Monovision!!!

[mullo]

I was just wondering how different fitters proceed with a monvision fit? Do you do a dominant eye test, do you use the swinging plus test or do you simply choose the least myopic (most hyperopic) eyewith the near correction? I have in the past found that the good old dominant eye test has served me well. Distance lens in the dominant eye and near lens in the non-dominant. I usually stick to approx. 1.5 D as a max range difference between the 2 eyes. I also play a little with O/R more plus in the distance to bring the 2 Rx closer if needed, but only when I'm pushing the upper limit of range difference. Just curious what works for you? And any tips you may suggest? Chip, where are you???? Mullo

[lguess]

mullo,

I think you're right on the money in describing your monovision method. I've tried a lot of variations for mono fits, and always end up going back to your method. I rarely fool with the distance Rx in the dominant eye; prefer to tweak the "near" distance Rx. I find that I can keep the "near" lens power fairly weak in younger myope/presbyopes, and have rarely been able to go over 2.00D difference between the two eyes. My most successful fits occupation-wise? School teachers.

Larry

[chip anderson]

Mullo:

Your method is fine. I know that as far as my own economics I am wrong in this but I do not approve of monovision or even precribing residual cylinder in spectacles, but I will tryst with monovision only now.
I personally do not like monovision (although I have patients who are happy with this and have on occasion failed with bifocal fitting and ended up with a patient quite happy with monovision) my reasons are:

1) the patient mantains depth preception, as both eyes available for distance should something cause a problem in the fellow eye/contact.
2) Being a usually successfull bifocal contact lens fitter, marks you as an "expert" as opposed to some doctor trying to have a sideline because he can't make it practicing medicine and surgery. If I had only the patients in my town that have been told you can't were contacts or bifocal contacts (some practioners will say the don't even make them, and I made my first in 1958) I would have the richest practice in the country and all the doctors would be happy because they would maintain the patient for medicine and surgery.
3) If I fail, it's me not the precribing doctor who looks bad.

Chip

[Corey Nicholls]

This may seem a little strange a question, but, how do you test which eye is the dominant one?

Corey

[mullo]

Corey,

Put both eyes in the ring and let them fight it out. The DOMINANT EYE will win and is fit for distance. You can do it a few ways, but I prefer the method that follows;

-have the patient hold their hands at arms length and make a small (the size of a golf ball) opening with their hands

-have them focus on a small object on the wall such as the light switch

-tell them not to move their hands nor their head

-have them close one eye at a time

-the eye they can still see the object with when the other is covered is the dominant eye and is fit for distance

Chip, I agree with you about monovision. Depth perception is compromised and the patient usually wants better near vision than is possible while still providing optimum distance vision.
I rarely do it anymore but still have to fix the errors other fitters from time to time. My company doesn't carry bifocals at this time. We had in the past but due to inexperience on the part of the majority of fitters they were discontinued. The fitters loved bifocal contacts because they could learn on company time. The only thing was that they weren't learning, fitting success rate was about 10%.............Mullo
:hammer:

[chip anderson]

Success Rates:
Amoung those people that "should be tried" in soft bifocals, i.e. those with less than 1/2 cyl. Success (defined as patient was satified enough to wear them and you did not feel vision was a danger to the patient [say: 20/30 or so dist]) should be around 25% if you try both concentric and aspheric before throwing in the towel. One thing that gets me P.O.'d is companies like J&J that allow only one or less trial lens replacement per sale. It often takes many and not every trial results in a sale.

Amoung rigid lens wearers that are already wearing S-V lenses before becoming presbyoptic sucess should be in the neighborhood of 85%+, if you have the capabilitly of doing your own PC and edge modification.

Amoung patients who have not worn contacts prior to becoming presbyoptic, rigid lens success (if you are a very good fitter and psychologist) might be 35%) less if you are old an burnt out like me.

Chip

[Jackie L]

Another way to determine which eye is dominant is to have the patient pick out an object accross the room. Then they are to point at the object and hold. (it doesn't matter which hand) Now they can close one eye at a time and whichever eye focuses on the object where the index finger is targeted on, that is the dominant eye.

[mullo]

Cool, Jackie!!! I'll use that way for now on it's easier to explain and execute.....Mullo

[Dannyboy]

I always start with the dominant for distance with a max dissociation of 1.5. In bifocals it is essentially the same technique that I use when everything else fails. One can get good binocularity in modified monivision (using multifocals) at least that my impression when testing the patients with the Fly test. In true monovision the pt. fails. Monovision really is a crummy way of correcting presbyopia with all the new multifocals. But when everything fails...monovision can give you a happy patient.
Any good multifocal torics ? Very interested on that one.

Dannyboy

:)