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Thread: Mono vision glasses?

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    Mono vision glasses?

    Does anyone ever do monovision glasses for their patients that wear monovision contacts? If you have, what was the outcome?

    I always have done progressives/bifocals or just single vision(for myopes). I had a patient ask for her glasses to be done in monovision and I was wondering if anyone else ever does that.

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    Imp of the Perverse Grubendol's Avatar
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    I've done it for readers over mono contacts and it's always worked well.
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    OptiBoard Professional Ory's Avatar
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    I've done it. Some people will not tolerate it despite their mono CLs. Remember to decenter the near lens PD based on a monocular PD measurement.

    There was a discussion not too long ago that brought this idea up: link

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    When I worked in a Laser center. . .

    We often made mono glasses for people who had mono surgery. The point there was to give them back their depth perception for driving at night. It almost always worked. Probably only 1 in 10 puked. So not bad.

    Good luck!!
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    I wasn't clear enough. I meant doing monovision glasses for when they aren't wearing their contacts. Does anyone do this rather then progressive or bifocals?

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    You can do monovision glasses, but with essentially the same limitations as with contacts, or horrors, monovision refractive surgery. The spectacle add plays a big part in determining success. There is a limit to what disparity people will tolerate, independant of image size, although it varies from one person to the next, but in my experience many people are uncomfortable with a disparity greater than about 1 D, and can often adapt to 1.5D. Emerging presbyopes can benefit from monovision spectacles the most, with absolute presbyopes being very poor candidates due to the higher add powers in the rx. Eventually, presbyopes must be introduced to progressives, and, as you know, its an easier road to start with lower add powers and work your way up, than to jump into them with a 2.50 add. I think there is a very limited benefit from monovision spectacles, and its limited to emerging presbyopes who want to "put off" the progressives for a year or two.

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    We have one patient in our practice that wears monovision glasses, when his cl are out. He has been very sucessfull for the last 12 years with monovision glasses.

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    If the patient is capable of steropsis (and you are talking about a pair of glasses to wear without contacts in lue of bifocal glasses) it ain't got a snowballs chance in ...... Think again about distortions and mental confusion that will result as patient looks down from center. Concider the image size difference (if the add is over .75). Sell 'um some bifocals.

    Chip

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    Quote Originally Posted by chip anderson View Post
    If the patient is capable of steropsis (and you are talking about a pair of glasses to wear without contacts in lue of bifocal glasses) it ain't got a snowballs chance in ...... Think again about distortions and mental confusion that will result as patient looks down from center. Concider the image size difference (if the add is over .75). Sell 'um some bifocals.

    Chip
    But many patients have rx differences of more the .75 diopters with no problems. I can see problems if the rx differences is very great, more then 2.50 or so, but not with .75.

    Also, since they would be single vision the patient can lower their head and look through the center just like patients do that wear distance rxs with lots of differences in the prescription. I never use slab offs in single vision even with significant prescription differences because of this.

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    I still say it ain't gonna work.
    However I have a question: Why in the H would anyone want to make a pair of monovision glasses (glasses to offsett the effects of monovision contacts [which I also think is usually a bad solution to presbyopia] I understand. But why monovision glasses, it surely can't be because the optician is too lazy or lacking the skills to make bifocal glasses. Why not let the patient see both distance and near with steropsis?
    Or phrased more delicately, what's the point of monovision glasses?

    And I certianly wasn't advocating a slab off in "monovison glasses."

    Chip

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    Quote Originally Posted by chip anderson View Post
    I still say it ain't gonna work.
    However I have a question: Why in the H would anyone want to make a pair of monovision glasses (glasses to offsett the effects of monovision contacts [which I also think is usually a bad solution to presbyopia] I understand. But why monovision glasses, it surely can't be because the optician is too lazy or lacking the skills to make bifocal glasses. Why not let the patient see both distance and near with steropsis?
    Or phrased more delicately, what's the point of monovision glasses?

    And I certianly wasn't advocating a slab off in "monovison glasses."

    Chip
    Okay, this is what made me think of this. As I stated, I have never done it, but I have a patient that is very happy with her monovision contacts. She wanted a pair of glasses for when she wasn't wearing her contacts. She assumed they would be monovision just like her contacts. I told her I have never done that and we use progressives(or bifocals). I made her some progressives.

