I have wanted to write this FAQ for a while because I get asked these questions a lot in my clinic when I am seeing patients for a cataract consultation or a LASIK consultation. Monovision has a lot of myths surrounding it, so I hope this article can help get some misconceptions cleared up.
What is Monovision LASIK?
Monovision LASIK is when we determine which of your eyes is dominant and then target that dominant eye for good distance vision. We then target the other non-dominant eye for good near vision. The amount of correction for near vision is typically determined by your surgeon based on your age and desires. I can discuss these considerations and personal preferences with you during your Free LASIK Consultation at Las Vegas Eye Institute.
What is the success rate of monovision LASIK?
This is a great question that we finally have a good answer for due to the recent Visx iDesign 2.0 FDA Monovision LASIK trial. As a refractive surgeon, I have performed a considerable amount of LASIK and cataract surgery targeting “monovision” and found it incredibly well-tolerated in my patients. I was taught during my residency that achieving monovision with contact lenses is only tolerated by about 60% of patients, so this data hasn’t necessarily matched up with my real-world experience. The FDA trial with iDesign 2.0 LASIK had 160 patients enrolled and at 6 months postoperative they found the following results:
- 88% with binocular vision of 20/20 or better (looking at the eye chart with both eyes open)
- <1% reported always having to wear glasses (down from 88%)
- 97% reported overall satisfaction with vision
These are very good and reassuring numbers (and keep in mind that about 5% of people aren’t happy in any given survey)! One main factor to point out, however, is that this FDA trial was for iDesign 2.0 LASIK, which is not the same as regular LASIK. iDesign 2.0 LASIK is far more technologically advanced in that it corrects astigmatism, integrates topography into its treatment plans, and attempts to decrease wavefront errors that other LASIK platforms may not. That being said, we’ve also had great results with wavefront optimized treatments on the Alcon Wavelight platform, so that can also provide great outcomes depending on the patient and the case.
What is the cost of Monovision LASIK?
At Las Vegas Eye Institute in 2019 our price varies between 3750 and 4250 for both eyes. This is with iDesign 2.0 and the Visumax Femtosecond Laser to create the flap. The price is the same for PRK (Photorefractive Keratectomy) or ASA (Advanced Surface Ablation.) Postoperative visits and necessary enhancements are included with this price. Call us or request an appointment online today if interested in a free LASIK consultation.
Will I still see in 3-D after monovision LASIK?
The short answer is a resounding YES! Our brains and how we see the world are obviously very complex, but our brain essentially determines an object’s position in space based on a few key ways: 1. Perspective (image size,) 2. Motion Parallax (movement against stationary objects), 3. Stereopsis, and 4. Shadows.
The key thing to realize is that much of our depth perception is not actually based on the use of both of our eyes together but is based on monocular clues. Perspective, shadows, and motion parallax can all be seen with only one eye. You can tell that you have reasonably good 3-D vision simply by closing one eye and looking around the room. You will notice that things don’t “feel” as 3-D but you have a pretty good idea of how far away the door is and I don’t think you will have much difficulty picking up a pen off the table in front of you even with one eye closed. Also, it is quite amazing how the brain adapts to one eye being set for good distance vision and the other eye for good near vision.
When may I not like Monovision LASIK?
Stereopsis does have its value or we wouldn’t all have two eyes. Its value is that when we have both eyes open, our brain can triangulate objects. This is VERY important for tasks where objects are coming at you fast and you need to quickly respond to them. The example I use for this is professional baseball players trying to hit a curveball and people who play tennis – they really do need this function. However, this function isn’t needed for all tasks and for many tasks we use steropsis only minimally. For instance, I know doctors that perform surgical procedures using monovision (again note that things aren’t typically moving fast in this environment).
For this reason, I do tell my patients that are interested in monovision that if they engage in these types of tasks which require tracking fast-moving objects, they may want to temporarily reverse their monovision when doing so. How can they do this? For tennis, they can put in a contact lens in the eye that is set for near vision so that they have sharp distance vision again. Then when they are off the court, they can take the contact out and enjoy near vision again. During the majority of their daily lives, they often find that monovision still affords them good stereoscopic vision as well as good near vision for tasks like reading their phone or using a computer.
I like to read will monovision work for that?
Yes – monovision at the levels I typically target will allow you to read. That being said, at Las Vegas Eye Institute we don’t set near vision targets for very high powers because that will decrease the quality of your distance vision, increase haloes at night time, and decrease the quality of your stereoscopic vision (yes stereoscopic vision is still present with monovision but reduced mildly). Because we don’t set the near eye that high, you will find monovision easy to adapt to, however, it can make reading for prolonged periods of time tiresome. You also may have difficulty reading very fine text like that found on pill bottles. This can often be overcome with regular over the counter reading glasses but a custom pair of reading glasses can be made.
Does Monovision LASIK cause haloes at night?
This is variable. Nearly all patients will see haloes initially after having one eye set for monovision. Fortunately for many patients, their brain adapts to this and shuts off the haloes over the course of the next few weeks. I have had some patients where the halos do not diminish sufficiently over time. The good news is that the haloes typically are visible ONLY at night or in dim lighting conditions and if truly bothered by them my patients will buy a custom pair of glasses to keep in the car for night driving.
I’m 35 years old should I get my eyes set for monovision anticipating the onset of presbyopia?
Surprisingly I have gotten this question during several LASIK consultations and my answer is “NO.” The reason I say no is that without any problems with your near vision at this age, you will see zero benefits to this and only downsides. You would likely get haloes from this and some level of eye strain. Most LASIK candidates will not be significantly bothered by presbyopia until about the age of 42 (this can vary person to person.) And even then, it usually is more of an annoyance and they can adapt to it by holding things further out to get them into focus. This is variable but most patients that I have seen don’t succumb to carrying reading glasses until the age of 45.