What is Monovision?

1:38

Video Transcript

What is monovision?
Hi, I’m Dr Rylan Hayes, specialist cataract, refractive, and pterygium surgeon here on the Sunshine Coast. Monovision is a vision strategy where we intentionally give each eye a different focal point — one eye for distance, one eye for reading — and let your brain combine the two into a full visual experience. It’s used to address presbyopia: the natural loss of close-up focus that happens to most people in their 40s and 50s. Rather than relying on reading glasses or multifocal lenses, monovision uses your two eyes working together to give you a functional range of vision. We can achieve this with laser vision correction — LASIK or PRK — or with lens surgery, depending on your individual suitability. It can take time for the brain to adapt — sometimes several months — and very rarely someone’s brain can’t reconcile the difference. That’s why we always try to perform a contact lens simulation trial before committing to any permanent procedure. If you’re tired of reading glasses and want to explore your options, come and see me.

What is Monovision?

Monovision is a well-established optical strategy for reducing — or in many cases eliminating — the need for reading glasses. It works by intentionally setting each eye to a different focal point, then allowing the brain to integrate both images into a seamless visual experience.

What problem does monovision solve?

The target condition is presbyopia — the progressive loss of near focusing ability that affects almost everyone from their late 30s to early 50s. Presbyopia occurs because the eye’s natural crystalline lens stiffens with age and loses its ability to change shape (accommodate) to focus at different distances. The result is that tasks requiring near vision — reading, screens, menus — gradually require reading glasses or bifocals to manage.

Monovision offers an alternative to optical solutions for presbyopia in appropriate candidates.

How does monovision work?

In a monovision correction:

• One eye is targeted for clear distance vision
• The other eye is intentionally left slightly myopic (short-sighted) to handle near and intermediate focus

The brain learns to use the appropriate eye for the task at hand, seamlessly blending the two inputs. Most people adapt to this without consciously noticing the process — they simply find they can read without glasses and see in the distance without glasses.

Does it matter which eye is dominant?

There is a vast array of evidence that says it does not matter, despite an outdated traditional teaching of the importance of dominance. In fact, a patient who has a strongly dominant eye may not tolerate mono vision very well! This can be established at a free eligibility screening.

How is monovision achieved?

Monovision can be achieved through two main pathways depending on your age, prescription, and eye anatomy:

• Laser vision correction (LASIK or PRK) — more suitable for patients who are very short-sighted
• Lens surgery (refractive lens exchange or cataract surgery with IOL selection) — appropriate for patients with long-sightedness or early cataract where lens-based correction is preferred

What about the adjustment period?

Adaptation to monovision varies between individuals. Many patients adjust within days to weeks. For some, it may take several months for the brain to fully integrate the two focal points. Very rarely — in a small proportion of patients — the visual difference between the two eyes causes discomfort or difficulty, and the arrangement cannot be tolerated.

The contact lens trial

Because of this variability, Dr Hayes always recommends a contact lens monovision trial before committing to any permanent procedure – though it is not always possible. This allows you to experience the monovision effect for days or weeks before any surgical step is taken — ensuring you know how your brain responds before proceeding. We offer free eligibility screening appointments to undertake scans and contact lens trials where appropriate.

Key Takeaways

• Monovision sets one eye for distance and one for near, letting the brain combine them into a functional visual range
• It is used to address presbyopia — the natural loss of near focus from the late 30s onward
• Can be achieved through laser vision correction (LASIK/PRK) or lens surgery depending on suitability
• A contact lens trial is usually performed before any permanent monovision procedure

Interested in reducing your dependence on reading glasses?

Book a consultation with Dr Rylan Hayes at The Vision Surgeon, Maroochydore.

References

• Goldberg DB. Laser in situ keratomileusis monovision. J Cataract Refract Surg. 2001.
• Evans BJW. Monovision: a review. Ophthalmic Physiol Opt. 2007.
• American Academy of Ophthalmology. Refractive Errors & Refractive Surgery — Preferred Practice Pattern. aao.org