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University of Florence Oto-Neuro-Ophthalmological Department Eye Institute

Alessandro Franchini MD Orsola Caporossi MD – Iacopo Franchini. “ Monovision : what is the best target refraction in the dominant and non dominant eye? ”. Over the last few years the expectations of cataract patients have increased and 85% of them whis to be glasses free

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University of Florence Oto-Neuro-Ophthalmological Department Eye Institute

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  1. Alessandro Franchini MD Orsola Caporossi MD – Iacopo Franchini “Monovision : what is the best target refraction in the dominant and non dominant eye?” Over the last few years the expectations of cataract patients have increased and 85% of them whis to be glasses free after surgery. Today to achieve this result we have three options : multifocal IOLs , accomodative IOLs and monovision. Even if multifocal and accomodative IOLs have represented a great step forward we seem to be far from representing the final solution for a number of reasons ( multifocal : influence of pupil diameter, reduction of contrast sensitivity (halo,glare), not suitable in ocular disease (glaucoma ,ARMD etc) – accommodative : low reliability, risk of posterior capsule opacification etc.) So the interest in monovision has increased. University of Florence Oto-Neuro-Ophthalmological Department Eye Institute I receive travel reimbursement from AMO None of the authors have a financial interest in the products or materials mentioned in this poster

  2. In the monovision option , the dominant eye is focused for distance vision, and the non-dominant eye is focused for near to intermediate vision because correcting the dominant eye for the most commonly used viewing distance maximizes blur suppression. According to some authors the ocular dominance represents an important factor in the overall success of monovision but still more important seems to be the magnitude of ocular dominance. In fact for a successful monovision ,interocular blur suppression should flexibly change in each eye at all distances. Material and Methods In literature is not clear what is the best target refraction in the eye corrected for near vision . In fact a high anisometropia guaratees a good rate of spectacle independence but a loss of stereopsis, exactly the contrary of what happens with a low refractive difference between the two eyes.

  3. Visual acuity - 2.00 D - 1.50 D Binocular near UCVA - 1.00 D 88% 75% 74% 100 48% 36% 36% 80 % 60 40 20 J2 J1

  4. Patients satisfaction - 2.00 D - 1.50 D - 1.00 D 91% 88% 86% 100 80 60 % 40 20

  5. Spectacle independence - 2.00 D - 1.50 D - 1.00 D 80% 62% 51% 100 80 60 % 40 20

  6. Reading Speed - 2.00 D - 1.50 D - 1.00 D Slow-fast reading test (Dr Giardini) 24 26 27 40 30 Lines / minute 20 10

  7. Contrast Sensitivity - 2.00 D - 1.50 D Scotopic conditions - 1.00 D 300 100 Functional Acuity Contrast Test (F.A.C.T.) 30 Contrast sensitivity 10 3 0.5 1.0 2.0 4.0 8.0 16.0 Spatial Frequency (cycles per degree)

  8. Key point for monovision option success Mini Monovision In our opinion a relatively low myopic shift in the non dominant eye (-1.00,-1.25 D) allows fusion and binocular vision without the need of suppression and produces an higher level of patient satisfaction and visual performance and a no significant reduction of spectacle independence • Questionnaire to identify appropriate candidates • Ocular dominance • Quantitative measurement of ocular dominance • depth Conclusion So today the so-called mini-monovison represents a considerable option for presbyopic patients who need cataract removal. In our opinion the most important point is the right selection of patients to identify appropriate candidates for this form of correction. REFERENCES Greenbaum S. Monovision pseudophakia.J Cataract Refract Surg 2002;28:1439-1443 Handa T,Uozato H,Higa R,Nitta M et al. Quantitative measurement of ocular diinance using binocular rivarly induced by retinometers. J Cataract Refract Surg 2006;32:831-836 Handa T,Mukuno K,Uozato H,Niida T et al. Ocular dominance and patients satisfaction after monovision induced by intraocular lens implantation .J Cataract Refract Surg 2004;30: 769-774 Evans B.J.W. Monovision : a review.Ophthal.Phisiol.Opt.2007 ,27: 417-439

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