Eyeworld

DECEMBER 2022 | EYEWORLD | 45 C by Liz Hillman Editorial Co-Director About the physicians Eric Donnenfeld, MD Ophthalmic Consultants of Long Island Garden City, New York Lance Kugler, MD Kugler Vision Omaha, Nebraska Bryan Lee, MD, JD Altos Eye Physicians Los Altos, California 1.5 D of near vision without splitting light and maintaining 20/20 vision at distance. It's ideal for post-refractive cornea patients who wish to be spectacle independent but are not good candidates for multifocal IOLs," he said. Bryan Lee, MD, JD, said he achieves monovision in three ways: with a monofocal or monofocal toric, with the Vivity IOL, or with the Light Adjustable Lens (LAL, RxSight). "I explain to [patients] that with the mono- focal, you have two points that are clear, while the Vivity provides more range for each eye. The Light Adjustable Lens is the most accurate both for distance and for near, which is the harder eye to target," he said. Dr. Kugler said he also uses the LAL as his "go-to option" for monovision in patients who have had previous corneal refractive surgery. He said some of his blended vision patients receive a monofocal lens in the dominant eye and an EDOF or trifocal in the non-dominant eye. "It's a different kind of blended vision but it has a very high satisfaction rate in the right patients," he said. Dr. Kugler added that the IC-8 Apthera IOL will be useful in some monovision cases. "If you've got a case where you want to avoid multifocality, but you want to give them a nice range of vision, it allows you to do that without the downsides of multifocality and without the limited range of vision that a fixed monofocal has. I think it fills an interesting niche," Dr. Kugler said. Assessing candidates Dr. Donnenfeld said he employs monovision because any residual dysphotopsias that might occur can be solved with a pair of glasses and because it preserves distance vision. Trifocals, Dr. Donnenfeld continued, come with a little bit of distance vision compromise. "For patients who say they want to reduce their dependence on glasses and wear them in- frequently, I want to be able to not have dyspho- topsias, or if they're not a great candidate for a trifocal … they can still be a good candidate for monovision," Dr. Donnenfeld said. Dr. Lee said he will consider monovision for a patient who has had vision corrected with this technique before and was happy with it. "If a patient likes monovision, I would continue it and never switch to a trifocal. At the same time, the only way I would do monovision in someone with no prior experience but too much cataract for a monovision contact lens trial would be with the Light Adjustable Lens," he said. In general, Dr. Lee said that monovision can give better reading vision than a presbyopia-cor- recting IOL in both eyes. He also said that some patients who are not good candidates for a trifo- cal IOL, due to ocular comorbidities, can still be a candidate for monovision. "Monovision avoids the halos associated with a diffractive IOL, and you can optimize night vision with a pair of glasses," he said. Some ocular comorbidities rule out mono- vision/blended vision as a viable option. These, continued on page 46 Dr. Lee uses the LAL as one of his options for achieving monovision. Source: Bryan Lee, MD, JD

• Blank Page
• Blank Page (1)