Presbyopes in Your Practice
Myth #3 "Patients Adapt to Monovision More Easily than to Multi-Focal"
Multifocal vs. Monovision
- Myth #1 - Monovision is the best place to start
- Myth #2 - Fitting monovision takes less chair time
- Myth #3 - Patients adapt to monovision more easily
- Myth #4 - Multifocal lenses compromise visual quality
- Myth #5 - Patients won't pay more for multifocal contact lenses
- Fitting Multifocals on a Monovision Patient
- Clinical Outcomes
- Assessing the Design of PureVision ® Multi-Focal vs. Monovision
There is little evidence to support the misperception that monovision is easier to adapt to than multifocals. In fact, the true measure of the ability to adapt is long-term patient satisfaction. In a recent crossover study of presbyopic patients wearing monovision and multifocal lenses, three out of four patients preferred the Bausch & Lomb Multi-Focal design over monovision. As shown in the chart below, almost three times more multifocal patients than monovision patients were still wearing their lenses at least three days a week, 6-12 months after completing the study.1
Even those patients who managed to adapt to monovision found multifocals to be a better match. These patients preferred the Bausch & Lomb Multi-Focal design over their current monovision lenses by a 3:1 ratio.1
Certainly, there is some level of adaptation necessary for any presbyopic correction and monovision is no exception. With a monovision correction, there are several areas of concern. First, because of the loss of stereopsis, people with significant distance acuity tasks will often have difficulties. Secondly, those who spend a lot of time working on computers may struggle, since there may also be compromised acuity in the intermediate ranges. Moreover, there is a necessary level of alternating ocular suppression, causing the brain to "learn" to see with the eye best suited for a particular task. This is why we find some monovision patients reverting back to their spectacles to achieve the desired level of vision to perform mid-range tasks. Many patients are not able to adapt to a monovision correction because of these challenges.
With multifocal lenses, the correction provides "simultaneous" vision, and the brain selects the clearest image at any particular distance. While this is a natural process, it still requires a short period of adaptation. However, for many patients, this brief adaptation period is worthwhile when they discover that a lens design like the Bausch & Lomb PureVision® Multi-Focal contact lens will provide them with a closer match to the natural vision they want, which is both eyes doing the same thing at the same time - true binocularity. PureVision® Multi-focal lenses use a center-near aspheric design and a wide-intermediate power profile to tackle the aforementioned limitations of monovision, providing visual function closer to the natural accommodative process. With this in mind, it would be advantageous to use multifocal lens correction as your first choice.
1. Subjective and Objective Performance of the Bausch & Lomb SofLens Mutlifocal and Monovision. Richdale, Kathryn, OD,MS. Ohio State University College of Optometry. Randomized two-month crossover study of 38 presbyopic patients. 2005