In my last post, we talked about monofocal IOLs (and also more about Seinfeld than I would’ve guessed). We talked about what they are. And today we’re going to talk about what they can do. A lens with space-age (literally!) optics and clarity opens up a lot of possibilities. That’s true for distance vision or near vision, and often for both at the same time. Distance and near without glasses will be the subject of our sequel. Today we’re here to talk about going the distance.

DVO – distance vision only

The maximum achievable distance vision happens when both eyes are maxed out for distance vision. This option is popular enough to have earned the honorific of its own initialism: DVO – distance vision only. There are two reasons why someone might choose DVO. The first is that some people don’t mind wearing readers. In fact, some people have readers firmly in place as a part of their identity.

Senator Carl LevinFor example, it’s impossible to find a photo of Senator Carl Levin without his readers. He even wore them in this official Senate portrait photo. And it’s a good thing he did. No one would know this was Senator Levin if he wasn’t wearing readers. This would just be a photo of Bob Newhart at the library.

More often, however, DVO is the choice for folks who need 100% of their possible distance vision. It may be a job requirement (CDL and pilot licenses come to mind) or it may be a vision requirement. The latter includes anyone who has impaired vision for reasons other than a cataract.

Whether it’s macular degeneration, a previous injury, scarring, amblyopia etc., sometimes the best vision possible isn’t 20/20. A+ vision is ideal, but there are a lot of variables that can constrain the best possible vision to a B+. In those cases, it’s wise to choose DVO rather than risk aiming for distance and near, only to find you missed both. Obtaining a grade of B+ for DVO beats a C- for distance and near.

A logical and fair question is, “Okay, let’s say B+ is my max. But if I’m upgrading my vision with these new IOLs, what’s the hold up on giving me B+ distance and near?” It’s a good question and the answer is so important, it’s worth dedicating the rest of this blog to it.

The cost (in terms of optics) of glasses-free near vision is paid with your distance-focused vision. When you’re a kid, it doesn’t matter. Your eye’s natural lens focuses effortlessly at near and back to distance at a snap. It happens so quickly that we never notice the secret behind that trick. Even then, with our young super eyes, we can only see clearly up close or far away – never both at the same time. And since youth is wasted on the young, we don’t appreciate that magic trick until we can’t do it anymore.

Losing Our Autofocus Ability

Once we lose that magical autofocusing ability – which is some of us at 40 and all of us at 50 – it is genuinely extinct. That autofocus lens has become a fixed focus lens, and no technology yet exists in IOLs to mimic that young autofocus. So we are faced with a choice that wouldn’t make sense at age 20, but makes perfect sense when we’re talking about lenses with a fixed focus.

Do we max out distance vision, or do we steal some of that distance vision to give us near vision too? If the best vision possible is a B+ (because of macular degeneration, injury, etc.) then you’ll notice even a small theft in distance clarity. In those cases, DVO with over-the-counter readers is the right play. To be clear, we’re still talking about miraculous vision improvement. Upgrading from a D- level cataract the best lens optics humanly possible is life-changing.

A Personalized Approach

The goal in cataract surgery should always be specific and customized for you personally. A “one IOL fits all” approach is thankfully an approach we can actively avoid. In any event, the best way to discover your personalized, maximum vision is a consultation. Find a doctor who cares about making it personal and fantastic for you. Bob Newhart (not pictured above) once said, “Don’t be silly and don’t waste your time.” It’s good advice when it comes to IOLs, too; it’s silly spending too much time researching IOLs before finding out which one(s) might be best for you.