5 EyeWorld Asia Pacific | June 2024 EDITORIAL BOARD Chief Medical Editor Graham Barrett, MD INDIAN EDITION Regional Managing Editor Abhay Vasavada, MD Deputy Regional Editor S. Natarajan, MD KOREAN EDITION Regional Managing Editor Hungwon Tchah, MD Deputy Regional Editor Chul Young Choi, MD APACRS Publisher: EyeWorld Asia-Pacific Edition (ISSN 1793-1835) is published quarterly by the Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS), c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. Printed in Singapore. Editorial Offices: EyeWorld Asia-Pacific Edition: Asia-Pacific Association of Cataract & Refractive Surgeons (APACRS), c/o Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751, telephone (65) 6322-7469, fax (65) 6327-8630, email ewap@apacrs.org. 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KDN number: PPS1766/07/2013(022955) MCI (P) 038/02/2024 CHINESE EDITION Regional Managing Editor Yao Ke, MD Deputy Regional Editor He Shouzhi, MD Zhao Jialiang, MD Assistant Editors Zhouqi, MD Shentu Xingchao, MD EDITORIAL MEMBERS Chan Wing Kwong, MD Singapore Ronald Yeoh, MD Singapore John Chang, MD Hong Kong SAR Pannet Pangputhipong, MD Thailand YC Lee, MD Malaysia Hiroko Bissen-Miyajima, MD Japan Kimiya Shimizu, MD Japan Sri Ganesh, MD India Chee Soon Phaik, MD Singapore Johan Hutauruk, MD Indonesia PUBLISHING TEAM Chief Publisher Ronald Yeoh, MD Executive Director Kathy Chen kathy.chen@apacrs.org Publishing Consultant Donald R Long don@apacrs.org Production Team Gretel Tan Aileen Bian ewap@apacrs.org monovision. Patients should always be able to comprehend the discussion and reason for selecting this modality. Occasionally, one can deviate from these guidelines. A patient who has always been significantly more myopic in one eye is likely to be more satisfied if the relationship between the two eyes is maintained. If the more myopic eye has a more dense cataract, I would still prefer to do this eye first but rather target this for near distance, unlike my usual routine. Similarly in patients with pre-existing high myopia, a target of -1.50 diopters instead of -1.25 diopters is recommended as these patients expect better unaided reading vision. Using these guidelines, the strategy of modest monovision has proved to be remarkably successful in providing a presbyopic solution to patients with a high level of satisfaction. Although modest monovision as this can be reversed using laser correction, this is exceptionally rare using these guidelines. When one targets a modest level of myopia, not all formulae will maintain accuracy. We have published a paper previously showing that the prediction accuracy for the Universal II formula is not impacted significantly by targeting a myopic outcome rather than emmetropia. Depending on the optical principle of a particular lens model, using extended depth of focus IOLs are well suited to being used in combination with modest monovision. An appropriate Extended Focus or Monofocal+ IOL provides better reading for a low level of myopia and the impact on stereo acuity is minimized due to the overlap of the defocus curve for the distance and near eyes. Similarly, the impact on distance acuity is less in the presence of residual myopia. Advanced methods of testing dominance are certainly worth evaluating, but using modest monovision within my clinical practice over many years have shown the practical effectiveness and reliability of these guidelines. these practical guidelines have proved to be extremely effective in using modest monovision in my clinical practice over many years. I hope this discussion provides you with “something to think about”, as you consider the different ideas curated within this issue of EyeWorld Asia-Pacific. Warmest regards Graham Barrett
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