EyeWorld Asia-Pacific March 2020 Issue

FEATURE 20 EWAP MARCH 2020 W hen faced with presbyopia correction, there are a variety of options for these patients. Brandon Baartman, MD, Lance Kugler, MD, and Luke Rebenitsch, MD, discussed using monovision, particularly highlighting which patients do best with this option, potential concerns, special testing, and other considerations. What percent of your presbyopic laser vision patients choose monovision? Dr. Kugler said he uses this option in his practice for around 80% of patients over 43 years old. He stressed the importance of referring to it more as “blended vision” rather than “monovision.” Monovision implies that the near eye is seeing closer than blended vision, he said. Blended is less near in the near eye, which allows the brain to blend the vision better together. He said almost all patients can tolerate –1 or –1.25 D in the nondominant eye, and it gives them almost a full range of vision. Dr. Baartman said monovision accounts for less than 10% of the laser vision correction in his practice. “However, those for whom I do perform monovision laser often swear by its results, making it something I’m certain to discuss with all eligible patients,” he said. “It is generally those myopic presbyopes, who have grown tired of bifocal spectacles or looking over or under their single-vision lenses, who opt for this method of presbyopic vision correction in contact lenses and choose to recreate this without the use of contacts.” He added that it’s critical to not only explain what the correction will do to uncorrected near vision but to show patients as well. For the presbyopic age group, Dr. Rebenitsch agrees with Dr. Baartman. “Blended vision is around 10% of my treatments for the presbyopic age group; 20% choose distance only, while 70% choose refractive lens exchange with a multifocal IOL. It does depend on where they are “coming from.” For myopes I am more likely to recommend blended vision. If they do not adjust as hoped, we will do a flap lift enhancement at no cost to bring them to full distance correction in both eyes. For hyperopes we tend to recommend distance only or RLE,” Dr. Rebenitsch said. What are the negatives you cover with them? For monovision/blended vision candidates, who are typically in their 40s and early 50s, Dr. Rebenitsch said it’s important to ensure the lens is clear. “We also simulate blended vision in the clinic,” he said, adding that he can typically tell within a few ‘Blended vision’ for presbyopia patients by Ellen Stodola EyeWorld Editorial Co-Director AT A GLANCE • Experts stressed the importance of referring to it more as “blended vision” rather than “monovision,” as monovision tends to have a negative connotation. • Ideal patient age may be in the 40s to early 50s. • A contact lens trial may be helpful to simulate for patients what their vision will be like after this procedure. This article originally appeared in the December 2019 issue of EyeWorld . It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Baartman: brandon.baartman@ vancethompsonvision.com Kugler: lkugler@kuglervision.com Rebenitsch: Dr.Luke@ClearSight.com Dr. Rebenitsch’s practice simulates monovision by adding plus in the nondominant eye until the patient loses stereopsis. Source: Luke Rebenitsch, MD