    I ran into her at my doctor's office(she worked there)and she told me she was having problems with them. I was thinking that perhaps she might be happier with the monovision glasses and wanted to get others imput.

    By the way, I wear monovision contacts with few problems. I do use my eye corrected for near at distance also. I just got back from Disney(fun!) and saw all the 3D movies just fine with the monovision contacts. If I closed the eye corrected for near I couldn't see 3D anymore.

    I think it is a widely held fallacy that people with monovision contacts don't have depth perception and don't use both their eyes togeather.

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    Happy: Wait til you have a two or more add. Then if you compare distance only with mono or bifocal with mono you will come to know about depth preception. But it's still a bad idea and a horrible idea in spectacles. And there is absolutely no reason to do this in spectacles.
    Unless you have a really dense old blond who wants to say: "I don't need bifocals, I just need one eye for near and one eye for distance."
    I don't know how many such women have told me: "I don't need bifocals I just have a pair of glasses for distance and another pair for near."
    What this accomplishes beyond possibly allowing them to think they are aging more slowly, I can't begin to imagine.
    Or course you could use this as a ploy to keep the patient from realizing in spectacles what they are missing in mono-vision contacts by not having binocular vision.

    Chip

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    I'd agree with most that optically its a pretty bad decision. However, I think there are some instances where it may be acceptable and even work better than progressives, bf, or tf. Not too many, but there could always be exceptions.

    I do have quite a few monovision contact patients that ask that question about monovision glasses. I think for the vast majority of these patients bf or PALs are still the way to go.

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    Acoording to our OD monovision does not work in glasses.
    My experience is opposite. Isaw quite a few Myops that are way over 40 and for some reason were undercorected in one eye.
    Guess what were the results!
    Monovison!
    Tried to give them a full correction in both eyes and multifocals and some of them kicked my ...

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    Quote Originally Posted by chip anderson View Post
    Happy: Wait til you have a two or more add. Then if you compare distance only with mono or bifocal with mono you will come to know about depth preception. But it's still a bad idea and a horrible idea in spectacles. And there is absolutely no reason to do this in spectacles.
    Unless you have a really dense old blond who wants to say: "I don't need bifocals, I just need one eye for near and one eye for distance."
    I don't know how many such women have told me: "I don't need bifocals I just have a pair of glasses for distance and another pair for near."
    What this accomplishes beyond possibly allowing them to think they are aging more slowly, I can't begin to imagine.
    Or course you could use this as a ploy to keep the patient from realizing in spectacles what they are missing in mono-vision contacts by not having binocular vision.

    Chip
    My add is +2.25. I have binocular vision with my monovision. If I close my "reading" eye, everything looks flatter and lacks depth. I wear two distance contacts on rare occasions. Yes, the distance is slightly better, but I can't see anything up close. It's a trade off.

    Monovision is not perfect, but neither are progressive/bifocal glasses. There are flaws with each. I wear progressives, too, I know the good and bad of each. I don't think monvision contacts are a bad idea at all. They work very well for many people. I have tried bifocal and multifocal contacts and I still perfer my monovision. I have tried distance only contacts with reading glasses and I perfer my monovision contacts.
    Last edited by Happylady; 11-22-2006 at 11:41 PM.

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    OptiBoard Professional Ory's Avatar
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    It is a fallacy that binocular vision is "gone" with monovision contacts. Pick up a stereo test (fly, randot, etc) and you will likely see the gross stereopsis image in 3D but some of the fine targets (rings or animals) will appear flat.

    Basically you are creating a central area of your field which does not have stereopsis. The size of this area is affected by the disparity between the images. Peripherally, where the visual acuity drops off a lot, your brain can merge the two images just fine.

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    I've seen two patients with monovision glasses, neither of them wore contact lenses. This seems to be more common in Asian countries, similar to myopic patients from the same area who prefer to be undercorrected.

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    Quote Originally Posted by Happylady View Post
    I think it is a widely held fallacy that people with monovision contacts don't have depth perception and don't use both their eyes togeather.
    Well said.

    My wife, and several of my patients, have "natural monovision", i.e. they are plano in one eye and about -1.25 or so in the other. They live normal lives not bumping into things. These people are real happy well into their fifties. In fact, if you try to correct the myopia in these people, they do nothing but complain. There's nothing wrong with emulating this in contacts and to a lesser degree in spectacles.

