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.
I've done it for readers over mono contacts and it's always worked well.
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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
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!!
Days where my gratitude exceed my expectations are very good days!
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?
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.
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.
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.Originally Posted by chip anderson
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.
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.
HappyLady,
I will often do a spec Rx for my monovision patients over their contacts. It usually comes up when they spend more than an hour continuously on the computer. Monovision is great for casual use, but when someone sits at the computer for a significant amount of time, the imbalance can cause headaches and eye strain. I like to trial fram the Rx in the office and let them sit at a computer. They will love for the extra effort.
Most doctors don't like to take the time to compute the prescription. I became tired of doing the calculation and I made a computer program that will do all the work for you. You only have enter the person's age, height, computer monitor distance and their general use Rx and contact prescription. It will even compensate for vertex distance.
If you would like to use it, shoot me an email:
DrLarryTarrant@aol.com
HAPPY "L''...................... Just as I suspected the lady with the mono specs (not over contacts) hated them... She's going to get lasik . I think in both eyes and then she'll be strapped to reading glasses until the end of time. I'd like to ask you something else.... I wear mono vision contacts and progressives and I think your rx is very similar to mine. Since I wear my contacts most of the time when I wear my progressives I can't see as well out of the reading area in my "dominant" eye. I wonder if you have the same experience and if my brain is just so used to using that eye for distance only that the plus power just seems useless in progressives. Anybody have any imput on this?
sharon
We actually have 3 patients who currently wear monvision glasses as backups to their contacts and love them that way.
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
Interesting discussion.
Group one: anisometropes
Group two: isometropes
Group three: monovision patients
Anisometropes more often than not do well with refractive imbalances because they "were born that way". They've adapted. As mentioned, a plano/ -1.25DS will be happy most the time uncorrected. A +1.00/+3.00 will be happy most of the time in +1.00 DS OU. What these folks don't do well with is FULL correction!
Isometropes, on the other hand, do not like to have induced refractive imbalances, as a general rule. Looky, the monvision success rate is generous at 50%, and that's factoring in all the minor +1.00 mono fits.
The success rate is going to go way lower than that when you make the imbalance at the spectacle plane, with the resulting image size difference, and the prismatic imbalance off-center. Why do this when better alternatives exist?
Monovision patients are isometropes that have been iatrogenically turned into anisometropes. They're a weird breed. They can tolerate more than expected, because either their system is plastic, or we've plasticized it. Can they wear distance or near compensating specs? Oftentimes, but it's still difficult. I think Ilan is right: give as little plus or minus as you can.
So, to the original thought: monovision spectacles in lieu of multifocals?
Maybe, maybe, on adapted monovision patients, but again: "Why"?
"...To boldly bold where no man has bolded before..."
DRK< Yes, I've seen od's back-off a little on one eye...a half a diopter at the most but to make one a single vision lens and the other a distance lens. I don't see how anyone could walk around much less drive or take stairs. It is so disorienting. And I'll ask it again if you can't get used to progressives how do you get used to these?
sharon
When you say "backups to their contacts" do you mean 'over' their monovision contacts or 'instead of' their contacts? I guess it depends on the RX as well as the person. I don't see how anyone could benefit from the latter.
sharon
Yesterday I dispensed a pair of monovision glasses to be used as backups and her evening at home pair. We put her in progressives and in straight tops in the past, but last year she said she would rather have monovision in the glasses. We warned her of potential issues, but when she put them on, she thought they were better than any of the other types of multifocal correction we have done with her in the past.
We don't have very many of them, but I can name at least 2 others besides her that we have done this with.
Cassandra
"Some believe in destiny, and some believe in fate. But I believe that happiness is something we create."-Something More by Sugarland
I just got some new Definity Short progressives. My distance is -2.25 -.25 in both eyes with a +2.25. I don't notice any more problem reading through my right eye in my progressives then I do with my left eye. Of course, I don't have any plus power in my glasses. The reading part is almost plano. I switch between my mono vision contacts and glasses easily.
I do wear a -.50 in my left contact so my close vision isn't quite as good as with my glasses(or without anything). Sometimes I use readers over them for extremely fine work.
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