My brother had monovision surgery a year ago and swore by it. Based on his advice I looked into it with his surgeon.

I am 44 years old, and have started having problems reading close up. Sometime s I need to remove my glasses to see thiings. I wear glasses to see my computer at work and contacts all other times. I currently wear contacts now witha correction of -5.0 in my right eye and -4.0 in my left.

My doctor suggested we go forward with Lasik monovision with a correction of -5.0 in my right and -3.0 in my left. I inquired about testing this out with contacts, and while he said this is not a perfect representation of the actual surgery, he agreed and provided me with the neccessary lenses.

I could not get used to the -3.0 undercorrection at all. I felt disoriented, dizzy and sick to my stomach. The doctor suggested that I try "stepping" into the -3.0 by first tring -3.50, then -3.25, then -3.0. I was able to get to the -3.25 without making myself dizzy, but could not read my computer without my right eye being completley out of focus. I bought a pair of +1.0 reading glasses that helped.

I went back to the surgeon who said "ok" we should do -3.25, and that I will still need reading glasses. I questioned the point of monovision at this point and he said it would be good because now I could at least see my watch and things of that nature without reading glasses.

I guess I don't see the point in monvision at this point. If it decreases my ability to see distance, yet I will still need reading glasses, why bother?

I don't like the fact that had I not "pushed" for the contact trial, I would have had Lasik at -3.0 in my left eye currently and been dizzy...

My doctor's theory in why I can see my computer with my glasses verus contacts f the same Rx is because the glasses do not correct as much as the contacts. If that is th case, why can't I have Lasikl which under corrrects just a little in both eyes, to mimic the feel I get from my glasses.

Sorry I am rambling....I am so confused abiut this and need to make a decision as I have put away $3,000 in my flexible spending to cover the cost and have to use it by the end of the year.....

Thanks!!!!!

If your wearing -5 glasses and -5 contacts then your glasses would be undercorrecting you around 1.25 diopters. This could be why your seeing the computer clearly with glasses and not contacts. -5 contacts are equivalent to -6.25 glasses and -4 contacts are equal to -5 glasses. The exact 1.25 ratio may be a bit different for you but it applies for me. my -4 contacts correct me as well as my -5 glasses.

If you dont like monovision by the sound of it, you have two choices. Correct both eyes to plano and use reading glasses for all near and intermediate work. Hope you dont get overcorrected at all or youll need bifocals
Your other choice and a safer one at that is undercorrect both eyes. This will reduce or eliminate your need for reading glasses and youd only need distance glasses for driving and maybe movies. If you sit 2/3 of a meter from the computer, youll want to be undercorrected by 1.5 diopters.

Hope this helps, feel free to reply.
one more thing, may I ask why you want lasik? Are your contact lenses irritating to your eyes?

Your next step should be to see a specialist for monovision contact lenses. In otherwords - you should see an optomestrist ASAP who is an expert at maximizing your vision. Once you figure out the optimal way to set up your vision, then you can consider proceeding with laser vision correction.
I hope this helps

Bill Trattler, MD
Miami, FL

That makes sense. I get the feeling my doctor (who is suppose to be one of the best in the state)only considers moovision or no monovision. He is pushing the monovision a lot, saying long term (5 - 10 years down the road) I will be happy I did it.

Thanks for the response. The reason I am considering Lasik is that I would like to reduce my dependence on glasses, and I also thought that if my Presbyopia continues to get worse then I would noty have to go the biofocal route.

Still not sure....

Hi,
I opted for monovision after it becan apparent that i would need an enhancement after my first Lasik procedure. I did not a contact trial and knew within a day or so that I could only tolerate a slight difference between my reading and distance eyes. After enhancement of my dominant eye only, my reading eye is about -1 diopter or about 20/40. My distance is good enough (about 20/30 or 20/25) and I am comfortable driving, even at night in the rain (wasn't at all before enhancement when both eyes were about 20/40). I do wear light reading glasses (+1) when sitting down to read a lot.

I think the monovision is worth it however because I can read my watch, prices on labels in stores, and the print on pill bottles etc without reaching for reading glasses. I have a friend that is about my age (mid-late 40s) who had both eyes corrected with Lasik to 20/20. She loves having the great distance vision, but she finds that she MUST have her reading glasses around her neck most of the time in order to do the small tasks I describe above. If you can tolerate it I think even slight monoision is the way to go even if you need a couple of cheap reading glasses for computer or just reading.

I also disagree with ACE that most people are happy with both eyes undercorrected. I was NOT. It is much better to need a cheap pair of reading glasses than need prescription glasses (an possibly perscription sunglasses) for driving, finding people in crowds, watching TV or movies etc. I am very happy with my results....

