Regarding why I undercorrect the "near eye" for distance: I noticed after a while that even though post-lasik I was able to correct both eyes to 20/20 with monovision glasses, many patients confessed that they never wore their glasses when driving at night. These were very basic spectacles: essentially plano in the distance eye, -2.25 in the near eye with an AR coating. When I questioned them further they admitted that the glasses caused them "strain or discomfort." This is strange because those same people claim that they experience no strain with their 20/400 eye (their -2.25 near eye) driving at night. I was baffled about this for a long time but was concerned about safety issues regarding monovision night driving. Ultimately, I began undercorrecting the near eye such that their BCVA was about 20/40 (instead of 20/200-20/400). This seems to have solved the problem for now. I suspect that anisometropia may have been the issue or perhaps that lasik creates islets of multifocality on the cornea that does not respond well to a high powered myopic correction.
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