Conventional monovision and carried out with Laser Blended Vision (LBV) methods

Surely you have heard that there was a grandfather or grandmother in someone’s family who never, even in old age, needed glasses either for distance or nearsightedness, and their falcon vision accompanied them for the rest of their lives. Is this possible? It is! Choć prezbiopia (starczowzroczność, dalekowzroczność starcza) rozumiana jako spadek akomodacji oka dotyczy każdego z nas, to u niektórych wydaje się nie pojawiać.

This is the case for people with congenital monovision resulting from varus (anisometropia), that is, with one eye being regular or nearly regular (if the eye is regular, the cornea and lens of the eye when looking into the distance collect light rays so that they are focused exactly on the retina – without any optical aids in the form of glasses or contact lenses), and the other with myopia up to approx. -3,00 D.

Someone like this spends a lifetime observing objects that are far away with one eye and those that are close by with the other.

Johann Wolfgang Goethe, for example, had an innate monovision, hence the German phrase Goetheblick – Goethe’s vision/seeing/sight.

For some, varifocality-related monovision accompanies us throughout our lives, while others may need monovision with glasses or contact lenses or through correction with an ophthalmic laser or intraocular lens implants.

When monovision can be carried out

Conventional monovision is one of the methods of vision correction used in offsetting the effects of presbyopia (presbyopia).

Presbyopia cannot be cured, but there are various possibilities to partially – and with the current state of knowledge and technology: almost completely – compensate for the loss of accommodative capacity of the eye.

Conventional monovision involves subjecting each eye to a different correction to prepare one eye for long-distance vision and the other for near-distance vision. The guiding eye is corrected for distance, the latter for nearsightedness.

The differential vision created in this way can be unacceptable to our brain. If the brain is unable to properly combine different information from both eyes, spatial vision is limited. About 70% of patients cope well with the differential vision resulting from monovision in everyday life, 30% have problems with it.

Therefore, before it is created surgically, a series of tests are carried out to determine whether neuroadaptation will be possible at all. To this end, the patient and his or her doctor attempt to achieve monovision vision improvement by searching for the ideal contact lenses.

Once the eye has become accustomed to this type of correction, the patient may decide to have laser monovision.

Monovision by Laser Blended Vision (LBV) methods: Presbyond, PresbyMAX, Supracore

An alternative to conventional monovision, which can result in loss of visual acuity at intermediate distances, loss of visual acuity to distance, loss of contrast, reduced retinal correspondence, reduced quality of binocular vision and loss of three-dimensional vision, are Laser Blended Vision (LBV) procedures:

• Presbyond method
• PesbyMAX method
• Supracore method

Unlike traditional monovision treatment, Laser Blended Vision (LBV) treatments solve the problem at all distances and allow you to see objects near, far and even at medium distances.

The essence of LBV methods is to increase the depth of field for each eye by using an original, nonlinear and aspherical laser ablation profile.

By taking advantage of naturally occurring spherical aberrations and a customized corneal ablation profile, these procedures do not impair the quality of vision and are much better tolerated than traditional monovision.

LBV treatments with micromonovision (the near eye has up to -0.75 diopter) involve harmoniously adjusting the vision of the eyes to produce sharp images for distance, near and intermediate distances.

The unquestionable advantage of these methods is the preservation of spatial vision (stereopsis) with minimal side effects when looking far away compared to the popularly used monovision – here one eye is “specialized” for looking far away and the other for looking close, while patients are bothered by the lack of good vision in the transition zones of the so-called “blend zone”.

LBV methods are well tolerated by an acceptable 97% of patients, but contact lens trials are also performed prior to their use to predict the effects of the procedure.

Is laser-assisted monovision reversible?

While surgical monovision is reversible, it is associated with the need for another surgical procedure.

If there is no neuroadaptation after the procedure and the existing difference between the eyes impedes daily functioning, there is no way out – it has to be done.