Contact Lens Practice Pearls

Thoughts on Monovision From a New Presbyope: Me

BY JOHN MARK JACKSON, OD, MS, FAAO

This year I reached a personal milestone: presbyopia (Figure 1) has finally caught up with me. The condition has been gaining on me for quite a while, but I have been able to outpace it pretty well…until this summer.

Figure 1. Welcome to Presbyopia, population: Me!

Summer is when I usually start wearing my orthokeratology lenses. Who doesn’t want to be able to go correction-free at the beach and wear sunglasses for driving? I started wearing my lenses a few weeks ago and immediately noticed the problem. With my distance vision fully corrected, I could no longer read the smaller print on my iPhone. My daughter would show me her latest artwork, and I had to hold it out at arm’s length to see it.

Oh, the humanity!

Seeking a Correction

So now that I could no longer get by without correcting my presbyopia, I needed to find a correction that worked for me.

At first I tried reading glasses, but that was no fun at all. Over-the-counter readers were hard to find in a style that I liked, and I hated putting them on and taking them off all the time. They kept falling out of my shirt pocket, too.

With my ortho-k lenses, my best option was monovision. I have always advocated multifocal contact lenses over monovision, but I had to give it a try. After all, I have been setting patients up with this correction for years, right? In my nondominant eye, I adjusted my correction to leave me at –1.00D of myopia, giving me a +1.00D add.

I am pleased to say that it worked pretty well. I can, however, better relate to what my patients have always said about monovision but that perhaps I haven’t taken to heart until now.

My Monovision Experiences

So here are some of my own personal clinical pearls about monovision. I bet you have heard some of these before! Others were somewhat of a surprise to me:

1. Driving has been pretty easy overall. Granted, I have a low add power so I’m only at 20/30 in my nondominant eye, but I still expected this to be harder than it is.

2. The hardest part of adaptation has been intermediate vision. My brain is having a hard time deciding which eye to “use” for my computer and a little beyond. This gives me a bit of a headache, but I’m dealing with it.

3. All distances have a slight “fog” to them. Patients have told me this, but it is hard to describe. I anticipated selective suppression to be, well, more selective than this, but the fog tells me that I’m paying more attention to the opposite eye than I thought I would.

4. Why did they start making print so darn small? Reading glasses make things look bigger because of the spectacle magnification effect, while contact lenses don’t. I just didn’t expect the difference to be so noticeable, especially at my low add. I still need the reading glasses when the lighting is poor or the print is really tiny.

Final Thoughts

Although I prefer to start patients in multifocal contact lenses when I can, sometimes monovision is the best option. For any younger clinicians reading this, I hope that my experiences with this correction can help you better relate to your monovision patients. CLS

Dr. Jackson is an associate professor at Southern College of Optometry where he works in the Advanced Contact Lens Service, teaches courses in contact lenses, and performs clinical research. You can reach him at jjackson@sco.edu.