How can this be monovision?

[Chicky Monkey]

I've posted here before about my struggle with monovision (performed 9/09) and my decision whether or not to get it reversed.

I discussed reversal with my surgeon as well as getting my distance eye touched up because I am still having trouble seeing distance, even distances of 25 feet or so. He explained that my distance eye was helping me see up close, and that there would be degradation in my close up vision if I had the distance eye corrected further. He said I was seeing "good enough for a driving test." Uh, ok.....

He gave me a -.75 contact to wear in the distance eye to see what it would be like if he touched up my distance eye. I didn't really care for it (only wore it for one day) and decided to just get glasses for those times when I just must see distance and for night driving.

At the eye exam today by a different doctor (my surgeon is 100 miles away) I was surprised to learn my monovision is....?? I don't know what. BOTH eyes are corrected to -.75. The doctor hesitated to comment on the surgeon, but he said in traditional monovision, one eye is corrected for near, one for far. Yes, that is what I expected. No wonder I can't see past 25 feet. Or at night. Or the words on a projector screen during a meeting.

I don't know what to do. I've made so many trips down to my doctor at 200 miles round trip, I don't know if another trip will answer the question....what kind of monovision corrects both eyes to the same correction?

I went ahead bought glasses so I can finally see the TV when I'm lying in bed and so I can drive at night without worry that I will kill someone.

Do I just work this out with distance glasses when I must see distance? Find another surgeon? Go back to my surgeon and ask for an explanation?

Thanks for any help or advice.

[PRKorIntacs]

What is your 20/xx now? Im guessing 20/40. What was the prescription and 20/xxx before laser? I had a consultation on March 25 and im going to ask for a -1 undercorrection. The optometrist says I have the accomodation of a 45 year old. Being -1 will mean ill only need glasses for driving and occasionally but not need reading glasses for everything which is far more annoying. You can wear your glasses for driving and whenever you feel the need. This is what im expecting if I get PRK. Much better than needing glasses full time and being 20/800 without my -5 glasses!

[Chicky Monkey]

Yes, I'm at -.75 both eyes now which is about 20/40 in both eyes. I'm not sure what 20/xx I was before but I was -6.0 right eye and -5.75 left eye. Yes, -.75 both is QUITE an improvement and I'm still glad I did it.

Here's what's disappointing:

I asked for monovision. It's obvious I didn't get monovision. I've complained as early as 1 month out from my surgery which was Sept 09 that I was having trouble seeing distance. I expected to see much better distance with a monovision correction. And in fact, when I wear a soft lens correcting my distance eye to perfect and my near eye to -.75 I see as I expected to see had I been corrected to monovision. I see beautifully distance and close up.

I know things happen. But I've met with my doctor and expressed my concerns numerous times. I've expressed to him I wanted my monovision reversed more than once. Seems like a perfect opportunity to tell me, "uh, guess what...both your eyes are the same correction. That's how it worked out, we can do a touch up on that distance eye." but HE NEVER TOLD ME. I had to go get an eye exam elsewhere in order to find out my eyes were both -.75. Why? Why not just tell me how the surgery turned out? I certainly expressed enough concern about it.

My surgeon tried to discourage me from a touchup on that distance eye. 20/40 is not good enough for me to see distance, watch tv, drive and certainly not drive at night. It may me LEGAL, but not comfortable.

I'm just baffled by my surgeon's behavior. This is a very well known surgical group in the Sacramento area. Everyone in the area knows their name. They do TV and radio personalities and sports stars. But I can't figure out why it seems that after my surgery there wasn't full disclosure of the outcome. After all my concerns and complaints, it seems that really all I need is a touch up to the distance eye...so why is he trying to discourage me? His success rate numbers? I can only wonder.

I only have to pay $150 for the touch up if I do it within 1 year of the original surgery so I need to make my mind up fast. The only other options are to wear glasses for distance or pay another surgeon $2,000 to go in an fix the distance eye. Sigh.

Sorry if I seem frustrated.

[PRKorIntacs]

Yes, I'm at -.75 both eyes now which is about 20/40 in both eyes. I'm not sure what 20/xx I was before but I was -6.0 right eye and -5.75 left eye. Yes, -.75 both is QUITE an improvement and I'm still glad I did it.

