Just wondering what everyones opinion is on Monovision with contact lenses how many patients have you fitted with this and how effective you have found it, or would you prefer to keep them in their Pals/Bifs?
Just wondering what everyones opinion is on Monovision with contact lenses how many patients have you fitted with this and how effective you have found it, or would you prefer to keep them in their Pals/Bifs?
The major phrase I use when describing this is compromise. Up to about a +1.75 add, you can get success in my opinion, after that it is giving up too much vision for good stereo vision, and they will always see better out of specs. They also become your worse nightmare after crossing a +2.00 add, as they don't really understand why the signs down the road look blurry at 300 yards, when they used to be able to see them (10 years ago). Read in, increase in chair time. Increase in "I don't see as good as I should" calls, and the other usual contact problems.
Remember, probably about 80% of these people are non-compliant with their cl wear, and it also brings in the lowest revenue to the office, so take it for what it's worth.
While I have a few patient that are happy with this. It is generally done by those too lazy or too unskilled to fit bifocals (i.e. busy OMD). Patient has minimal if any depth preception (despite those on the board that wear this and think they have depth preception.
Fit the patient in a bifocal or progressive CL or trifocal CL.
Never be so foolish as to attempt mono-vision spectacles.
Think what happens if the patient is a long way from home and something happens to the contact in the distance eye. Or the patient who doing something delicate (like eye surgery) and something happens to the near eye.
Don't be lazy learn what you are doing with contacts or refer the patient to someone who does.
And as my opinion on monovision as a refractive surgery technique, you don't want to know.
Chip
I have to echo these guys. Its a poor solution for the patient that brings little money to the table.
Wesley S. Scott, MBA, MIS, ABOM, NCLE-AC, LDO - SC & GA
“As our circle of knowledge expands, so does the circumference of darkness surrounding it.” -Albert Einstein
Sorry, but I guess I am too stupid and lazy.
I have found monovision CLs to be very effective under certain conditions up til about age 50, then auxiliary near vision, and/or driving glasses should be added. So for those of you who are greedy, there is no worry about making a profit
Bifocal CLs sometimes work, but also poop-out at age 50. These folks never seem to have good vision at any distance in either eye...at least monovision patients have it in one eye at some distance or another.
Rules I live by related to monovision:
1. Patient must have relatively equal BVA in both eyes. No amblyopia, no strabismus, no reduced acuity of any kind in either eye.
2. It works better on right handed people better than left. Why? you might ask? Am I prejudiced against lefties? No I am not. When testing eye/hand dominancy in patients, I have found that right handed people are almost always wired to be right eye dominant. (again...assuming equal BVA in each eye). Left handed people, I find are often cross-dominant, IOW, about 50 percent of the time, they are right eye dominant, and 50 perecent are left eye dominant. They don't do as well.
3. Determine eye dominancy by taking a +1.50 trial lens and holding it in front of the patient's normal distance correction. With both eyes open, place it first in front of one eye for a few seconds, then the other, and ask the patient "in front of which eye does the lens blur the DVA less (or not at all)". The eye where the lens is held and causes the least amount of DV blur , that becomes the near eye. So, in general, if a right handed person reports they see little or no blur when you hold the trial lens in front of the left eye, you stand a very good chance of being successful.
4. A little plus goes a long way. In order to preserve a patients safety, never compromise the DVA in the near eye to less than 20/50, no matter what their add requirement is. I generally find that +1.25 is the maximum amount of plus that I would give to the near eye, but it often holds the patient to age 50-52. Then auxiliary spectacles for distance and/or near become necessary. You would be surprised how many patients like to brag to their friends that they only need glasses for driving at night and for prolonged reading of fine print. They are usually thrilled that they can see their computers and cell phones and read a menu,
5. As you would with any patient, advise them to keep an emergency pair of lenses or spectacles with them for emergency use...and stay away from brain surgeons.
These guidelines preserve a patients safety, and obviously makes them happy with less expense and chairtime for both the patient and practitioner...unlike with bifocal CLs. I use a fair amount of bifocal CLs too. They have a place. They are getting better, but IMHO, they are mostly smoke and mirrors (sorry I can't match your fitting skills, Chip). Any day of the week, I'll put up one of my monovision patients against your bifocal patients when it comes to driving at night, working at a computer, reading email on a cell phone, or trying to decipher a menu in a dark fancy restaurant...not Mc donalds.
Remember: even one eyed patients have depth perception...they can hold a valid drivers license in all states, and there are no statistics that say they are worse drivers.
This reminds me of the one eyed patient I had some years ago....
