Monovision LASIK

What is Monovision LASIK?

Monovision LASIK, also called "blended vision," corrects presbyopia, which is when someone cannot see up close. This laser vision correction surgery corrects one eye to see distance and the other eye to see near. Monovision LASIK is different from standard LASIK, which corrects both eyes to see far. 

What is Presbyopia? 

The natural lens inside your eye focuses your vision to see up close. There are muscles attached which flex or relax the lens, depending on if you are viewing near or far.

Presbyopic patients usually wear bifocal or multifocal lenses to focus close-up and read. Many people with presbyopia are good candidates for monovision LASIK, which corrects this vision problem.

Over the age of 40, our lenses start to stiffen. As this occurs, the muscles are unable to flex the lenses easily. This process impairs your ability to see up close and is what we call presbyopia. Once presbyopia begins, you either need to wear reading glasses, use contacts, or undergo eye surgery to improve your vision.

Presbyopia typically occurs between the ages of 40 and 65.

Other Vision Considerations

To help decide if monovision LASIK is suitable for you, consider your type of vision:

  • Farsightedness (hyperopic) patients have more trouble seeing up close with age. They can also elect monovision LASIK. They cannot correct both eyes to see up close. Otherwise, their distance vision will be blurry.
  • Nearsightedness (myopic) patients have difficulty seeing far but see well up close without glasses. Myopic patients should know that a standard LASIK procedure will correct their distance vision in both eyes, but takes away the ability to see up close. You can have a standard LASIK procedure and need reading glasses afterward, or have monovision LASIK.
  • Emmetropic patients are neither hyperopic nor myopic. They only need reading glasses with age. These patients only require surgery in one eye to correct their near vision.
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Since monovision requires your brain to use one eye for distance and the other for near, there is an adjustment period. If you are considering monovision LASIK, ask your eye doctor if you can try monovision contact lenses first. It is important to see if you can adapt to monovision before committing to the surgery.

How Monovision LASIK Works

Your eye doctor will check your prescription and determine which eye is dominant:

  • The dominant eye is usually the distance eye
  • The non-dominant eye is the near eye
  • A small percentage of people do not have a dominant eye. In this case, you can try monovision contacts with the right eye as the dominant eye. Then, you can try contacts with the left eye as the dominant eye to see which way feels more comfortable.

About two-thirds of the population are right eye dominant.

Your doctor can then prescribe contact lenses with monovision correction. After trying the contacts for a few weeks, you will know whether or not monovision is right for you. If you struggle to adapt to monovision contact lenses, monovision LASIK may not be the best option. Although, if you are happy with monovision contact lenses, you can move forward with the surgery. 

The actual procedure and recovery are the same as a standard LASIK surgery. Monovision LASIK cost is also similar to a standard LASIK procedure. 

With monovision LASIK, the main difference is the adaptation time after surgery. Not only will your eyes need to heal, but your brain will have to adjust to monovision. Adaptation can take a few weeks or even up to a few months.

If you have reduced vision in one eye (such as from trauma, disease, or amblyopia), monovision LASIK may not be the best option for you. Consult your surgeon to see if you are a candidate.

Monovision LASIK Pros and Cons

Compare the advantages and disadvantages of monovision LASIK below:

Pros of Monovision LASIK

  • Reduce dependence on glasses or contacts. Many patients seek monovision LASIK so they can be free of any corrective lenses post-surgically. 
  • Future touch-ups are possible. Since your vision may change after monovision LASIK, there is a possibility you can have a second LASIK procedure in the future.
  • The near vision is customizable. If you find monovision contacts challenging to adapt to, you can consider mini-monovision. Your surgeon will reduce the near vision correction, which will improve your distance vision. Mini-monovision is also easier to get used to than standard monovision. While your near vision may not be as clear as possible, mini-monovision still gives you some ability to read. This is an excellent option if you drive a lot but don’t spend too much time reading.

Cons of Monovision LASIK

  • Vision imbalance. If your brain has difficulty adapting to monovision, your vision may feel imbalanced or dizzy. You can experience discomfort or temporary double vision. This sensation usually improves over time.
  • Blur at a distance or near. Your distance or near vision will generally be slightly less clear than with both eyes viewing at the same time.
  • Reduced depth perception. Monovision can affect activities that require depth perception, such as driving or sports. If you perform many of these activities, consider monovision carefully.
  • Vision changes. With age, your near vision may continue to worsen, even after receiving monovision LASIK. Patients that experience these changes need to have a touch-up LASIK procedure or go back to wearing glasses and contacts.

How much does monovision LASIK cost?

Monovision LASIK typically costs $4,000 or more ($2,000 per eye). Since LASIK is an elective procedure, it is not covered by insurance.

How long does it take to adjust to monovision LASIK?

Most patients adapt to blended vision surgery after 6 to 8 weeks. This is because the brain has to get used to your new vision, which can take a few weeks or months. Patients who wore monovision contact lenses before getting monovision LASIK may adapt to the surgery quicker than others.

Why do I have blurry vision after monovision LASIK?

Blurry vision can occur after monovision LASIK surgery. It may cause minor irritation, but will resolve after about two days. Blurry vision after LASIK is usually harmless and normal.

Can monovision LASIK be reversed?

Yes, monovision LASIK can be reversed. If you are unable to adapt to the treatment, your optometrist may recommend an enhancement procedure in the near eye. After the reversal, reading glasses will be necessary to complete near tasks.

Author: Melody Huang, O.D. | UPDATED April 21, 2020

Resources

Lanchares, Elena, et al. “Hyperelastic Modelling of the Crystalline Lens: Accommodation and Presbyopia.” Journal of Optometry, vol. 5, no. 3, 11 June 2012, pp. 110–120., doi:10.1016/j.optom.2012.05.006.

Pieramici, Sean, and Brad H Feldman. “Monovision LASIK.” American Academy of Ophthalmology, 22 Oct. 2019, www.eyewiki.aao.org/Monovision_LASIK

Vastardis, Iraklis, et al. “Femtosecond Laser-Assisted in Situ Keratomileusis Multifocal Ablation Profile Using a Mini-Monovision Approach for Presbyopic Patients with Hyperopia.” Clinical Ophthalmology, 14 July 2016, pp. 1245–1256., doi:10.2147/opth.s102008.

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