Meant to say that I DID do a trial with contacts ;)

Also Joe, the push that got me to finally go with the LAsik (after thinking about it for several years) was the fact that I was heading toward biocals. I was very myopic (-6 and -7 diopters), and was starting to loose my close up vision. I was too myopic to just take of my glasees to read, and contacts (and using reading glases over them) didn't work for me.

Just hated the thought of bifocals!!!!

Im in agreement with SU

"I opted for monovision after it becan apparent that i would need an enhancement after my first Lasik procedure."

That was a wise thing to do. Many people enhance both eyes or get both eyes fully corrected and end up carrying reading glasses with them at all times, sometimes like a necklace!

"enhancement of my dominant eye only, my reading eye is about -1 diopter or about 20/40. My distance is good enough (about 20/30 or 20/25)"

Then I guess your -.5 in the distance eye which isnt bad at all and too close to plano to enhance further or risk overcorrecting.

"but she finds that she MUST have her reading glasses around her neck most of the time in order to do the small tasks I describe above."

Id much rather be undercorrected than carry reading glasses at all times. Ill only need distance glasses occasionally. This is much preferred to needing reading glasses at all times. Plus I spend many hours at the computer so I want to see clearly with BOTH eyes, not with only ONE eye!

"I also disagree with ACE that most people are happy with both eyes undercorrected. I was NOT."

I can not speak for everyone but I love being undercorrected! Around the house and for the computer I undercorrect myself to -1.5 diopters which gives me 20/80 vision. I can see clearly at arms length which is perfect for the computer and around the house.

I undercorrect myself by only -.5 diopters when I go out. This helps alot with my intermediate vision and prevents me from getting headaches. It also should help resolve some of my pseudomyopia(I am going to the optometrist for a cycoplegic refraction soon)

"It is much better to need a cheap pair of reading glasses than need prescription glasses (an possibly perscription sunglasses) for driving, finding people in crowds, watching TV or movies etc."

Depends on the person. If I fully correct myself, ill be MORE dependant on glasses than if I undercorrect both eyes. I do alot more near seeing than distance seeing. This includes hours a day on the computer. I would rather need distance glasses 10% of the time than reading glasses 90% of the time! My BCVA is only 20/30 with glasses so undercorrecting myself to 20/40 isnt enough to make things from near clear, just intermediate. If I undercorrected myself to where you are, id be seeing like 20/60 in the distance.
20/40 vision for me is very good and almost the best possible vision I can be corrected to but its not enough to provide clear near vision. Im thinking of getting bifocals or even progressives when I get out of the house and sticking with my computer glasses at home. Kinda sucks having to do all that when im only 23! If I were to get lasik I would still need glasses anyway.

How do you correct yourself???????

I am loosing sleep over this decsison!

I just don't know if it is worth giving up my distance sight (I wear contacts) and then have to wear glasses to see up close....but I do see your point....My doctor explained that it would be helpful so that I would not have to use reading glasses for "every picky thing" such as looking at my watch, etc.

I tried reading glasses with my contacts, and was not thrilled with that either.

I hear tey have bifocal contacts. If that works, it would be the best of both worlds...When your vision gets worse, you just chnage prescriptions.

I am not sure about the bifocal contacts. I wore soft contacts occasionally before my surgery, mostly for sports, but due to my astigmatism they did not correct me very well (toric) and were not comfortable. I guess you could try them out. I almot went with jut the one contact instead of getting the enhancement because it was so light and comfortable compared to my old toric ones. But then I thought about still needing to carry around solutions and deal with it sos I went for the surgical correction.

I do agree with ACE in that it is a personal decision and you probably will need some type of glasses one way or another. For me I want my distance vision to be as close to 20/20 as possible because that is what my old coke bottle glasses corrected me to. I can deal with having reading glasses by bed, downstairs, and at work. I guess I figure that's just part of getting older aong with other things)!

Joe you say you want to reduce your dependency on glasses, and that is they key to any laser eye surgery. Before my Lasik, I could not find my glasses if I put them down in an unusual place. It would have been bad to lose them in an emergency or disaster. Even before my enhancement, I could function OK at 20/40 (except for driving).

I am not tyring to convince you to get the surgery, only you can decide. Believe me I took 3 years to decide. An all in all I am happy with it. There are still goo days and bad days though (mostly due to dry eyes in the winter) and as I age things will probably change. But after wearing glases for 35+ years, it is nice to see the clock across the room at night and be able to find my kids in the pool. The MOST important thing is to find a DR. that you trust and that explains everythin and that doesn't try to decide for you or rush you into it.

Good Luck and let us know what you ecide.

