IOL Monovision For Cataract Surgery

IOL monovision corrects your vision by implanting lenses with different focusing distances.

If you are undergoing cataract surgery, your clouded, natural lenses will be replaced with intraocular lenses (IOLs). You have several choices during this surgery, including:

• Type of lens: Traditional monofocal lenses (set to one distance only) or multifocal or accommodative lenses (allowing you to seeing clearly at more than one distance, similar to bifocal glasses)
• Type of surgery: traditional cataract surgery or laser cataract surgery
• Type of implant technique: The way the replacement lenses are used together to correct vision

What is IOL monovision?

One implant technique, known as IOL monovision (or pseudophakic monovision), may help reduce your dependence on glasses following cataract surgery. Monovision corrects your vision by using a different monofocal replacement lens – i.e., each lens is set to a different distance – in each eye.

How does monovision work?

Typically, a lens set to far distances is implanted in your dominant eye, while a lens set to near distances is implanted in your non-dominant eye. While it may sound strange to deliberately make the two eyes have different focusing powers, the two eyes actually can work together well to provide clear, blended vision at all distances.

Monovision works because your brain automatically adjusts your visual system to achieve clear vision when you are focusing on near and distant objects.

When you focus with your “near eye” on near objects:

• Your brain partially suppresses vision in the distance eye
• This suppression helps the near eye take in the full stereo picture

When you focus with your “distance eye” on distant objects:

• Your brain partially suppresses vision in the near eye
• This suppression helps the distance eye take in the full stereo picture

Am I a good candidate for IOL monovision?

You may be a good candidate for IOL monovision if you:

• Desire high-quality vision at all ranges (near, distance and intermediate) without glasses or contact lenses
• Cannot wear or don’t like bifocals
• Cannot wear or don’t like contact lenses
• Love outdoor activities and sports for which wearing glasses is inconvenient

You are not a good candidate for IOL monovision if you:

• Have a history of eye muscle surgery, double vision or prism in your glasses
• Need perfect, fine stereovision for your job, such as flying an aircraft
• Cannot pass pre-operative monovision screening tests
• Have significant astigmatism and are not interested in having it corrected (there is an extra out-of-pocket cost that is not covered by insurance)
• Have a history of severe eye problems in the past, one eye or both eyes, such as lazy eye, severe glaucoma with significant loss of peripheral field vision, severe diabetic retinopathy or severe macular degeneration with multiple medication injections into your affected eyeball(s)
• Have a history of stroke with severe side vision loss, history of Parkinson’s disease or history of severe Graves Eye Disease (thyroid-related eye disease)

Before your cataract procedure

Before your cataract procedure, we will conduct a careful preoperative personal consult about your lifestyle, job and hobbies, and perform a series of tests and eye measurements to determine if you are a good candidate for monovision.

If you are a good candidate for IOL monovision:

• We will select appropriate intraocular lenses with different powers to correct one eye for distance and the other eye for near vision.
• If you have significant astigmatism, you will likely need to have your astigmatism corrected during your cataract surgery – otherwise you may still need to wear your glasses for most of your daily activities.
• With laser-assisted cataract surgery, the monovision technique can be expected to be more precise.

After your procedure

• You can be expected to be glasses free for most of your daily activities due to increased focus depth with good vision for far, intermediate and near.
• However, you may still need a pair of glasses for backup, such as for nighttime driving or reading small print for a few hours or more.
• You may experience some mildly compromised fine depth perception in certain specialized tasks, such as threading a needle, which may require reading glasses.
• But you should not expect to have a problem for daily activities that require stereovision, such as navigating curbs, stairs and steps.
• If you decide you no longer want monovision, you can simply reverse the effects by wearing glasses. The need to have implant exchange is extremely rare.

Monovision for presbyopia

Monovision may also be used to correct presbyopia, a natural, age-related condition where the eye’s lens loses its ability to change shape, making it difficult to focus on near objects. Presbyopia treatment focuses on correcting this vision loss. One option is refractive lens exchange, which involves the same steps as cataract surgery – although in this case, the lens being replaced does not have a cataract. Monovision may be included as part of this procedure to correct presbyopia.

Eye surgery experts

Henry Ford is a leader in cataract and refractive surgery. Our expert surgeons will complete a thorough evaluation of your eyes and recommend the procedure we feel is safest and best for your eyes.

At Henry Ford, patients come first.

The Henry Ford Department of Ophthalmology is committed to providing our patients with compassionate, personalized care. We feature the most advanced treatments in eye care and are dedicated to vision research – always staying at the forefront of innovation. A leader in Michigan, as well as one of the largest ophthalmology practices in the United States, we treat more than 55,000 patients per year at 12 locations throughout southeast Michigan. In addition, our team works closely with Henry Ford Medical Group physicians in other departments, providing multidisciplinary, coordinated care for those patients who need it.