EyeWorld India March 2015 Issue

42 EWAP CATARACT/IOL March 2015 of his career. In fact, in a paper conducted by the Moorfields IOL Study Group comparing multifocal lenses to monovision, Dr. Greenbaum was credited with being the first to publish on this technique back in 2002. In the Moorfield’s paper, published in the December 2013 issue of Ophthalmology, investigators found that the rate of spectacle independence with multifocal lenses was 71% in a group of 200 patients, Dr. Greenbaum said. “That included six patients who were brought back to the OR to have one or both of their lenses removed,” he said. Meanwhile in their monovision group, they aimed for –1.25 D in the near eye, resulting in just a 25% elimination of spectacles with this To determine the dominant eye, the patient should make a circle with the pointer nger and thumb and extend the arm. After spotting a distant object through the circle, each eye should be closed one at a time to determine which one the object can still be viewed through. Source: Scott Greenbaum, MD by Maxine Lipner EyeWorld Senior Contributing Writer Making sure monovision gets more than a wink Opening eyes to the procedure A cataract patient comes in asking to be spectacle independent. While many practitioners immediately reach for multifocal lenses, there is another highly effective, much less costly option, according to Scott Greenbaum, MD , Greenbaum Eye Associates, and clinical assistant professor of ophthalmology, New York University Medical Center, New York. The answer is monovision, he is convinced. The full monovision option, in which the dominant eye is completely corrected for distance and the near eye for reading at –2.75 D, is something Dr. Greenbaum has chosen for much combination, Dr. Greenbaum said. However, his own published results from 2002, which were not included in this new paper, showed a 91% rate of spectacle independence with monovision, he said. “That was superior to their results,” he said. While his own results ultimately appeared in a letter to the editor in Ophthalmology in July 2014, their superiority was not acknowledged, Dr. Greenbaum said. “That gave me the idea that what’s called monovision by people who don’t do it is not really monovision,” he said. Instead the comparison is being made to more of a mini-monovision with less disparity between the eyes. Full correction embraced The hesitancy for many to opt for full monovision is the erroneous belief that patients will not tolerate the disparity between –2.75 correction and Plano in the other, he thinks. Dr. Greenbaum’s own experience taught him otherwise. “I was very lucky early in my career when I had a patient referred to me by an administrator at Manhattan Eye and Ear,” he said. The patient was unhappy because his eye remained nearsighted, with a –2.75 D correction. “The patient was ready to sue the surgeon and the hospital, and [he] was sent to me to see what I could do,” Dr. Greenbaum said. Using a simple sighting technique, Dr. Greenbaum proceeded to determine whether it was the dominant or the non- dominant eye in question. He asked the patient to keep both eyes open