You were probably no better than 20/800 before so to see 20/40 is a 20x improvement. I am a -5 or -5.25 so I know what 20/800 is like. I would be absolutely thrilled to see 20/40, even 20/100 would make me glad. Vision this good would mean a huge reduction in glasses dependancy without needing reading glasses. What were you told before your laser surgery? What were you expecting? I want to be realistic when/if I go ahead with PRK so I end happy.

Here's what's disappointing:

I asked for monovision. It's obvious I didn't get monovision. I've complained as early as 1 month out from my surgery which was Sept 09 that I was having trouble seeing distance. I expected to see much better distance with a monovision correction. And in fact, when I wear a soft lens correcting my distance eye to perfect and my near eye to -.75 I see as I expected to see had I been corrected to monovision. I see beautifully distance and close up.

Did your surgeon understand your intentions? I want *both* of my eyes to be a -1(but will be happy if I end up between -0.5 and -2.5) I don't want monovision as I don't feel balanced with two different prescriptions. Maybe your surgeon was afraid youd experience anisometropia. On another note, what was your reasons for lasik(prk?) were your contact lens uncomfortable? I can't tolerate contact lens, if I could, id wear them to see better without glasses.

I know things happen. But I've met with my doctor and expressed my concerns numerous times. I've expressed to him I wanted my monovision reversed more than once. Seems like a perfect opportunity to tell me, "uh, guess what...both your eyes are the same correction. That's how it worked out, we can do a touch up on that distance eye." but HE NEVER TOLD ME. I had to go get an eye exam elsewhere in order to find out my eyes were both -.75. Why? Why not just tell me how the surgery turned out? I certainly expressed enough concern about it.

What stuff did he tell you? Did he explain anything?

My surgeon tried to discourage me from a touchup on that distance eye. 20/40 is not good enough for me to see distance, watch tv, drive and certainly not drive at night. It may me LEGAL, but not comfortable.

From what I read, most surgeons consider you a success if you see well enough to drive without glasses. Funny that my lasik center claims a 97% chance of 20/20. I think they don't count those who ask for monovision or an undercorrection as well as not counting anyone who can't correct to 20/20 with glasses. I obviously won't count in the 3% who don't get 20/20. How often did you use to wear glasses? Contacts? How often do you now? What did you see with glasses? Contacts? Now with thin glasses?

I'm just baffled by my surgeon's behavior. This is a very well known surgical group in the Sacramento area. Everyone in the area knows their name. They do TV and radio personalities and sports stars. But I can't figure out why it seems that after my surgery there wasn't full disclosure of the outcome. After all my concerns and complaints, it seems that really all I need is a touch up to the distance eye...so why is he trying to discourage me? His success rate numbers? I can only wonder.

If he wanted to boost the percentage who get 20/20, he would enhance anyone that didn't get 20/20. He may be discouraging you because of the risks, including overcorrection which would be ten times worse than now. I have seen many people end overcorrected from their enhancements and back in bifocals full time. Others experience complications after enhancements. Your surgeon knows all this and honestly feels there's too much to risk for such a tiny undercorrection.

I only have to pay $150 for the touch up if I do it within 1 year of the original surgery so I need to make my mind up fast. The only other options are to wear glasses for distance or pay another surgeon $2,000 to go in an fix the distance eye. Sigh.

You should not have to pay $2000 when you can pay $150. Ask your surgeon his reasons for and against enhancing you. Ask him the odds of overcorrection and complications. He might give you a 25% chance youll end up worse. Only you can decide if it's worth that risk. I personally would not risk an enhancement for myself if I end up a -2.5 or better as I will see so much better than before and greatly reduce my dependancy on glasses.

Sorry if I seem frustrated.

Your results would make me 20/happy and let me see very well without glasses. I see 20/30 *with* glasses so 20/40 is very close. My brother sees 20/60 without glasses and has no interest in lasik/prk as his eyes are too good to take the risk. He sees slightly blurry but acceptable that he rarely wears glasses for reasons other than driving. My dad read this and says you probably were expecting perfect 20/20 vision in at least one eye and you paid good money for that. If you feel that strongly, you can insist on an enhancement and hope it goes well. Don't you think you could get used to 20/40 and only wear glasses for driving? Perhaps you can ask for a partial refund since you didn't get 20/20, a few lasik centers will actually guarantee 20/20 or you get a partial refund.

