Richard A. Levinson, M.D. > Monovision


Monovision, an option for avoiding reading glasses after 40

If you are over forty years old, please read this section very carefully. It may seem confusing, and you probably think that this will never happen to you, but it is important that you understand this information. If you are over forty-five, you’ll understand.

Here come the reading glasses…

Around age forty to forty-five, you will begin to lose the ability to focus your eyes for seeing at near. The medical term for this aging change is “Presbyopia” which comes from the Greek words meaning “old” and “vision.” EVERYBODY develops Presbyopia because with aging, the natural lens in our eye becomes rigid, losing its elasticity. Although the focusing muscles in the eye still work well, the lens no longer will focus images at near. You will have difficulty focusing your eyes to read! If you are going to have Laser Vision Correction, you must decide how you will compensate for your inevitable loss of near vision. Laser Vision Correction does not cause Presbyopia. It is due to aging and everybody loses the ability focus at near.

What options do I have?

If you have Laser Vision Correction and are over the age of 45 and want to read, you have two choices. You can either wear reading glasses or you can have Monovision. I am a very strong proponent of Monovision. If you are Presbyopic and decide to have Laser Vision Correction and do not have Monovision, you will have to wear reading glasses 100% of the time – to see your watch, to read a menu, to dial a phone, to read the newspaper. I feel that the goal of Laser Vision Correction is to decrease the patient’s dependence on corrective lenses. If we do not Monofit and you are 45 or older, you will have excellent distance vision, but will have to wear glasses 100% of the time to see near. This dependence on glasses for reading somewhat diminishes the benefit of Laser Vision Correction. However, with Monovision, patients are much less, if at all, dependent on correction.

What is Monovision?

Monovision is an updated version of the monocle. In the “old days”, people wore a monocle in one eye for reading and used the other eye for distance vision. With Laser Vision Correction we can, once again, use this “monocle” concept, now called “Monovision” or “Monofit”, to address the problem of Presbyopia. With Monovision, one eye is set with the Laser to focus at distance and the other eye is set to focus at near. When a patient is Monofit, the patient can see both at near and at distance without the need for glasses. There is no need to close one eye to see near or far; the brain makes the adaptation without the patient even being aware of which eye is being used for near or far. Monovision may sound archaic and difficult to tolerate, but in fact, it has worked very well for most patients. Peripheral vision and depth perception are minimally, if at all, affected by Monovision.

How difficult is it to adapt to Monovision?

Getting used to Monovision generally takes several weeks. Most Monovision patients will almost never use glasses and are able to see well for both distance and near without correction. Patients with Monovision can legally, and safely, drive a car without correction. Occasionally, patients with Monovision will want to wear glasses to “fine tune” their vision. This may be only for night driving or for prolonged reading or computer use.

I went to other laser centers that said Monovision doesn’t work and don’t even consider it!

I hear this quite often and I vehemently disagree! Those centers are simply denying their patients access to a very powerful option; that of not needing reading glasses! I am monofitting myself and I promise you it works extremely well for me. I have a visually demanding job as an Eye Surgeon and can see extremely well to perform my job, without reading or distance glasses. I do agree that most Laser Centers don’t encourage monovision. Either they not experienced enough with monovision to understand how well monovision works for the vast majority of men and women over the age of 45, or they are in too big of a rush and don’t want to spend the time necessary to fully explain monovision to prospective candidates. I do agree that monovision may initially sound crazy and it takes time to explain to patients the advantages of monovision. Many Laser Centers simply do not want to spend the necessary time with you to explain monovision. Monovision works in over 95% of my patients! I remind you that I do not charge extra for monovision and if you do not like monvision, I will retreat you at no charge and undo the monovision for you. If a Laser Center discourages you from considering monovision (rarely, people may have specific work or recreational situations not suitable for monovision, but this is rare!), I would invite you to have a free consultation with me and my staff regarding Laser Vision Correction and monovision.

What if I am Monofitted with the laser and hate it?

If you choose Monovision, with one eye being Lasered as a distance eye and the other eye being Lasered as a reading eye, and can not adapt to it, the “near” eye can be corrected for distance with a second Laser procedure. This second Laser procedure on the eye that we initially Lasered to make a reading eye is done at no charge, is painless and very safe. If you only have one eye Lasered for distance, leaving the unlasered eye as a reading eye and don’t like this monofit situation, we can then Laser your previously unlasered reading eye, making it a distance eye. (Obviously, in this situation, you would have to pay the Laser fee to have the second eye lasered.) I’ve done Monovision on 60% of my Laser Vision Correction patients and I have had to undo less than 1% of the Monofit patients! Undoing the Monovison will eliminate the remaining nearsightedness. However, you will then need to wear reading glasses to see up close.

At what age do you recommend Monovision?

I strongly encourage any patient who is presently having trouble reading or who presently wears bifocals or reading glasses to have the Monofit. For patients between 35 and 45 who are not yet having trouble reading, I strongly encourage them to at least consider Monovision. For younger patients, I briefly mention Monovision as an option but realize that they would not benefit from the Monovision until they reach their mid-40’s.

I’m over 45, nearsighted and just take my glasses off to read.

Some nearsighted patients over forty-five do not wear bifocals, but merely take off their distance glasses when they want to read. If you must take off your distance glasses to read or see up close, then you have Presbyopia. After Laser Vision Correction you will no longer be able to take your glasses off to read because you will no longer be wearing glasses! If you are nearsighted and take your glasses off to read and are not interested in Monovision, you must consider if you really want to have Laser Surgery for your nearsightedness. If you have Laser Vision Correction for nearsightedness and you do not have Monovision, you will just be exchanging distance glasses for reading glasses.

What happens if I just ignore all of this?

If you have Laser Vision Correction and don’t do the Monovision, you will have to wear reading glasses to see at near after age 45, for the rest of your life.

I still don’t get it…..

This issue of Presbyopia is confusing and if this information just confused you more, please feel free to call our office at 303-393-0347 for clarification. We offer free, complimentary consultations for anyone considering Laser Vision Correction. We can actually show you in our office what Monovision would look like. And if you are presently wearing soft contact lenses, we can give you a temporary soft contact lens so that you can actually see what it is like to experience Monovision.