Surgical monovision reasonable alternative for carefully screened presbyopes

Surgical monovision is an attractive option for the patient with presbyopia who seeks refractive surgery and expects glasses- and contact lens-free vision after the procedure, said Mark J. Mannis, MD, at Refractive Surgery 2006.

Dr. Mannis, department of ophthalmology, University of California, San Diego, reported the results of a study include 87 patients who underwent LASIK monovision. All were at least 40 years old. Preoperative refractive errors included spherical myopia, myopia with astigmatism, hyperopia, hyperopia with astigmatism, and mixed astigmatism. Thirty-five patients had a contact lens trial preoperatively.

Postoperative, mean SE was 0.02 D in the distance eye and -1.27 D in the near eye.

Overall, 98% of patients were satisfied. Two patients underwent monovision reversal; neither had a preoperative contact lens trial. However, 31 eyes underwent LASIK enhancement, which most often was performed for the distance eye.

"Surgical monovision using LASIK or PRK is a tool many refractive surgeons have used for a long time," Dr. Mannis said. "This study supports its role, but there are some special considerations.

"Practitioners should expect long chair times preoperatively and a relatively high enhancement rate postoperatively because even small amounts of astigmatism may require correction," Dr. Mannis said. "In addition to careful screening and counseling, we also recommend a presurgical contact lens trial for all patients, suggest a minimum 3-week acclimatization period after surgery, and use of 'glove box' glasses for scoptic conditions. In addition, this method is not recommended for certain patients, including pilots or professional drivers."