Monovision Spectacles

[Shwing]

Ehllo, all. I would like your input on something I have come across today. I believe I had posted this to the original 'Board, but that was about 9 months ago, and, well, this is THE NEW 'Board (ominous music).

So, the subject. Monovision in spectacles.

Had a 'lady' in this evening with a non-descript script (ha!). Something like Pl -.50x180 O.U. w/ a 1.50 add.

She didn't want dist. only, nor bifocal of any kind. She wants (which tense shall we use, this is still on- going...) monovision spectacles.

I said something intelligent to the effect of "Huh??"

She wants monovision, and the doc o.k'ed it(note he didn't record it as such).

Aside: About 9 months ago I had a different lady, and different doc who wanted the same thing. In my 10ish years I hadn't heard of this. After a consult with my provincial association; my guru; & the doc, (and a written rx), I grudgingly filled that monovision rx.

Now this one wants it(oh and she'll get it, alright, Mrs. Snarkiness)... I will be phoning the O.D. in the morning to 'see' what he says.

Meanwhile, I am now NOT inclined to produce this for Mrs. Snarkiness.

Here is why: (With contacts, it is a bit of a different issue). The key here, in my opinion, is that spectacles are the very base of the emmetropic assisted prosthetic device.

That is, one must obtain a Best Corrected (D.)V.A. of or near 20/ 20. If one wants contacts of monvision, fine, it is a bit of a compromise, but can be done successfully.

The fallback is still the specs, and 20/ 20. If the contacts (or even specs) don't (best)correct to about 20/20, then there are liability and safety issues(but we wont' delve into the theoreticals).

In addition, there is anisometropia, and possibly aniseikonic issues as well. These don't manifest themselves as much with contacts. (and there is still the fallback of the 20/ 20 specs...)

So, you get the idea. Is this a new method of dispensing that I missed??

Your thoughts are always appreciated.

------------------
Shwing;-}

[This message has been edited by Shwing (edited 06-06-2000).]

[Matthew]

In my 16 years of dispensing I have only made 2 pairs like this. most patients would hate it but 1 in 10,000 wants it. It is not a new thing only an odd thing. What can I tell you.

[Clive Noble]

Over the last couple of years we have indeed done many pairs of Monovision contact lenses and spectacles and the majority are very successful, about 80%.

Usually the reason is (for a contact lens patient) that presbyopia sets in and they don't want readers, whereas the usual reason with specs is either before a cataract operation when the Px becomes more myopic, or after.

It's certainly worth trying it out, and it never fails to amaze me how the brain copes with it!

[Framebender]

Very interesting!! I have a friend who works at a laser center & he makes quite a few pair that bring the reading eye back to distance for night driving & such.

It is something that hadn't occurred to me. Clive, you old frame bender you, I bet you could get a bat to 20/15!;-)

I hope you're all having fun & making money!!

[chip anderson]

Originally posted by Shwing:
Ehllo, all. I would like your input on something I have come across today. I believe I had posted this to the original 'Board, but that was about 9 months ago, and, well, this is THE NEW 'Board (ominous music).

So, the subject. Monovision in spectacles.

Had a 'lady' in this evening with a non-descript script (ha!). Something like Pl -.50x180 O.U. w/ a 1.50 add.

She didn't want dist. only, nor bifocal of any kind. She wants (which tense shall we use, this is still on- going...) monovision spectacles.

I said something intelligent to the effect of "Huh??"

She wants monovision, and the doc o.k'ed it(note he didn't record it as such).

Aside: About 9 months ago I had a different lady, and different doc who wanted the same thing. In my 10ish years I hadn't heard of this. After a consult with my provincial association; my guru; & the doc, (and a written rx), I grudgingly filled that monovision rx.

Now this one wants it(oh and she'll get it, alright, Mrs. Snarkiness)... I will be phoning the O.D. in the morning to 'see' what he says.

Meanwhile, I am now NOT inclined to produce this for Mrs. Snarkiness.

Here is why: (With contacts, it is a bit of a different issue). The key here, in my opinion, is that spectacles are the very base of the emmetropic assisted prosthetic device.

That is, one must obtain a Best Corrected (D.)V.A. of or near 20/ 20. If one wants contacts of monvision, fine, it is a bit of a compromise, but can be done successfully.

The fallback is still the specs, and 20/ 20. If the contacts (or even specs) don't (best)correct to about 20/20, then there are liability and safety issues(but we wont' delve into the theoreticals).

In addition, there is anisometropia, and possibly aniseikonic issues as well. These don't manifest themselves as much with contacts. (and there is still the fallback of the 20/ 20 specs...)

So, you get the idea. Is this a new method of dispensing that I missed??

Your thoughts are always appreciated.


You and were quite correct in being disinclined to dispense same. You could actually cause some kind of muscle problem. At the least, you will give patient eyestrain and one hell of a headache. Monovision is a dumb idea in contact lenses. Used usually by Practioners who fill thier own Rx's and are too lazy and unskilled to fit a bifocal as well as being too proud or cheap to refer the work out to a independent who can. How's that for cahonies?

[Dave Nelson]

I beg to differ... Monovision is a dumb idea in cl? There are many people who gain just as much benefit with mono as they would with bi's... without the extra expense and chair time. Translating RGPs aside, simultaneous vision bifocal contacts simply refine monovision, and when fitting soft bi's I invariable have to "lean" on the dominant eye for dist. va. The trick is to fit lower adds,minimal residual astigmatism, and prounounced ocular dominance.I've done hundreds of mono and bifocal cls, and never considered myself lazy...just keeping my "tool chest" as full as I can.