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More surgeons discovering benefits of pseudophakic monovision presbyopia correction
A surgeon describes his own visual result 1 year after pseudophakic monovision cataract surgery.
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I have regularly received letters and e-mails from both colleagues and patients in response to this series of columns dealing with pseudophakic monovision presbyopia correction, but the volume has increased significantly in recent months. This, to me, indicates that pseudophakic monovision is finally getting the serious consideration it deserves as a bona fide approach to the surgical correction of presbyopia. This heightened interest could stem, in part, from several recent articles depicting the problems many surgeons are facing with multifocal implants. While I cannot answer all of these letters, I include two of the recent ones below. To protect the privacy of the writers, names have been withheld.
Conventional wisdom off the mark
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These letters highlight several important misconceptions surrounding pseudophakic monovision. I have endeavored to address this perception gap in past columns, and I am grateful for this opportunity to have you read it from someone other than myself. I am particularly struck by the patient-surgeon’s experience described in the second letter. It brings to light the sharp contrast between the visual and optical concerns the average surgeon still often associates with pseudophakic monovision and the results the patients actually experience. This surgeon’s “real world” experience as patient is particularly important for what he has not mentioned in describing his surgical result:
- No period of neuroadaptation
- No compromise in stereopsis
- No compromise in depth perception
- No compromise in contrast sensitivity
- No compromise in fine-print reading
- No compromise in intermediate focus
- No need for “accommodating exercise”
This colleague’s surgical result is precisely what I and many others have come to expect from the pseudophakic monovision approach to presbyopia correction. After my experience of more than 20 years, which includes several thousand cases, I advise patients to expect an immediate stable restoration of that precise range of uncorrected vision that has been customized to his or her unique goals, targeted with the results of a comprehensive preop analysis.
| Dear Dr. Maloney, I have been following your columns on lens-based refractive surgery in OSN, and I really appreciated the March 1 column on pseudophakic monovision. I, too, have often felt that I am “whistling in the wind” with my work on LASIK monovision. I have enclosed two of my references. At the time I started to study surgical monovision in 1998, there was almost nothing in the peer-reviewed literature on surgical monovision, and as you know, the widespread attitude in ophthalmology was very negative. Subsequently, I have given a course at ASCRS on succeeding with surgical monovision. I hope to attend your course at ASCRS in San Diego and will introduce myself. If I could contribute to any future courses as a junior instructor, I would be delighted. Name withheld |
| Dear Dr. Maloney, Your article about pseudophakic monovision in last week’s issue of Ocular Surgery News reminded me to write to thank you for pointing out the advantages of monovision in pseudophakia. One year ago when I faced cataract surgery, I was emboldened by your stance in favor of monovision in my decision to choose monovision, even after carefully examining many ReSTOR lens (Alcon), crystalens (eyeonics) and ReZoom lens (Advanced Medical Optics) patients in our practice. My partners could not imagine that I was going against the flow toward these multifocal pseudophakoi. Now, 1 year later, I know that my decision was the correct one. I have strong monovision with –0.25 D in my dominant right eye and –3 D in my nondominant left eye. I can read the finest print in dim light in an examination room, yet I can also drive an automobile without spectacles. In fact, the only time I even tried to use spectacles after my surgery was in the operating room, but now I find that it works just as well to simply dial my –3 D into one ocular of the operating microscope. Keep up the good work! I always enjoy reading your column in Ocular Surgery News. Name withheld |
Time for independent assessment
I have been writing that pseudophakic monovision is the best approach – for the widest range of candidates – presently at our disposal. Review our colleague’s description above again. As the experience of more surgeons comes to the fore, it is becoming increasingly evident that authentic pseudophakic monovision has many compelling advantages over the premium implants. With our understanding of the neurophysiology of the visual cortex, the potential problem of prolonged neuroadaptation with multifocal lenses should not have surprised us – yet clearly it has. In my view, it is critical that we assume a more active role in our professional due diligence by objectively assessing the risks and drawbacks of new technologies and not allow others to simply hand us information regarding what is best for our patients. This after all, is precisely what our patients assume we have done before making any particular recommendation on their behalf.
For more information:
- William F. Maloney, MD, is head of Maloney Eye Center of Vista, Calif., and a well-known teacher of cataract and lens-based refractive surgery techniques. He can be reached at 2023 West Vista Way, Suite A, Vista, CA 92083; e-mail: maloneyeye@yahoo.com. In the interest of objectivity, Dr. Maloney has no financial interest in any ophthalmic product and has no financial relationship with any ophthalmic company. Dr. Maloney welcomes questions from readers but regrets that, due to time constraints and the volume of messages, a personal reply cannot be guaranteed.
- Lens-based Refractive Surgery Column Mission Statement: To educate readers on all aspects of lens implant refractive surgery including presbyopia correction, refractive cataract surgery, refractive lens exchange and phakic IOLs.