Eyeworld

EW REFRACTIVE 66 January 2018 Another investigation of visual quality after monovision LASIK in 50 eyes of 25 patients (mean age 49 years) revealed that near vision was greatly improved but that contrast sensitivity and stereoacuity were significantly reduced. In these eyes, the dominant eye was plano and the non-dominant eye was set at –1.25 D. 4 Monovision or multifocals? For patients requiring cataract sur- gery, advanced (multifocal or EDOF) IOLs and monofocal IOL monovi- sion appear to address presbyopia with a high level of patient satisfac- tion. A recent review of the litera- ture comparing multifocal IOLs with pseudophakic monovision in the treatment of presbyopia showed that distance vision was generally similar in both groups. Near vision was bet- ter with multifocal IOLs, and inter- mediate vision appeared to be better in the monovision group. More patients reported complete spectacle independence with multifocal IOLs, but these patients reported more glare and halos as well. 5 Clinicians can use the data from a wealth of studies to help make a considered decision in choosing the right type of implant. However, my- opic patients expecting "near-sight- ed near" vision require additional considerations. "I tell patients interested in implant technology that the ability to take your glasses off and see the wings on a fly will not be possible," Dr. Thompson said. "Patients who want near-sighted near vision need to be made a –2.00 D myope with spherical monofo- cal implants and wear glasses for distance. Patients interested in modern day technology need a kind attitude adjustment with regard to near-sighted near. If you are my- opic and want to go for complete spectacle independence, you need to give up on that [near-sighted near] thought." EW References 1. Marques FF, et al. Evaluation of visual performance and patient satisfaction with pseudophakic monovision technique. Arq Bras Oftalmol. 2009;72:164–8. 2. Finkelman YM, et al. Patient satisfaction and visual function after pseudophakic monovi- sion. J Cataract Refract Surg. 2009;35:998– 1002. 3. Durrie DS. The effect of different monovi- sion contact lens powers on the visual func- tion of emmetropic presbyopic patients (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006;104:366– 401. 4. Alarcon A, et al. Visual quality after monovi- sion correction by laser in situ keratomileusis in presbyopic patients. J Cataract Refract Surg. 2011;37:1629–35. 5. Greenstein S, et al. The quest for spectacle independence: a comparison of multifocal intraocular lens implants and pseudophakic monovision for patients with presbyopia. Semin Ophthalmol. 2017;32:111–115. Editors' note: Dr. Thompson has no financial interests related to his comments. Contact information Thompson: vance.thompson@vancethompsonvision.com Corneal continued from page 64 " In general, patient satisfaction after monovision is reported to be high without as many complaints about glare and halos as with multifocals. We use it a lot in corneal refractive surgery, and it also works well with implants. " —Vance Thompson, MD

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