[Chicky Monkey]

Thanks for your response PRK!

Yes, my surgery was definitely supposed to be monovision. I wore specs around their office to see if I liked it and signed all kinds of paperwork in regard to the monovision. I walked in wanting it and that was all we discussed from day one. When I talked to the surgeon about getting the monovision "reversed" after my unsatisfactory results, he never said "whoa, whoa! you don't have monovision! We didn't talk about that!" Rather, he said "wait another month and think about it." What was he going to do had I returned and said yes, I want it reversed? Why the shadyness?

And Yes, your dad is right. My expectation was 20/20 vision. These doctors have a "20/20 vision or your money back" guarantee. You have to pay extra for that guarantee though, which in and of itself seems silly (we'll only get you 20/20 vision if you pay us more?) and I did not pay the extra for it. I may not have even been eligible because there are restrictions.

My expectations were also based on the following statement from their website:

98% percent of our patients see 20/20 or no worse than 20/25 after their first treatment.

What would most people expect with a statement like that? 98% SURELY I'm in 98%, right?

And my favorite statement, right off their site:

We put ourselves in our patients' shoes and realize that if you are best corrected at 20/20 now with glasses or contacts and only achieve 20/30 or 20/40 with laser vision correction that you will not be happy.

Nope, you're right! Not happy!

So, I flip flop back and forth every day whether or not to go back in and try to get that right eye fixed to perfect vision or leave my 20/40 eyes alone and wear glasses for anything more than 20-25 feet away. For me, that means glasses while watching TV, every business meeting (I can't read the words on the projector), grocery shopping (can't read the signs above the aisles), driving, etc. So I went from comfortable disposable soft lenses that I had no trouble with and perfect vision near and far to glasses 1/2 the time? Whoopee! Let me see if I can contain my excitement a bit.... :-/

I was shown the Lexus on the lot and drove away in the Corolla (while making the Lexus payment!) and now everyone's like...what's the problem?

Is it really ok to tell someone 98% of people get 20/20, and you should be happy with your 20/40 just because it's better than you had before? Yeah, it's better, but I wanted what I was told I could have.

And I feel like there's been something strange going on when my monovision eyes turned out not monovision and NO ONE TOLD ME.

Would I do it again? Yes, hmmmm. I waffle between I don't know and probably. But I wouldn't go to this surgeon, and I can't in good conscience recommend them because I don't think they've done right by me.

[PRKorIntacs]

Thanks for your response PRK!

Yes, my surgery was definitely supposed to be monovision. I wore specs around their office to see if I liked it and signed all kinds of paperwork in regard to the monovision. I walked in wanting it and that was all we discussed from day one. When I talked to the surgeon about getting the monovision "reversed" after my unsatisfactory results, he never said "whoa, whoa! you don't have monovision! We didn't talk about that!" Rather, he said "wait another month and think about it." What was he going to do had I returned and said yes, I want it reversed? Why the shadyness?

Ask him if he even programmed monovision into the laser. If not, he owes you a refund for one eye since it was his fault. I would hope the surgeon programs -1 for both eyes if I do go ahead with PRK.

And Yes, your dad is right. My expectation was 20/20 vision. These doctors have a "20/20 vision or your money back" guarantee. You have to pay extra for that guarantee though, which in and of itself seems silly (we'll only get you 20/20 vision if you pay us more?) and I did not pay the extra for it. I may not have even been eligible because there are restrictions.

Most people won't pay for the guarantee if they believe the 98% chance of 20/20. How much extra was that guarantee? Maybe I should pay for them to guarantee ill end up between -0.5 and -2.5. Should be cheap since the odds are good ill end up in that ballpark. Much easier than trying to end dead on plano. Ill be worried if they can't even guarantee ill end between -0.5 and -2.5.

My expectations were also based on the following statement from their website:
98% percent of our patients see 20/20 or no worse than 20/25 after their first treatment.
What would most people expect with a statement like that? 98% SURELY I'm in 98%, right?

