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Near Vision Correction (Monovision)
As we age, our eyes lose the ability to change focus from distance images to near images. We continually move an image, such as a book or newspaper, farther and farther from our eyes in order to bring it into focus. This condition is called presbyopia. When presbyopia progresses to the point where our arms are not long enough, we need reading glasses or bifocals. Everyone will experience presbyopia, whether they started with corrective lenses or not. Presbyopia is simply an aging process of the internal lens of the eyes and typically begins around age 40 to 45.
However, people with moderate nearsightedness or myopia may not need reading glasses as their refractive error allows for near vision. If corrected for distance vision, you take away the moderate nearsightedness, therefore the patient may now notice problems with near vision.
If you are presbyopic, NEAR VISION CORRECTION (monovision) is an option to help correct both your distance and near vision. The monovision procedure corrects the focus of one eye for distance vision and the other eye for near vision. One eye will see things close up, the other eye will see things farther away, and the brain will integrate the visual information from both eyes and filter out any blur. You will not need to consciously make any adjustments and the brain will usually adjust within 6-8 weeks to each eye focusing at a different distance. Monovision has been used successfully with contact lens and refractive surgery patients for over 20 years.
The decision to have near vision refractive surgery is dependent on your age, profession, hobbies and desires. We do not recommend it for people under 38 because you will not experience its full benefit for several years, and it is possible that surgeries that directly cure presbyopia will become available in the future. People who need to see better than the average person, (e.g., pilots, racecar drivers, or nighttime truck drivers) are also advised against monovision.
It is a good idea to simulate monovision on a trial basis by using contact lenses. This can be adjusted to reflect the different possible corrections and give you a good idea of whether you would like monovision. You can see how well you adjust to having your eyes focus differently, determine what visual range can be accommodated, and experience the quality of your vision while driving at night.
Near Vision refractive surgery is not a cure for presbyopia. It simply "resets the clock" for near vision, giving you an additional 5 to 10 years without reading glasses for most tasks. Until there is a specific cure, all refractive corrections will involve some compromise for people 40 and over. You might decide to have both eyes corrected for distance vision and use reading glasses for all near tasks. Or, you might try monovision and delay the use of reading glasses for several years. Even with monovision, however, there may be some situations when the very best vision might require "special needs" glasses, such as night driving in unfamiliar areas.
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