EyeWorld Asia-Pacific September 2013 Issue

43 EWAP CATARACT/IOL September 2013 different ways on a couple of different visits to confirm, especially for these patients who can switch dominance, if possible,” he said. Dr. Hovanesian said in his practice, he uses a disposable film camera to determine dominance. Patients are asked to hold up the camera to simulate taking a photo of themselves in a mirror, which allows them to show which eye is dominant without thought, he said. “It’s simple and it’s quick, and patients don’t think twice about it. Patients almost always show you their dominant eye that way. But if we choose their dominant eye to do certain tasks, we basically force them to pick an eye,” he said. Pearls Dr. Hovanesian said that in monovision, measurements for refractive accuracy are important, especially in the dominant or distance eye because of the importance of uncorrected distance vision. “One of the pearls we learned from any type of refractive/ cataract surgery is that without good, clear uncorrected distance vision, patients are generally not happy,” he said. “No matter what you give them as near, you’ve got to give them distance.” He recommended that when performing monovision, the near eye could be a quarter to half a diopter off, as slight error can be tolerated in the near eye. But the distance eye must be as perfect a possible. “In the distance eye, you’ve got to hit emmetropia, you’ve got to correct the astigmatism, because that’s the only eye they’re depending on to see the television clearly, to see road signs clearly,” he said. He said that when the target is not in monovision, physicians should be aware that an enhancement will most likely be necessary. “If they say, ‘I can’t see road signs. I had this surgery so I could see far, and I could see near,’ they are going to be unhappy,” he said. Dr. Chu said establishing patients’ needs with a preoperative discussion about lifestyle is critical. He said patients need a great deal of education on monovision’s strengths and weakness. One potential strength of monovision is improved near vision, while two weaknesses are a slight loss in depth perception and an intermediate blur zone, he said. Dr. Thompson said bothersome blur at a distance from the near eye that may require distance lenses is not the only problem patients might face with monovision—the distance eye might also create near blur for some patients. If they can’t ignore this near blur they may need reading glasses for longer, more intense reading times. “That is why I tell monovision patients that the goal is to minimize dependency on glasses, but when they need both eyes at a distance or both eyes up close, having their bifocals to help when necessary is very acceptable. If they can accept this fact, they are more likely to be good candidates to start the monovision journey,” he said. “This is all about setting up pre-experience expectations and then being willing to repeat postop what you said preop [because] they often do not remember everything you said,” he continued. “Being patient and a quality educator sets you up for great success in monovision care.” EWAP Editors’ note: Drs. Chu, Hovanesian, and Thompson have no financial interests related to this article. Contact information Chu: 952-835-0965, yrchu@chuvision.com Hovanesian: 949-951-2020, drhovanesian@harvardeye.com Thompson: 605-361-3937, vance.thompson@vancethompsonvision. com I am quality I am durable I am reusable I am innovative I am effective I am unique I am cost-efficient I am modern I am steel & composite made I am made by Moria I am... by Moria is pleased to introduce coMposites! Composites by Moria is an innovative range of reusable instruments set to push the boundaries of ophthalmic instrumentation. This new generation of instruments offers the quality and precision you would expect from Moria, at a competitive price that will surprise the market. www.moria-surgical.com