an elective surgery that drives a SODA/SI just because you hate bifocals. Just stop being a cheap @!#& and buy the good ones.
I have one artificial lens. Because it was not done as a pair (damage to one eye only) the FAA treated it as if I had done exactly like what you propose. Different lense in each eye. Even though the docs at Landstuhl basically matched existing/ good eye closer than most people's eyes are to each other naturally.
#17
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.... who does the surgery:
https://crstoday.com/articles/2002-oct/1002_171-html
Because the success rates with contact lens monovision range from 50% to 70%, at least half of the patients who try it may be unhappy with the results. Although monovision should be part of every refractive surgeon's armamentarium, knowing its limitations and carefully selecting patients are paramount.
Interocular blur suppression is the adaptive mechanism that allows monovision to succeed. If this mechanism is not adapted, the patient may experience reduced binocular visual acuity and reduced depth perception, especially early on. As with most adaptive mechanisms, the brain needs time to adapt to this new visual function before it embraces the visual compromise that is monovision.
Interocular blur suppression is the adaptive mechanism that allows monovision to succeed. If this mechanism is not adapted, the patient may experience reduced binocular visual acuity and reduced depth perception, especially early on. As with most adaptive mechanisms, the brain needs time to adapt to this new visual function before it embraces the visual compromise that is monovision.
During the 10 years I have performed cataract and refractive surgery, I have compiled the following list of monovision's limitations. I hope that it will help other physicians to select monovision patients more carefully and avoid the pitfalls I have experienced. Whether we practice cataract or refractive surgery or general medical ophthalmology, understanding monovision and its limitations is the key to success and happy patients with this treatment.
1. PATIENT SELECTION CAN BE DIFFICULT
Patient education is the key to success with monovision, and it requires your time and patience. Explaining how the monovision optical system works will save you time in the long run, especially if the patient is unhappy because he did not understand what monovision meant. This process also allows you more time to get to know your patient and assess his visual needs and personality type.
2. REDUCED BINOCULAR VISUAL ACUITY
I find that my post-LASIK patients require 20/20 vision in their dominant eye and at least J2 in their reading eye or they may not be satisfied. Increased amounts of anisometropia accentuate this effect, as this decreases the synergy for binocular visual acuity. In order for a 60-year-old patient to achieve this quality of vision, the reading eye may require -1.5 D to -2.0 D of myopia. As we age, the myopia that we need for excellent reading vision increases. When inducing monovision, we must compensate for this by adding more myopia in the reading eye, which will further reduce distance vision in this eye. Increased amounts of anisometropia accentuate this effect and decrease the synergy for binocular visual acuity.
3. EXTENDED READING REQUIRES BRIGHTER LIGHTS
We have all occasionally treated an emmetropic 50-year-old patient who can read without aid in bright-light conditions. We have also seen the 50-year-old monovision patient who, despite a “good” refractive result, may require bright light to read comfortably. During the monovision education process, it may be wise to suggest to the patient that higher intensity light may be necessary to enjoy monovision to the fullest.
4. PATIENTS MAY STILL NEED GLASSES
I recommend distance glasses for night driving and other visually demanding events such as theatrical performances or spectator sports. Make sure to state this information clearly to the patient before the surgery.
5. DIFFICULTY IN CHOOSING THE CORRECT AMOUNT OF MONOVISON
There is a fine balance in providing the patient with excellent reading vision while minimizing anisometropia and maximizing binocular visual acuity. I try to never induce more than 1.5 D in difference between the two eyes.
6. OCCASIONAL REVERSALS/ENHANCEMENTS
Despite perfect technique and surgical outcomes, patients may not adapt to monovision and therefore want reversal in the form of converting the reading eye to distance. I recommend waiting at least 3 months to allow the patient an adequate trial with his new monovision, and to allow the eye a chance to heal adequately after surgery. If after this trial he is still unhappy, I proceed to reverse the monovision in order to achieve our ultimate goal: patient satisfaction.
7. TEST CONTACT LENSES FIRST
Proceed cautiously with monovision in patients who have not tried it in the past with contact lenses. Encourage a trial to ensure the patient's ultimate success and happiness with the result. For many of our patients, comfort while wearing contact lenses is difficult to achieve due to contact lens intolerance, but encourage them to ignore the discomfort and emphasize whether “visual comfort” is either achieved or possible.
