Monovision for Presbyopia

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Monovision for Presbyopia
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How the eye works

• Light rays enter the eye through the clear
  cornea, pupil and lens.
• These light rays are focused directly onto the
  retina, the light-sensitive tissue lining the
  back of the eye.
• The retina converts light rays into impulses,
  sent through the optic nerve to your brain, where
  they are recognized as images.
• 70 of the eye's focusing power comes from the
  cornea and 30 from the lens.

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Refractive errors

• Inability to see clearly is often caused by
  refractive error.
• Four types of refractive error
• Myopia (nearsightedness)
• Hyperopia (farsightedness)
• Astigmatism
• Presbyopia

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Refractive errors myopia

• The distance between the cornea and the retina
  may be too long or the power of the cornea and
  the lens may be too strong.
• Light rays focus in front of the retina instead
  of on it.
• Close objects will look clear, but distant
  objects will appear blurred.

Myopia, or nearsightedness
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Refractive errors hyperopia

• In hyperopia (farsightedness), there is too
  little optical power.
• The distance between the cornea and the retina
  may be too short.
• Light rays are focused behind the retina instead
  of on it.
• In adults (but not children), distant objects
  will look clear, but close objects will appear
  blurred.

Hyperopia, or farsightedness
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Refractive errors astigmatism

• In astigmatism, the cornea is curved
  unevenlyshaped more like a football than a
  basketball.
• Light passing through the uneven cornea is
  focused in two or more locations.
• Distant and close objects may appear blurry.

Astigmatism occurs when light passes through
uneven cornea
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Refractive errors presbyopia

• Presbyopia is a normal condition in which your
  eyes gradually lose the ability to focus things
  up close.
• When we are young, the lens in our eyes is
  flexible and is able to change focus easily
  between near and far objects, like an autofocus
  on a camera.
• At around age 40, this flexibility naturally
  begins to gradually decrease, making it more
  difficult to see objects up close.

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Non-surgical correction of presbyopia

• Presbyopia is often corrected with reading
  glasses, bifocals or contact lenses.
• People within the presbyopic age who have good
  vision at distance usually use reading glasses
  for close-up vision and remove them to see
  far-away objects.

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What is refractive surgery?

• A group of outpatient surgical procedures used to
  alter how your eye focuses light rays on the
  retina, thereby improving vision and reducing
  dependence on glasses and contact lenses.
• In most cases, refractive surgery affects the
  shape of your cornea to redirect how light is
  focused onto the retina. Popular procedures
  include LASIK, LASEK, PRK and CK.

Refractive surgery procedure on the cornea
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What is refractive surgery?

• Most refractive surgery is performed on the
  cornea and affects only the front of your eye,
  while the rest of your eye will change naturally
  as you age.
• In some cases, refractive surgery procedures
  dont reshape the cornea instead, the eyes
  natural lens is either replaced or enhanced by an
  implantable lens that helps correct vision.

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Monovision for presbyopia surgery

• Adjusting each eye for different focusing
  distances can reduce or eliminate the need for
  glasses or contacts.
• Monovision, sometimes known as blended vision,
  allows for different focusing distances in each
  eye separately.

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Monovision for presbyopia surgery
With monovision, one eye is corrected
surgically to allow clear distance vision
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Monovision for presbyopia surgery
while the other eye is either not treated, or
is partially treated, to allow clear vision close
up.
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Monovision for presbyopia surgery

• Monovision for presbyopia yields clear vision,
  one eye for distance and one eye for near.

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Types of surgery

• Monovision can be achieved through these types of
  surgery
• Laser In Situ Keratomileusis (LASIK)
• Epithelial Laser In Situ Keratomileusis
  (Epi-LASIK)
• Photorefractive Keratectomy (PRK)
• Laser Epithelial Keratomileusis (LASEK)
• Conductive Keratoplasty (CK)
• Phakic Intraocular Lenses (IOLs)
• Refractive Lens Exchange (RLE)
• Intrastromal Corneal Ring Segments (INTACS)

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Monovision for presbyopia surgery

• While the brain does get used to seeing with
  monovision, it can take up to six to eight weeks
  for your eyes to adjust.
• It may be useful to try monovision with contact
  lenses before having the monovision surgical
  procedure, as some patients may not be good
  candidates for the surgery.

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Considerations for monovision for presbyopia
surgery

• Reduce or eliminate the need for both reading and
  driving glasses.

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Considerations against monovision for presbyopia
surgery

• May not be recommended for people needing to see
  better than average and binocularly for certain
  activities at either distance or near (like
  pilots).
• May not be recommended for people requiring rapid
  improvement in vision, as it may take up to two
  months for your eyes to adjust to monovision.
• Night driving vision may be more difficult since
  there can be reduced depth perception.

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To be a candidate for monovision surgery, you
should

• Be over over 40 years of age.
• Have an appropriate, stable refractive error
  within a correctable range.
• Be free from eye disease.
• Understand and accept risks, limitations and side
  effects of the procedure.

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Risks and possible side effects of monovision for
presbyopia surgery

• Infection.
• Over-correction or under-correction (with a
  possible need for a re-treatment).
• Visual aberrations, such as seeing halos around
  lights at night.
• Lack of depth perception.
• Inability to adapt to the monovision state,
  possibly requiring a re-treatment.

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Is refractive surgery right for you?

• Advanced surgical procedures, including
  monovision for presbyopia, are creating more
  opportunities for people who want to be less
  dependent on glasses or contacts.
• Surgery may not entirely eliminate your need for
  corrective lenses. Glasses/contacts may still be
  needed for activities such as fine or detailed
  work, reading and perhaps night driving.
• If an accommodating or multifocal IOL is used,
  then reading as well as distance vision may be
  improved.

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Is refractive surgery right for you?

• A large part of the success of any refractive
  surgery depends on your understanding of the
  procedure and your expectations.
• Since refractive surgery is an elective
  procedure, you have the opportunity and
  responsibility to become fully informed about its
  risks and benefits.
• Your ophthalmologist will explain the specific
  technique, its benefits, as well as possible
  risks and side effects associated with your case.

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Discuss options and questions with your
ophthalmologist

• With the help of your ophthalmologist, its
  ultimately your responsibility to weigh the risks
  and side effects of a procedure with the benefits
  it has to offer.
• If you decide refractive surgery is right for
  you, you may join millions of people who have
  reduced their dependence on glasses or contacts.