Monovision in LASIK

Purpose: To evaluate the preoperative characteristics and postoperative outcomes of presbyopic and prepresbyopic patients selecting monovision correction by LASK Design: Retrospective observational case series. Participants: One hundred seventy-two sequentially treated myopic and hyperopic patients, 45 years or older, who sought LASIK vision correction with the goal of monovision. Methods: Patients treated with monovision correction by LASIK were measured and categorized. All treatments were conducted using conventional (nonwavefront) technology. Main Outcome Measures: Acuity, refractive and functional success of monovision correction based on postoperative manifest refraction relative to target correction, and patient enhancement rate. Results: Of 284 consecutively treated LASIK patients 45 years or older, 188 (67%) chose to be corrected for monovision and 96 (34%) chose bilateral distance correction. Of the patients seeking laser vision correction, women (60%) outnumbered men (40%), and women selected monovision slightly more often than men (66.9% vs. 60.5%, P = 0.14). A majority of patients (85%) chose their dominant eye to be corrected for distance. Patients who selected their dominant eye for near vision correction had similar acceptance and refractive success rates. Hyperopic patients achieved results comparable to those of myopic patients. Of the 172 patients treated with monovision correction, only 7% chose to forego monovision and subsequently enhance the near eye to distance vision. However, 27.9% of monovision patients underwent subsequent enhancement of their distance vision eye. Conclusions: LASIK monovision correction represents a viable and increasingly popular method of correcting presbyopic and prepresbyopic patients considering refractive surgery. Crossed monovision may be applied successfully to appropriately chosen patients. The distance vision eye in the monovision patient may have a lower tolerance for residual refractive error and require a higher rate of enhancements than a standard laser vision correction patient.