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84 | EYEWORLD | APRIL 2019 R EFRACTIVE PRESENTATION SPOTLIGHT Contact information Assia: assia@netvision.net.il by Stefanie Petrou Binder, MD EyeWorld Contributing Writer pia, or between –0.25 and –0.75 D. "Conventional monovision aims for far and near vision, while with mini-monovision, the focus is on intermedi- ate vision," Dr. Assia said. "The potential candidate for monovision would be any patient who has good vision in both eyes, who desires spectacle independence and un- derstands how monovision works," Dr. Assia said. Contraindications to monovision include ocular disease that affects or threatens vision and astigmatism that cannot be surgically corrected. Severe eye dominance, exophoria, and pediatric patients whose eyes are still growing constitute relative contraindications to monovision. Monovision versus multifocality "In most studies, unaided distance is very similar between multifocal vision and monovision. The difference is in the intermediate and near," Dr. Assia said. "As for unaided intermediate vision, often times monovision does even better than multifocals, but slightly at the expense of near vision. As for unaided near vision, it is improved whether we use monovision or multifocals, but some studies show superiority of multifocals. But one word of caution: Most of the studies in the literature today used bifocals, not trifocals. Also, multifocal torics were not available for earlier studies, despite one third of the population hav- ing astigmatism of at least 1.0 D. We need to look at past studies with the perspective that they did not use the best lenses, compared to today." M onovision is a proven and trust- worthy option to attain spectacle independence in patients undergo- ing cataract surgery. According to Ehud Assia, MD, the best results are attained by waiting for the outcomes of the first-eye surgery before moving on the create monovision. "I will often set the second eye for mono- vision once I have the first-eye outcomes, even if the patient did not intend to have it to begin with," Dr. Assia said in a presentation at the 36th Congress of the European Society of Cataract and Refractive Surgeons. "In my personal experi- ence, –1.75 D is optimal, and although monovi- sion may be slightly less effective than multifocals, there are also far fewer side effects." In conventional monovision, the dominant eye is targeted for distance and the nondominant eye for near. In crossed monovision, the domi- nant eye is targeted for near and nondominant eye for distance. Hybrid monovision refers to the use of both monofocal and multifocal lenses, in which one eye (usually the dominant eye) is set for distance using a monofocal IOL and the second eye with the multifocal lens to achieve good near and intermediate distances. Ophthalmic surgeons distinguish between two types of monovision. Conventional mono- vision is set for less than or equal to –1.50 D, or somewhere between –1.0 and –2.0 D. Mini-mono- vision allows a maximum of –0.75 D anisometro- Choosing between monovision and multifocals To determine the dominant eye, the patient should make a circle with the pointer finger and thumb and extend the arm. After spotting a distant object through the circle, each eye should be closed one at a time to determine which one the object can still be viewed through. Source: Scott Greenbaum, MD About the doctor Ehud Assia, MD Director of the Center for Applied Eye Research Department of Ophthalmology Meir Medical Center Kfar Saba, Israel

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