He had been fit with a wooden prosthetic eye, yes wooden...probably by Chip, anyway...he was kinda sensitive and insecure about it and didn't like to go out much for fear that people would stare at him.
Well, one night, he gets up the courage to go out to a bar to meet a girl. (you know where this is going)... He spots one sitting by herself in a dark corner...alone, nobody paying much attention to her. He notices she is not particularly attractive and has a hair lip, and like himself, probably didn't have a lot of friends...but he decides to make his move anyway. He walks up to her and asks, "Would you like to dance?" With that the girl jumps up, thrilled and shouts, "Wouldn't I,... Wooden eye"!! With that, he shouts back, "hair-lip, hair-lip".
They never did hook up. So beware, if you fit monovision, your patients will never be able to hook up at a bar and you might get sued.
Last edited by fjpod; 12-20-2011 at 04:34 AM.
I just wonder why someone would pay someone else to make sure one or the other of their eyes is out of focus all the time.
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
Why? Cause they hates glasses, that's why! And who can blame them? If the majority of cars were complete junk...aka OTC readers... I'd walk too!Originally Posted by DragonLensmanWV
So then you wouldn't want anybody to fit you with bifocal CLs because they are NEVER 20/20 at any distance...at least with monovision, each eye has clear vision at some distance.
The near eye is not blurry all the time, in fact it is quite in focus for near and intermediate tasks, and a lot of our world is near and intermediate. Surely you have seen -1.50 myopes who almost never wear their DV Rx because they are "20/happy" and their near vision is great. And surely you have seen the anisometrope with plano in one eye and -1.50 in the other...these people hate to wear glasses of any kind...and many of them drive and are not a threat to society.
This reminds me of the one eyed patient I had some years ago....
He had been fit with a wooden prosthetic eye, yes wooden...probably by Chip, anyway...he was kinda sensitive and insecure about it and didn't like to go out much for fear that people would stare at him.
Well, one night, he gets up the courage to go out to a bar to meet a girl. (you know where this is going)... He spots one sitting by herself in a dark corner...alone, nobody paying much attention to her. He notices she is not particularly attractive and has a hair lip, and like himself, probably didn't have a lot of friends...but he decides to make his move anyway. He walks up to her and asks, "Would you like to dance?" With that the girl jumps up, thrilled and shouts, "Wouldn't I,... Wooden eye"!! With that, he shouts back, "hair-lip, hair-lip".
They never did hook up. So beware, if you fit monovision, your patients will never be able to hook up at a bar and you might get sued.[/QUOTE]
Doc, I first heard that joke more than 30 years ago ! And chip, you can't tell me you didn't used to fit monovision. Before these new soft bifocals and gas perms,bifocals were a nightmare. the asphere GP's had to be fit so steep the corneal molding caused such severe Rx change from AM to PM that a patient needed 2 pair or more glasses to function if not wearing contacts. Higher myopes could wear crescent segs better than hyperopes but it was always a challenge to fit. Soft bifocals until the last few years were essentially and in fact still are largely monovision. High add in non dominant eye -low add in dominant.
RDcoach: I made the first fused bifocal CL in 1958. It wasn't the first CL bifocal ever, but I have almost never seen the need for monovision. Beginning to miss the fused PMMA bifocal because it worked when nothing else would.
Chip
I have worn monovision contacts for 12 years. I have also worn bifocal and multifocal contacts but prefer monovision for the exact reasons that some people posted here. With multifocal contacts my vision was poorer, the distance was compromised in both eyes and the near was also. I also tried one distance and one multfocal and one near and one multifocal. They didn't work better then monovision for me either.
With monovision the distance is good in one eye and until recently the near was good in the other. I could also see distance with my near eye though it was somewhat blurry. It was clear enough to pass my driving test a couple of years ago, though. I also thought my depth perception was good with monovision but since Chris insists that it couldn't be I guess I must be wrong about this.
But this is just ME. Plenty of people are happy with multifocal contacts. But I do think past age 50 or so everything is a compromise in contacts no matter which is used.
I am 55 now and in the past year have mostly worn glasses after mostly wearing contacts since my teens. Since I am about a -2.00 in both eyes if I wear contacts I wear a -2.00 in my right eye and a -.50 in my left. This gives me decent distant vision, good intermediate and fair near. I have over the contacts sunglasses and clear glasses (for night time driving). I need readers for tiny print and poor light.
I sometimes just don't wear any contact in my left eye. That gives me fair distance, fair intermediate and good near. That -50 really helps the distance and intermediate.
