Monovision vs. Multifocal

[OnlineVisitor]

I have latent hyperopia (+1.00) and am trying multifocal contact lenses (ranging from 0 to +1.00) to deal with it.  The optometrist that I saw said that I would do better in multifocal contact lenses than in monovision.  Every time an optometrist or a doctor tells me I should do one thing rather than another I get very skeptical of late.  I am looking for a specific answer to the following query - not simply a "you need to see an optometrist or an opthamologist" which I already have and will do again, with all due respect.  My query is whether there is consensus in the medical community regarding whether monovision contact lenses are superior to multifocal contact lenses or visa versa.  I understand that one may work better than another for a specific client - that is the case with any remedy.  But I am specifically trying to understand the pros and cons concerning the two and whether there is in fact a general sense that one is better than the other.  

[John C Hagan III, MD, FACS, FAAO]

-

[EyeNut]

Just goes to show how risky assumptions can be. Apologies for my misunderstanding, you had it all right.  

No, monovision unfortunately doesn't give you a range of powers. It's, in it's purest form, two powers, one for distance, and one for near. It demands of the wearer that he/she actively "switches" between the sharpest image, the brain (partially) suppressing the blurry eye for a certain distance.

As such, monovision is usually not the ideal way to correct latent hyperopia, since one eye will be seeing blurrier then it needs to; which eye depending on the distance at which you're looking.

Bear in mind, some contact lens manufacturers use a monovision like system in multi focal lenses, where both lenses have a gradient of powers, but the more dominant eye is more focused on distance vision, the less dominant on reading. By the sound of it, you'd be best of with with a normal multifocal lens on both eyes, one that has the same gradient for both.

Hope that helps.

[OnlineVisitor]

EyeNut,

Thanks very much.

Before I had the latent hyperopia corrected, I had problems with glare.  I went to an optometrist who told me that I needed -0.50 and did not diagnose me with latent hyperopia then.   After a few months with that prescription, I started getting headaches, and then saw another optometrist who told me that I didn't need -0.50 glasses - that that prescription was wrong - and that I had latent hyperopia with a correction of +1.00.  (They did the cycloplege dilation to determine the +1.00 latency; under regular conditions, I am 20/20).  

Ultimately, I began wearing +1.00 glasses after some tinkering with the prescription - but those quickly gave me headaches too.  I used them primarily for reading and computer work, but the computer work caused headaches - I think it was because of the intermediate distance involved in computer work - and so I returned to the optometrist.  An opthamologist told me I didn't need glasses at all, and for the most part I don't, other than that I now experience headaches during computer without wearing glasses too.  

So I returned to the optometrist and asked about contact lenses.  Initially, I wanted +1.00 ones to wear all day long - but the consensus was that that would just cause headaches, so he prescribed a multifocal lens that ranges from 0 to +1.25 - and these seem to work very well for the most part.  (In fact, and I think it is simply by chance because these were the lowest prescription they had, but they do provide 0.25 stronger than the actual prescription, as you suggested.)  

I ask about monovision contact lenses - the ones where one eye has one prescription and the other eye a different prescription - because I was under the impression that they could result in the same effect as a multifocal lens, like a progressive lens in glasses.  In this kind of monovision lens, my understanding is that one eye corrects near vision and one eye distance - and thereby provided a range of correction - but it sounds like I'm wrong on this.  

So my query was directed towards finding out whether the multifocal contact lens remedy was the only remedy available for providing a range of power - it sounds like it is, is that right?  Thanks again!

[EyeNut]

I'm not entirely sure whether there is an actual consensus in the US, but on the basis of eyes being eyes in the US as they are in the Netherlands, here's the general concept.

To define first, there are two ways to interpret monovision. What I think you mean with monovision lenses is a monofocal lens, a contact lens with a single power, as opposed to a multifocal lens, which contains a gradient of powers.

The reason why I want to define this up front is that t  single power lenses, then no, there isn't really a better system. Multifocal lenses will allow you to actively find the most comfortable power for you at any given moment. They do have some disadvantages. Depending on your age, if you're a younger person, chances are you have quite large pupils, which, in the case of mutifocal lenses, might cause you some distortion of how you perceive the world. You can test this yourself quite easily; if you have no complaints about your vision at night using the contact lenses, then you shouldn't have too much of a problem with multifocal as a system.

What I am willing to say is that the most common way of "treating" latent hyperopia, especially if the expected value is low like yours is, is to measure the visual acuity, and prescribe monofocal lenses +0,25 dpt stronger then your actual prescription. This will drop your distance acuity slightly, but should, in time, allow your over-worked accommodation to drop a little. Frequent follow-ups are often needed to keep correcting until you'll allow the highest reachable correction.

There is one very important question though. Did you experience any problems before you started having the latent power corrected, and if so, what were these?