Rejection of Depth perception

[leeopt]

A post lasik patient overview as follows:
+1.75 -0.50 x28
pl -1.75 x64 +2.50
Uncorrected VA 20/70 ou
Corrected VA 20/20 od 20/30 os
"Looking straight ahead distance is clear and sharp. When I cover my right eye it's a little fuzzy. When I turn my head or walk around it's...I don't know how to describe it...like looking into one of those viewfinder toys?"

Wearing a Choice 17 can see at all visual tasks. RX good/fit good.
Doesn't seem to be aware of a lasik induced monovision. +1.75 readers less of the viewfinder sensation and improved vision.

Anyone else run into this and have some jedi mind trick to get the patient to accept depth of field again?

[revein]

Problems are often caused by a difference in retinal image size. In such cases the brain is unable to combine monocular visual information from both eyes into a single binocular one.

Best thing to do in your situation would probably be to undercorrect the left eye: instead of plano, add some plus and see what works out. The reason why the patient seems to find +1.75 readers more comfortable is because the left eye is nicely suppressed.

[Robert Martellaro]

Contact lenses might help. But I suppose that was tried without success before the refractive surgery decision.

It might look like monovision, but this is technically best described as a cluster****. When was the surgery?

How many days have the eyeglasses been worn?

[Robert_S]

Contact lenses might help. But I suppose that was tried without success before the refractive surgery decision.

It might look like monovision, but this is technically best described as a cluster****. When was the surgery?

How many days have the eyeglasses been worn?

is it just me, or is monovision a ridiculous idea anyway.

[Tallboy]

I am remaking a shamir computer for a gentlemen who recently had "monovision lasik".

We are trying reading glasses now, I don't think anything is going to work unfortunately, He still is subconciously shutting out one image, not fusing them. Very simalr rx to the OP actually.

[Robert Martellaro]

Problems are often caused by a difference in retinal image size. In such cases the brain is unable to combine monocular visual information from both eyes into a single binocular one.

Best thing to do in your situation would probably be to undercorrect the left eye: instead of plano, add some plus and see what works out. The reason why the patient seems to find +1.75 readers more comfortable is because the left eye is nicely suppressed.

Good info and advice.

I've found that at this level of anisometropia, even when surgically induced, most will adapt. Same for the VI induced at near with multifocals, although avid readers might need SVRO.

is it just me, or is monovision a ridiculous idea anyway.

Not just you. I tell my clients to ask for the best monofocal IOLs (aspheric?), aiming for a refractive error of about -.50 D sph equiv, although some might choose a little more minus for intermediate or near. I might opt for my habitual -3.50; I've never needed to use magnifier, and in my business as an optician/musician/electronics, peeking under the lenses is just way too handy. YMMV.

That said, there's probably a very small percentage that will be grateful for a little monovision, when reducing their dependence on optical devices is more important to the client than the best possible vision and comfort. On paper, it's more acceptable when done on the lenticular plane, although a difference of about 1 D is as far as one should go, I think. Something like -.50 D, and -1.50 D in the fellow eye seems typical. A trial run with CLs seems prudent. However, eyeglasses for these RXs are more difficult to design, with varying results, as the OP's client is experiencing.

[TLG]

I agree with Robert. We see a lot of this and I find that with differences of 2.00D or less, adaptation is possible although the greater the difference the less likely. A contact lens, at least for the right eye, will go a long way toward solving as well.

[fjpod]

It depends on a lot of things. What is the patient's habitual state? Do they normally walk around wearing no Rx, and they think of their glasses as "reading" glasses? If so, this Rx would seem like too much plus in the OD, and too much anisometropia stemming from the cylinder in the OS.

Also how long post-op is the patient? Month? Years? Did the Dr. modify the Rx based on history or did he/she just write the manifest refraction as a final Rx?

Those +1.75 OTCs...is the patient using them for distance? If so, it is a signal that there is more cylinder in the Rx than the patient really needs.

Depending on the answers to some of the questions, I might try to reduce plus a little OD and reduce the cyl moderately OS.

[leeopt]

Patient is about 8 years post op. OD says she rejects taking away any power. We put her in a trial frame, the glasses we made her are better.
The OTC +1.75 OD is better at distance and OS better at near. This idea was to re-establish mono correction and lose depth of field.
There is no enthusiasm for CL.
She has had glasses for three months. Her only complaint is Depth perception.
She wore progressives successfully in the past and really theses are good when she doesn't move.