Funny not everyone is eligable for the guarantee if they are so sure almost everyone gets 20/20. Im thinking *maybe* that 98% odds only applies to those that *are* eligable for the guarantee. If you aren't eligable, you can bet they think your odds are much lower. My own laser center pretty much said the same, they also said 70% end up 20/15. At least I believe them when they said only 4 ever got 20/10 out of 16,000+ you can pretty much bet that getting 20/10 is almost as slim as winning the lottery. I doubt ill get better than 20/20 BCVA anyway as I don't correct to 20/20 now with glasses, my retina might not be capable of such perfect vision as 20/20.

And my favorite statement, right off their site:
We put ourselves in our patients' shoes and realize that if you are best corrected at 20/20 now with glasses or contacts and only achieve 20/30 or 20/40 with laser vision correction that you will not be happy.

I for one wouldn't be happy to see 20/40 from near since I see almost 20/20 near without glasses(at 8 inch) or with computer glasses at about 2 feet. I do not want to need reading glasses to have crisp near vision. I know my distance vision won't be 20/20 if my near vision is 20/20 but presbyopes can't have both. They can either have 20/20 distance vision(plano or 0.25 diopter) or they can have 20/20 near vision(if -1, then at 1 meter) I can tell you right now that no presbyope will be happy if they end with any hyperopia.

Nope, you're right! Not happy!

Well your choice is either 20/20 distance vision if your enhancement goes perfect(but then your near vision will be poor) or stay where you are and have 20/20 intermediate vision(1.33 meters)

So, I flip flop back and forth every day whether or not to go back in and try to get that right eye fixed to perfect vision or leave my 20/40 eyes alone and wear glasses for anything more than 20-25 feet away.

We can see how it turned out the first time. My dad said he would never touch a -0.75 correction. There's no guarantee youll be 20/20 in the right eye, in fact there's no guarantee youll even be 20/40 if you end overcorrected or have a complication. I know there's no guarantees if I do go ahead with PRK. Id like to find out my odds of ending between -0.5 and -2.5 and see if I can insure that in case I end outside that, id want a full refund of surgery costs. If they say 99% chance, then insurance should not be more than 2% the cost of surgery. This will give them 2:1 profit.

For me, that means glasses while watching TV, every business meeting (I can't read the words on the projector), grocery shopping (can't read the signs above the aisles), driving, etc. So I went from comfortable disposable soft lenses that I had no trouble with and perfect vision near and far to glasses 1/2 the time? Whoopee! Let me see if I can contain my excitement a bit.... :-/

Couldn't you simply sit 10-15 feet away to see clear? I am wondering why you choose laser surgery if you could tolerate contact lens, wouldn't they have kept you out of glasses with a minimum of hassles? There doesn't seem to be much benefit to laser surgery for contact wearers. Much more benefit for us glasses wearers. Couldn't you still wear one contact lens in your dormant eye for distance?

Is it really ok to tell someone 98% of people get 20/20, and you should be happy with your 20/40 just because it's better than you had before? Yeah, it's better, but I wanted what I was told I could have.

They have no right making that 98% claim if something like 50% of random people end up 20/20 short term and long term. This causes people to have unrealistic expectations. My expectations are to simply reduce my dependancy on glasses and be 20/happy(being able to see the computer without glasses)

And I feel like there's been something strange going on when my monovision eyes turned out not monovision and NO ONE TOLD ME.

You need to insist on an explaination. Let us know what the surgeon says.

Would I do it again? Yes, hmmmm. I waffle between I don't know and probably. But I wouldn't go to this surgeon, and I can't in good conscience recommend them because I don't think they've done right by me.

You should tell people the 98% figure for 20/20 is nonsense. I am making a guide that ill post(I can email it to you if address is provided) and you can print it and show others. Basically they need to expect to still wear glasses(reading glasses if presbyopic and not myopic), just not as often. Also they can expect a big improvement(if their vision is bad) in how well they see without glasses. Basically if they aim for plano, they can expect to be between -1 and +1 after laser surgery. If they aim for -1, expect plano to -2(which is the case for me)