8. REDUCTION IN STEREO ACUITY/DEPTH PERCEPTION
While this effect usually improves following adaptation, I will rarely perform monovision on patients who require excellent stereo acuity. I proceed cautiously with (1) patients who are marginally ambulatory or disabled and at high risk of falling, (2) patients whose hobbies include golf, tennis, and baseball, and (3) pilots, truck drivers, or law enforcement officers.
9. HIGHER COST FOR THE SURGEON
Because the enhancement rates for monovision are higher, the cost to perform the procedure is higher as well. In addition to requiring more preoperative chair time, monovision demands a postoperative result of at least 20/20 in the distance eye and J2 in the reading eye. Although the cost of enhancement is actually the same as the original surgery, rarely do we charge full price for an enhancement or reversal. In essence, this ends up being a “free trial” if the patient fails to adapt to monovision. The time we spend in counseling, the examination, in surgery, and postoperatively is often the same as for an enhancement. The good news is that we expend no marketing dollars and have no keratome blade cost.
10. COMPROMISE
Monovision entails concessions from both the surgeon and the patient. The “wow factor” is lessened with monovision, rendering these patients slightly less satisfying to work with and more demanding. The measure of “success” in each monovision patient is different and difficult to define. The key to a successful outcome is preoperative counseling and staightforwardness prior to surgery. To each of my monovision patients, I state that monovision is a compromise: “You will give up something (binocular balance/acuity) to get something else (ability to read).” Only the patient knows whether the advantages of monovision will outweigh the disadvantages.
IN SUMMARY
Perhaps in no other situation does the patient's occupation, personality type, goals, age, and visual demands play as large a role as when we educate our patients to help them make informed choices regarding monovision. In these situations, we must reinforce the idea of “compromise” so that patients understand that certain aspects of their vision may be compromised to gain reading vision.
Timothy L. Schneider, MD, specializes in refractive and anterior segment surgery and is in private practice at Schneider Eye Associates and Laser Center, Jacksonville, Florida. Dr. Schneider may be reached at (904) 371-0000; jaxeye.net or [email protected].
1. PATIENT SELECTION CAN BE DIFFICULT
Patient education is the key to success with monovision, and it requires your time and patience. Explaining how the monovision optical system works will save you time in the long run, especially if the patient is unhappy because he did not understand what monovision meant. This process also allows you more time to get to know your patient and assess his visual needs and personality type.
2. REDUCED BINOCULAR VISUAL ACUITY
I find that my post-LASIK patients require 20/20 vision in their dominant eye and at least J2 in their reading eye or they may not be satisfied. Increased amounts of anisometropia accentuate this effect, as this decreases the synergy for binocular visual acuity. In order for a 60-year-old patient to achieve this quality of vision, the reading eye may require -1.5 D to -2.0 D of myopia. As we age, the myopia that we need for excellent reading vision increases. When inducing monovision, we must compensate for this by adding more myopia in the reading eye, which will further reduce distance vision in this eye. Increased amounts of anisometropia accentuate this effect and decrease the synergy for binocular visual acuity.
3. EXTENDED READING REQUIRES BRIGHTER LIGHTS
We have all occasionally treated an emmetropic 50-year-old patient who can read without aid in bright-light conditions. We have also seen the 50-year-old monovision patient who, despite a “good” refractive result, may require bright light to read comfortably. During the monovision education process, it may be wise to suggest to the patient that higher intensity light may be necessary to enjoy monovision to the fullest.
4. PATIENTS MAY STILL NEED GLASSES
I recommend distance glasses for night driving and other visually demanding events such as theatrical performances or spectator sports. Make sure to state this information clearly to the patient before the surgery.
5. DIFFICULTY IN CHOOSING THE CORRECT AMOUNT OF MONOVISON
There is a fine balance in providing the patient with excellent reading vision while minimizing anisometropia and maximizing binocular visual acuity. I try to never induce more than 1.5 D in difference between the two eyes.
6. OCCASIONAL REVERSALS/ENHANCEMENTS
Despite perfect technique and surgical outcomes, patients may not adapt to monovision and therefore want reversal in the form of converting the reading eye to distance. I recommend waiting at least 3 months to allow the patient an adequate trial with his new monovision, and to allow the eye a chance to heal adequately after surgery. If after this trial he is still unhappy, I proceed to reverse the monovision in order to achieve our ultimate goal: patient satisfaction.
