MONOVISION OR MULTIFOCAL IOL

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

This study was in the Sept issue of Journal of Cataract and Refractive Surgery 35:1501;2009

Reading ability with pseudophakic monovision and with refractive multifocal IOLs: comparative study
Misae Ito and Kimiya Shimizu

CONCLUSION: The monovision method group had better reading ability however careful patient selection is essential

JCH MD

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

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[JodieJ]

Dr. Burton Kushner at the University of Wisconsin has published several articles about patient selection for full monovision.  (Try googling.)  My impression is that although there are no guarantees about who will have problems, anyone with a history of strabismus should definitely avoid it.  Probably people with a phoria (good eye alignment with both eyes, but eye turning when one eye is covered) aren't great candidates either.  (Many people who have a phoria aren't aware of it.)  Based on my personal experience, I also think that anyone with sub-normal vision in one eye (e.g., residual distortion from a retinal condition) would be happier with both eyes set for the same target.

When monovision works, it gives the sense of having continuously sharp vision (as if you never developed presbyopia if the targets are distance/near), as long as the difference between the targets doesn't exceed 2 diopters.  (With a difference greater than 2 diopters, there would probably be a gap in sharp vision.)  Most people would not be aware of a loss of depth impression, and glare and halos should not be a problem.  I don't think any of the currently available premium IOLs can offer this.

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

If you use the search feature and archives you will see many scores of discussions about what people expect from multifocals and also from monovision. Some expectations are totally unrealistic. The secret is trying to make each patient understand what is reasonable. Many people think that because they pay several thousand dollars extra that they can buy a eye that works as good as when they were 16. Isn't going to happen.

JCH MD

[NeLso]

Thank you so much for that piece of info!
If possible, could you highlight the "patient selection" requirement?  

Thanks!

I am taking the forum's vast wealth of knowledge and experience and decided on mono-vision (near/intermediate) for my surgery.  One eye is already near (-3.5D), so the other will be targetted for computer reading.  Progressive glasses for everything out in the yonder.  Crossing my fingers that I don't get dizzy!