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    I routinely prescribe "monovision" distance glasses for any patient of mine who has had monovision lasik or is wearing monovision contact lenses. Intially, the glasses were plano in the distance eye and about -2.00 in the near eye (the usual prescription for a presbyope). They would wear this mainly at night when they drove. At times we would do it with transitions so that they could wear it during the day as well. It works quite well except that after doing this hundreds of times I've learned to undercorrect the near eye by about 0.50 to 0.75. For example, a 55 year old presbyope who actually needs -2.50 to see optimal distance in her reading eye would only get about -2.00 instead.

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    Quote Originally Posted by ilanh View Post
    I routinely prescribe "monovision" distance glasses for any patient of mine who has had monovision lasik or is wearing monovision contact lenses. Intially, the glasses were plano in the distance eye and about -2.00 in the near eye (the usual prescription for a presbyope). They would wear this mainly at night when they drove. At times we would do it with transitions so that they could wear it during the day as well. It works quite well except that after doing this hundreds of times I've learned to undercorrect the near eye by about 0.50 to 0.75. For example, a 55 year old presbyope who actually needs -2.50 to see optimal distance in her reading eye would only get about -2.00 instead.
    Let me see if I understand you correctly: For the monovision lasik patient you have plano (or very close) in one eye and then the -2.00 in the other (instead of -2.50)? Curious to know why you feel the need to lower it -0.50 to -0.75, especially if they are specifically for driving. Difficult to adapt? Patients still wanting some up close vision? Just asking because I have more experience with monovision contact patients, and never had that problem, or havent' yet at least :)


    Back on topic. I did have a guy come in last week that was very adamant about having "monovision" glasses just like his contacts. Turns out his contact was undercorrected by about -0.25, but it was hard to tell since he was a new patient. New fitting put it more along the lines of -0.75 undercorrected and he want the exact same thing in his glasses, despite my five to ten minute discussion of all of his options and my recommendations. Not sure what he ended up doing in the end.

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    I'm not sure why the undercorrection either, but it may be due to a small eikonic imbalance.

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    Are we talking about 2.50 diopter anisometropia or greater? Remember that for every 1.00D of anisometropia, that there will be aniseikonic problem of about 0.05 difference. . Thus at 2.50 there is already 1.50x. The eye and brain can tolerate about 1.6x difference before losing central fusion. T hen peripheral fusion locks are used. Ergo, loss of stereoacuity centrally but still probably able to do 400 seconds on the stereo fly.

    In addition, monovision works because of a loss of retinal rivalry. Retinal rivalry is hardwired. Therefore, a simple test can determine who will benefit and who will not. For those who show excessive retinal rivalry, no amount of lens power manipulation will change the outcome

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    I have a couple of questions and hope you guys don't mind answering them.

    1) Why wouldn't monovision glasses necessarily work.

    2) If someone has perfect distance vision and would have plano for distance power and an add for near,whatever the add power may be, would monovision work in this instance if there was one plano lens and one near add lens?

    3) Does vertex distance play any significant role in the dynamics of fitting monovision glasses.

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    I often use "compensater" spectacles as well, primarily for night driving, but rarely over 1.5 D since I virtually never use more + than this on the contacts in the first place. I have also noticed, to my surprise, that some people who are completely occluded monocularly while looking through a phoroptor are often completely unaware of it.

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    Quote Originally Posted by rolandclaur View Post
    I have a couple of questions and hope you guys don't mind answering them.

    1) Why wouldn't monovision glasses necessarily work.

    2) If someone has perfect distance vision and would have plano for distance power and an add for near,whatever the add power may be, would monovision work in this instance if there was one plano lens and one near add lens?

    3) Does vertex distance play any significant role in the dynamics of fitting monovision glasses.
    Depends on your definition of "work." For an emmetrope (distance Rx plano OU) they will most likely subjectively notice a huge drop in binocularity and vision in the distance with a monovision spectacle Rx. A lot just wouldn't like it... Also, other options just work better in most cases. Why not just Readers that they take off? Why not BF or PAL if full time wear is needed? Most often, these are much better choices and provide as close to optimal vision as possible for the patients particular needs.

    Were you looking for something a little more specific or optically detailed?

    NPDR is correct, if I remember its around 3D in diopter difference where the brain has difficulty with image size differences.

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