The customary goal of laser vision correction is usually stated as, “to reduce or eliminate the need for glasses and contacts”. If you are over 40, you may wonder, “What about reading glasses and near vision problems that occur with age?” For patients over age 40, Monovision (with LASIK, PRK, or contact lenses) may be a great choice. Monovision can help the majority of patients achieve good distance and near vision without glasses. Keep reading if you are trying to figure out if Monovision may be right for you.
First, a brief lesson may be helpful. Presbyopia is a normal age related eye condition in which the natural lens of the eye hardens and loses the ability to “autofocus” for near work. Sooner or later, presbyopia causes a gradual worsening of near vision during the forties. Whether or not you have LASIK, you can expect to eventually become “presbyopic” during your mid-forties; this is why people begin wearing bifocals, reading glasses, or taking off their distance glasses (if they are nearsighted). Yes, even after LASIK, if you are corrected for perfect distance vision (“Full Distance”) in both eyes, you will eventually need reading glasses for near work. Though many patients are not opposed to using over-the-counter reading glasses for near work as they age, others truly want to be “glasses-free” for near work. If the mere thought of still needing reading glasses would defeat the point of having LASIK in the first place, you may want to learn about the pros & cons of Monovision.
With Monovision, one eye is “set” for distance focus, and the other eye is set for better near focus. Having mild nearsightedness in one eye can help negate the effects of presbyopia and restore/preserve near vision. Monovision allows a patient to see both distance and near images without glasses by having blended visual focal points. The goal of Monovision is to be independent of glasses for most day-to-day activities. After Monovision it is realistic to be able to read a menu, do computer work, watch TV, and drive a car legally without glasses.
While Monovision is not a “perfect” solution to presbyopia, for carefully selected patients, it is well tolerated and very satisfactory over 85% of the time. Most patients who choose Monovision are satisfied with both near and far vision without glasses. Alternatively, about 15% of Monovision patients notice certain tradeoffs, including difficulty with high performance sports or night driving, or with intricate close work. Monovision may be appropriate for a 50 year-old accountant, but not appropriate for a 50 year-old motorcycle police officer. My goal is to help my patients be satisfied with their vision, for their specific lifestyle and activities, regardless of their age. Ultimately, deciding between a Full Distance correction and a Monovision correction is an individualized choice that is based on many factors. Accordingly, there is not one “right” answer. After getting to know your goals and lifestyle, I can help guide you to the most appropriate procedure for your specific needs.
To help you decide if Monovision may be right for you, these real patient situations can help clarify certain issues that may still be confusing. See if you identify with any of these situations listed below.
Case 1: Should a 30 year-old computer programmer consider Monovision?
Case 2: Can Monovision be fine-tuned, if distance vision is not good enough?
Case 3: “Doc, just make me 20/20, I can deal with readers”
Case 4: “I want better distance vision, but don’t want to lose my near vision”
Case 5: “I want better near vision, but don’t want to ruin my distance vision”
Case 6: A change of heart!
Case 7: Sometimes Lens Implant surgery is preferred to LASIK
Case 8: Some expectations just can’t be realistically fulfilled.
Case 9: Still on the fence? What is Mini-Monovision?
Mary S. is a 30 yr old woman with mild nearsightedness, who works for a high-tech company as a software programmer.
Jim R. is a 56 year-old attorney with moderate nearsightedness and mild astigmatism. He currently uses progressive bifocals. He spends most of his workday on a computer or doing deskwork. He does drive at night a few times a week, if he works late. He also plays recreational tennis during the day about twice per month and skis a few times per year.
Mark R. is a 44 year-old contractor with farsightedness and astigmatism. He only rarely does any deskwork, but he wants to be able to comfortably see his dashboard instruments and GPS navigation system in his car.
Sarah V. is a 49-year-old accountant with mild nearsightedness. She only occasionally wears her distance glasses for driving at night and watching movies. She has excellent near vision without glasses. She normally does not even wear glasses when she is at work or home.
Jacqueline A. is a 48 year-old women who always had great distance vision without glasses, but now requires reading glasses for close vision. She is tired of having to put glasses on & off throughout the day. She wants to be able to see her cell phone, price tags in a store, a menu, and putting on makeup. She also wants to be able to watch TV and feel safe driving. After a contact lens trial in her non-dominant left eye, Jacqueline was reassured that her distance vision would still be good enough after having Monovision LASIK to improve near vision.
Nancy S. is a 55 year-old paralegal with moderate nearsightedness and mild astigmatism. She doesn’t play sports but she does a fair amount of driving at night. As a paralegal, most of her job entails near/computer work. She was primarily interested in good near vision, but was slightly skeptical if she would tolerate Monovision. Because she was “on the fence”, I suggested a Monovision trial with contact lenses. With the Monovision contact lenses, she said that her near vision was good, but distance was still a little blurry with night driving. Weighing all the pros and cons, Nancy felt comfortable with the tradeoffs and benefits of Monovision.
Will M. is a 72 year-old retired banker. He has mild farsightedness and advanced presbyopia. He has very early signs of cataract formation.
David V. is a 53 year-old dentist who plays tennis and frequently drives at night. He also does very intricate near work for dental surgery. He wants very good distance and near vision, but does not want glasses for either.
Cliff is a 47 year-old business owner who is very active in sports and fitness. He would like to have “some” near vision, but is worried about the potential tradeoffs of Monovision. He is not completely opposed to reading glasses, but it would be nice to be able to see a menu and check emails on his iPhone without glasses.