My DR told me that the monovision would only work for a while (few years?) because eventually the undercorrection would not be sufficient enough to offset the presbyopia. At that point in time, I could go in and have the undercorrected eye brought up to 20/20. I may or may not do that depending on my vision at the time.
Sue

"How do you correct yourself???????"

With glasses and occasionally contacts. When I got contacts for the first time, I could not believe how blurry my near vision was(sad when your only 23) and those contacts were only -3.5 too!(comparable to -4.25 to -4.5 glasses) so I was still a bit undercorrected at 20/40 instead of my 20/30 BCVA I had taken my near vision for granted and always read without glasses, granted I had to bring material less than a foot away.
Ive been told im too young to have presbyopia but my symptoms reflect presbyopia anyway.

"I just don't know if it is worth giving up my distance sight (I wear contacts) and then have to wear glasses to see up close"

If you wear contacts that fully correct both eyes, you STILL need reading glasses. I see your trying monovision. ive tried that, dont like it plus contacts arent comfortable so im sticking with glasses. I just take em off or peek under them for close up.

"My doctor explained that it would be helpful so that I would not have to use reading glasses for "every picky thing" such as looking at my watch, etc."

so why not get what SU did? Get one eye to plano or close to plano and the other eye a little undercorrected like the 20/40 shes at? You will still need reading glasses but only for stuff like fine print or reading for hours on end.

"I tried reading glasses with my contacts, and was not thrilled with that either."

Neither was I! It defeats the purpose of contact lenses! Not that I find them comfortable either to begin with!

"I hear tey have bifocal contacts. If that works, it would be the best of both worlds...When your vision gets worse, you just chnage prescriptions."

Give those a try. me and mom did and didnt like em. Vision isnt as clear with those.

If contacts are comfortable to wear, why get lasik in the first place? Those who do didnt find contacts comfortable

"but due to my astigmatism they did not correct me very well (toric) and were not comfortable."

How true. I hear people complain all the time with torics with them irritating their eyes and rotating and thus disorting vision. I know a lady whos looking into wavefront lasik because of this. She also doesnt like glasses and has been spoiled with near full time contact wear so shes just not used to glasses.

"I do agree with ACE in that it is a personal decision and you probably will need some type of glasses one way or another."

This is what has discouraged lasik for me. I know ill still need glasses anyway. There is NOTHING that can be done to eliminate my dependancy on glasses, period. I can get closer to plano than my -5 pescription, thats all. Actually, lasik is advertized to reduce dependancy on glasses. Key word: reduce!

"For me I want my distance vision to be as close to 20/20 as possible because that is what my old coke bottle glasses corrected me to."

which do you use your eyes more for, seeing in the distance or up close?

"I am not tyring to convince you to get the surgery, only you can decide. Believe me I took 3 years to decide."

Yea, its not something one should rush into. For me, lasik is gonna be a tradeoff plus ill lose some ability to see at night, have more dry eyes, need reading glasses or even bifocals and ill be taking the risk and expense of surgury. Ill probably end up 20/50 to 20/100 after lasik, correctable to 20/30 to 20/50 depending how well it goes. Lasik isnt for me, but it may be a possibility for some. Think carefully before dedicing

"But after wearing glases for 35+ years, it is nice to see the clock across the room at night and be able to find my kids in the pool"

yea! Everyone comments how nice its to see their clock when they wake(unless they are low myopes to begin with) I can see the clock which is 5 feet from me without correction but its blurry.

"My DR told me that the monovision would only work for a while (few years?) because eventually the undercorrection would not be sufficient enough to offset the presbyopia."

only for near. Your -1 undercorrection will countinue to work forever for intermediate at around 1 meter. This means no reading glasses for the computer or anything arm length away from you.

"At that point in time, I could go in and have the undercorrected eye brought up to 20/20."

Theres no guarantee. Will you be happy if it falls short at 20/25? What if you end up a little overcorrected or some induced astigmastim? Then itll be blurry at all distances! Plus if you give up your -1 monovision youll have to carry reading glasses at all times and need them even for using the computer if you want it to be really clear. I think you have it the BEST now. Nothing can be done to reduce your glasses dependancy anymore than where its at now.

My point of view is that even if you were to go for 20/20 in both eyes there's no guarantee you'll reach this goal so you might end up being off in one or both eyes anyway. After healing all you have to do is insert a + whatever contact lens and you have instant monovision. Also near vision changes frequently but far does not nearly as often. I'm having lasik next week, I'm 40 and they asked me if I want mini or regular monovision and I'd rather just place either a bi-focal (part near vision and part uncorrected vision) or a near vision contact lens in for work. Just another point of view. To me it makes more sense to control with a contact lens what changes the most frequently (near vision) than to permanantly control what changes often (near vision with lasik rather than with a contact lens) hope I've provided you with another point of view that might help.
Daniel