Question: Dear Dr Mistra,

Thanks for your advice in my earlier thread
https://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=397427

My latest conditions –
• LE myopia -8.25, ERM, trace cataract. I have done OCT for my LE since XXXXXXX 2019, has ERM. My RE was operated in May 2019 due to ERM, LE not yet operated, VA still quite good, latest check in July is 20/20-1. Seems that my LE ERM is stabilising according to progress as reflected in past OCTs.
• RE operated 2019 due to ERM. Dr said recovered well, and I feel so, but when I look at Amsler grid, the straight lines are not that straight, still slight bending. Now RE has cataract, near sightedness has increased from -8.00 to -10.00. My RE can still see quite well after full correction with contact lens, but not as good as before ERM onset.
• When my eyes were healthy before ERM of LE and RE emerges, I am RE dominant. Now after RE cataract develops, has become LE dominant.
• My doctor said my RE cataract is intermediate stage and advised me to do cataract surgery because the surgery risk will increase when the lens grow harder. He said my LE ERM surgery can be done later together with LE cataract surgery later.

Questions -
1. Dr Mistra, for my LE, do you think it advisable to do ERM and cataract surgeries in one go? If done in one go, will my LE recovery after ERM surgery affect the intended visual outcome of my cataract surgery? If I do ERM surgery for my LE first and then do cataract surgery after recovery from ERM surgery (say 6 months after ERM surgery), will the calculation for my intended myopia power for LE be more accurate? My concern is that if my post ERM recovery progress will affect the precision of intended outcome of cataract surgery, I would prefer doing ERM surgery first and then cataract surgery for my LE separately. Any advice, Dr Mistra?


2. I wish to have XXXXXXX monovision IOL. My doctor suggest me to have RE target for near vision, and later when I go for LE ERM surgery, I can do cataract surgery in one go and target for distance vision. His recommendation for setting RE for near and LE for distant is that he think that as my LE still has good VA, he opined that my LE will recover from my future ERM surgery better than RE. He said that as my RE still see slight bending of straight lines with Amsler test, he think that if I set RE to distant vision, the distant vision quality after cataract will probably not be as good as LE as compared to if I set LE for distant (as he considered my future recovery from ERM surgery for LE will be better than RE).

- I wondered whether distance vision should be set for dominant eye, but my doctor said it doesn’t matter as the brain will adapt. This advice is new to me. Dr Mistra, what do you think? Is dominant eye can change? If I am really RE dominant but I set it for near vision, and distant vision for non-dominant LE, will this be a mismatch and adversely affect the intended achieved outcome and vision quality, thus requiring correction by glasses or contact lens and defeating the purpose of mono vision for less spectacle dependence?

3. I tried contact lens monovision with a myopia power difference of 1.00, but I feel a bit disparity/imbalance, a bit floating vision and inter-ocular double vision. When I tried a smaller power difference of 0.50, the disparity seems less but still there.

- Dr Mistra, can monovision cause double inter-ocular double vision?Or is my inter-ocular double vision is due to my LE ERM? I wonder whether the disparity and double vision are due to both monovision and ERM in LE now.
What do you think?

- Because now my LE has ERM and my RE has cataract, my optometrist said that I cannot try out the real effect of monovision by contact lens now.

- I am afraid I may not tolerate great power difference between two eyes and need to correct the disparity feeling by spectacles after cataract surgeries, which I don’t like and very concerned. So I am thinking of setting RE to near vision (take my doctor’s advice mentioned above) to -1.50, then later LE to -0.5 or - 0.75. Dr Mistra, any advice on my this thinking?

Looking forward to your reply. Your advice has always been very helpful to me in considering what actions or treatments to proceed and to discuss with my doctor so as to make the best choices. Really grateful for your expert advice

Dear Dr Harshita,

Thanks for your suggestion of correcting both eye for distance and then wear near vision aid. But I want to be able to read my XXXXXXX phone a bit, so I tried monovision with contact lens with a myopia power difference of 1.00, but I feel a bit disparity/imbalance, a bit floating vision and inter-ocular double vision. When I tried a smaller power difference of 0.50, the disparity seems less.

Dr, can monovision cause inter ocular double vision? If so, at what myopia power difference between both eyes can such double vision be avoided/minimised? Or is my inter-ocular double vision is due to my LE ERM?

Dr, my dominant eye seems has changed from RE to LE previously. Dr, can dominant eye change?

If I opt for monovision IOL, if I am in fact RE dominant but I set it for near vision, and set distant vision for non-dominant LE, will this be a mismatch and adversely affect the intended achieved outcome and vision quality, thus requiring correction by glasses or contact lens after cataract surgery and defeating the purpose of mono vision for less spectacle dependence?

Appreciate your advice. Thanks much