Mostly I wear my glasses. I have great distance, great intermediate, and good near. I have great near if I take my glasses off. I feel somewhat sad about having to wear glasses now but they just work better. I wear my contacts just a couple of times a week.
This should be a sticky if we had a Contact Lens forum (which we need really), Thanks
You've expressed the exact sentiments of the hundreds of monovision patients I work with. True some are not happy, especially after age 50, but it was great while it lasted, wasn't it?I have worn monovision contacts for 12 years. I have also worn bifocal and multifocal contacts but prefer monovision for the exact reasons that some people posted here. With multifocal contacts my vision was poorer, the distance was compromised in both eyes and the near was also. I also tried one distance and one multfocal and one near and one multifocal. They didn't work better then monovision for me either.
With monovision the distance is good in one eye and until recently the near was good in the other. I could also see distance with my near eye though it was somewhat blurry. It was clear enough to pass my driving test a couple of years ago, though. I also thought my depth perception was good with monovision but since Chris insists that it couldn't be I guess I must be wrong about this.
But this is just ME. Plenty of people are happy with multifocal contacts. But I do think past age 50 or so everything is a compromise in contacts no matter which is used.
I am 55 now and in the past year have mostly worn glasses after mostly wearing contacts since my teens. Since I am about a -2.00 in both eyes if I wear contacts I wear a -2.00 in my right eye and a -.50 in my left. This gives me decent distant vision, good intermediate and fair near. I have over the contacts sunglasses and clear glasses (for night time driving). I need readers for tiny print and poor light.
I sometimes just don't wear any contact in my left eye. That gives me fair distance, fair intermediate and good near. That -50 really helps the distance and intermediate.
Mostly I wear my glasses. I have great distance, great intermediate, and good near. I have great near if I take my glasses off. I feel somewhat sad about having to wear glasses now but they just work better. I wear my contacts just a couple of times a week.
Thank you...but what's the matter, you didn't like my joke?
Yes.Maybe I need to give multifocals another try, it's been a couple of years. But I'm afraid I won't be happy with the vision, my glasses give me such wonderful vision and are so easy to pop off to see close up if I want to.
Newer generations of soft multifocals are getting better, but It's really hard to get a 2 diopter myopic presbyope happy with them...or even monovision for that matter, after age 50. But...I would give it another whirl.Yes.
You folks ever heard of rigid multi focals? You can see with them. Especially the translating ones.
Chip
I was reasonably happy with monovision up until this past year. I was out of work for about 6 months (a very nice break!) and got out of the habit of wearing my contacts everyday. My vision is just so much better with glasses and my husband doesn't care if I wear glasses or not. I still like the way I look better without glasses but it's not a huge deal.
I think my vision has been better with glasses for several years but I got used to things being slightly less clear.
Chip, when you made the almost first rigid MF lens in 1958, some people were willing to wear them...because there was nothing else to wear. You know darn well that there is almost no patient that is willing to wear RGPs today. Forcing them on patients, will lose you patients.
And I don't agree. Rigid MFs do not have a better success rate than some of the current soft ones.
Success should be measured by whether a patient comes back six months, 1 yr, 2 yrs later to reorder. Most multifocal wearers never come back to reorder. Most monovision patients do.
Last edited by fjpod; 12-20-2011 at 08:45 PM.
Where I used to work one of the doctors started fitting a lot of them. The vision was great for many people but the success rate wasn't as high as she expected because a lot of people just didn't find them comfortable.
The fitters job is to make or modify them until they are comfortable and providing optimal vision and corneal health.
Actually fijpod had me thinking since his last post on whether I should agree with him concidering that my contact lens practice has fallen off a lot. Then I had 3 cone patients in today and one patient with a 6 cylinder. All failed soft lens wearers who see from 20/30 to 20/15. The six cylinder patient sees 20/20 and 20/15.
But I do agree that fjpod has a point.
Chip
And I agree that cones and six diopter astigmats generally do better with a rigid lens.
I tend to look at the use of the monovision technique as just another weapon in the arsenal of weapons available to create comfort, and improve functionality.
I don't use any weapon without thought, and consideration of the consequences.
The limitations, noted in previous posts, are many, but I do use the technique where multifocals are uncomfortable, too soon, or as a viable secondary/occasional use product........
The problem is not as severe and permanent as those who elected to go with monovision after cataract surgery.I've made lots of glasses for these unfortunates with +1.00 in one eye and -1.50 in the other eye.
DragonlensmanWV N.A.O.L.
"There is nothing patriotic about hating your government or pretending you can hate your government but love your country."
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