7. TEST CONTACT LENSES FIRST
Proceed cautiously with monovision in patients who have not tried it in the past with contact lenses. Encourage a trial to ensure the patient's ultimate success and happiness with the result. For many of our patients, comfort while wearing contact lenses is difficult to achieve due to contact lens intolerance, but encourage them to ignore the discomfort and emphasize whether “visual comfort” is either achieved or possible.
8. REDUCTION IN STEREO ACUITY/DEPTH PERCEPTION
While this effect usually improves following adaptation, I will rarely perform monovision on patients who require excellent stereo acuity. I proceed cautiously with (1) patients who are marginally ambulatory or disabled and at high risk of falling, (2) patients whose hobbies include golf, tennis, and baseball, and (3) pilots, truck drivers, or law enforcement officers.
9. HIGHER COST FOR THE SURGEON
Because the enhancement rates for monovision are higher, the cost to perform the procedure is higher as well. In addition to requiring more preoperative chair time, monovision demands a postoperative result of at least 20/20 in the distance eye and J2 in the reading eye. Although the cost of enhancement is actually the same as the original surgery, rarely do we charge full price for an enhancement or reversal. In essence, this ends up being a “free trial” if the patient fails to adapt to monovision. The time we spend in counseling, the examination, in surgery, and postoperatively is often the same as for an enhancement. The good news is that we expend no marketing dollars and have no keratome blade cost.
10. COMPROMISE
Monovision entails concessions from both the surgeon and the patient. The “wow factor” is lessened with monovision, rendering these patients slightly less satisfying to work with and more demanding. The measure of “success” in each monovision patient is different and difficult to define. The key to a successful outcome is preoperative counseling and staightforwardness prior to surgery. To each of my monovision patients, I state that monovision is a compromise: “You will give up something (binocular balance/acuity) to get something else (ability to read).” Only the patient knows whether the advantages of monovision will outweigh the disadvantages.
IN SUMMARY
Perhaps in no other situation does the patient's occupation, personality type, goals, age, and visual demands play as large a role as when we educate our patients to help them make informed choices regarding monovision. In these situations, we must reinforce the idea of “compromise” so that patients understand that certain aspects of their vision may be compromised to gain reading vision.
Timothy L. Schneider, MD, specializes in refractive and anterior segment surgery and is in private practice at Schneider Eye Associates and Laser Center, Jacksonville, Florida. Dr. Schneider may be reached at (904) 371-0000; jaxeye.net or [email protected].
#18
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I have high end progressives. It's not a 30 minute adjustment. It took a fairly long time. Beats me how long but it wasn't a matter of days. But now? They're awesome.
Granted I'm also the guy that had to take my glasses off when I first got them and turned my head. I could see the objects moving faster traversing across the lenses and it would impact my balance and trigger some queasiness. Yeah, that was nuts.
Going down any steps, with even normal glasses, took awhile to adjust to. With all the motion sensitivity and depth percention issues I was thinking "how does the FAA allow anyone to fly with glasses!?!?" It's no big deal now but each transition to cheaters, glasses, bifocals, transitions, trifocals took awhile to become normal.
Having the blurriness/lack of clarity off center used to bug me. Now it's no big deal.
Granted I'm also the guy that had to take my glasses off when I first got them and turned my head. I could see the objects moving faster traversing across the lenses and it would impact my balance and trigger some queasiness. Yeah, that was nuts.
Going down any steps, with even normal glasses, took awhile to adjust to. With all the motion sensitivity and depth percention issues I was thinking "how does the FAA allow anyone to fly with glasses!?!?" It's no big deal now but each transition to cheaters, glasses, bifocals, transitions, trifocals took awhile to become normal.
Having the blurriness/lack of clarity off center used to bug me. Now it's no big deal.
I had cataract surgery and splurged for the upgraded lenses. 20/20 distant and no restrictions for near. No SODA required.
#19
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#20
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I think that is what I am looking at. Only need one eye done (for near vision). and i have no issue with wearing bifocals for flying, its wearing readers in my daily life that drives me bonkers...taking them off, putting them on. anyway, i have talked to a couple pilots who have had the lens repalcement and are very happy with it. still in the research phase.
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