I have a client who is monocular pseudoaphakic, secondary to trauma. (hockey stick, how Canadian) He is a young guy, moderate/high myope. The surgeon very wisely, left him myopic in the injured eye, thus avoiding a lifetime of imbalance issues. He presented with a new rx in which the prescriber wrote a full distance correction for both eyes. Since he has no accomodation in the implanted eye, and full accomodation in the normal eye, it presents a number of ways to proceed. He is resistant to a multifocal of any kind, including a progressive. At near, he tends to suppress the presbyopic eye, but when corrected for near, he is able to achieve convergence and stereopsis. In the end, I continued with what he has been doing for 2 years, and is quite happy with.I simply reduced the dist correction in the injured eye by 1.25 (monovision, if you will) and continued on. I have to wonder if this is really the best for him, though, as he will use a progressive if I insist on it. Long term, I am a bit concerned about maintaining convergence if the stimulus is reduced. What are the short and long term options for this patient? How would you proceed?
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