Monovision - Laser Eye Surgery for
Presbyopia
Reading without Glasses for the
over 45’s
Reading Glasses (Presbyopia)
|
When you reach your mid forties reading gets harder especially
in poor lighting. You have to hold things farther away to be able
to read them clearly. Soon your arms are too short and an expensive
trip to the opticians is needed. This is because the lens and
muscles inside the eye have become stiff with age. You can no
longer flex the lens to give it the extra power needed for reading.
The need for reading glasses is different to the need of glasses
for good distance vision. Reading glasses help distance vision for
people only with long sight.
|
|
Life without Reading Glasses
Monovision can restore youthful vision and let you once again
enjoy life naturally without glasses. Monovision could allow you to
shed that old aged look of glasses perched on the end of your nose.
You can read the newspaper, see a menu clearly, use a mobile phone,
score your golf card in the rain, put on make up and fiddle with
all the other little things in life which have become
difficult to see. Unfortunately Monovision is not for
everybody, so please read on.
Monovision
During the consultation your weaker eye (non dominant) will be
identified and selected to be made slightly short sighted for
better closer up vision. Your strongest (dominant) eye remains
untreated (unless you need treatment for distance vision as well).
The result is that one eye sees well in the distance and the other
sees close up objects well. Good vision for both near and far
objects at the same time without glasses is achieved.
Monovision is a compromise and not everybody likes it. Some people
will take to it quickly while others will take a considerable
amount of time before they get used to it. Acquiescence is
necessary and Monovision will not suit the impatient, the
depressive or the perfectionist person. Those who can relax and
wait for their brain to adjust to Monovision can reap the rewards
and will be delighted with their new found vision. You need the
right attitude to get used to Monovision and as you will read
later, it is a compromise which works wonderfully for most
patients.
Results
The aim is to give patients independence from glasses and is
achieved in all patients who persevere. Patients are usually
delighted with the treatment. Patients can read the newspaper or
smaller print following treatment and will not need glasses for
walking around, swimming etc. and everyday enjoyment of life. When
the difference between eyes is large (say 2.5 and above) occasional
contact lenses may be used for difficult conditions such as driving
at night or skiing in cloud.
Suitability
You should be suitable if you have healthy eyes and good sight
with glasses. Monovision cannot make your vision better than with
glasses therefore people with damaged or diseased eyes will not
benefit from Monovision. A list of conditions which make treatment
inadvisable is given on the last page.
Common Visual Problems Explained
The need for Reading Glasses only (Presbyopia)
Many people only need glasses for reading when they reach 45 or
thereabouts (this is called Presbyopia, with no need for distance
glasses). If you have had normal vision all your life and do not
want this need for glasses you can consider having only one eye
treated to achieve Monovision. Your prescription will look like
this: - Sph and Cyl boxes will read 0 or plano (=plane glass or
zero) and will have a positive number (e.g. + 1.5) in the near
box.
Poor distance vision as opposed to the need for reading glasses is
usually caused by one of the following conditions: Long Sight
(Hyperopia); Short Sight (Myopia) and Astigmatism often
colloquially called Stigma. Some small amounts in your prescription
(.5 or less) can be ignored and Monovision can be successfully
achieved without treating these small distance corrections
prescriptions.
Long Sight
Long sighted people are able to see better at long distance than
seeing near things. If you are long sighted and need glasses for
good distance vision you will need treatment to both eyes to
achieve Monovision. The stronger (dominant) eye is treated to get
good distance vision and the weaker eye is treated to be
deliberately short sighted to achieve clear close up vision. Laser
treatment for long sight up to + 4.5d is very effective and
patients get good results.
Your prescription will read plus (e.g. + 2) in the Sph box and have
Add and a number (e.g. + 1.5) in the near box. When you were
younger you could use the elasticity in the eye muscles to see
clearly in the distance and you probably only needed occasional
glasses. However this can cause eye strain and headaches as the day
wears on because using the eye muscles all day makes the eyes tired
(these muscles are designed to be used only for reading and not all
day).
Short Sight
People with short sight have much better sight at short
distances than at long distances. If you are moderately short
sighted you can take off your glasses and read well. You can have
your short sight corrected by laser but if you have both eyes
corrected for distance and you are over 45, you will immediately
need reading glasses unless you choose Monovision. Treatment for
short sight up to -10d is very effective and patients get good
results. Your prescription will read minus (e.g. -2) in the Sph box
and have Add and number (e.g. Add +1.25) in the near box.
Astigmatism
People with astigmatism have blurring of vision at all
distances and will need treatment to both eyes to achieve
Monovision. Small amounts of astigmatism (up to 1 or thereabouts)
are common and can often be ignored especially when young.
Astigmatism is often combined with short and long sight and is
treated at the same time at no additional cost. Treatment is very
effective, and patients with severe astigmatism are the most
pleased. Your prescription will read plus or minus (e.g. +2 or
-1.5) in the Cyl box and have Add and number in the near box (e.g.
Add +1.75).
The Level of Correction Required
As you get older stronger glasses are needed as the eye muscles
gradually lose their remaining elasticity. Reading glasses are
available in powers of up to +3. The average person will have the
following progression of strength of reading glasses as they get
older, but it varies between individuals:-
At 45 +1 correction required
At 50 it goes to +1.5
At 55
,, +2
At
60 ,,
+2.5
At
65 ,, +3
Your eye will stop getting worse at around 65 and +2.5 to +3 should
give good reading for the rest of your life.
The level of correction will be discussed with you on consultation.
The level given depends on how old you are, how long you can wait
until you get comfortable vision and the number of years you want
to have pin sharp close vision.
The correction given will be greater than you currently need to
allow for future deterioration.
A higher correction will take longer to get used to but near vision
should remain good for a very long time. A correction of +2 may
only last 10 to 15 years and a smaller correction of say +1.5 may
only last up to 10 years before additional correction is needed.
The level of correction will be discussed at your consultation, but
there is nothing to stop you having further treatment in the
future. A typical 45 yr old will be recommended +1.75 of correction
in the one eye, an older person of say 55 the correction will be
corrected to say +2.25.
Becoming Comfortable with Monovision
The time it takes to feel comfortable with Monovision depends on
the difference in the prescription between your eyes after
treatment. A small correction (of say 1) could be tolerated in a
few days to a month, and there isn’t usually any problem with
differences up to 2. A large difference (of about 3) can take 6
months or more to get used to. For this reason you will be offered
a simulation of Monovision with a contact lens.
Contact Lens Trial
Monovision can be achieved by wearing a contact lens in one eye
(or one of less power if you already wear them for distance
vision). When you visit Optimax on consultation you will be offered
a free trial with disposable contact lenses. The Optometrist will
put a lens in your non dominant eye and ask you to go away for a
period from a few hours to a period of a few weeks. This period
depends on how long you wish to try it for, you may find after a
few hours that you like it but on the other hand you may wish to
try it for much longer. If you have a trial for longer than your
visit to Optimax the necessary training will be given to teach you
how to insert and remove these lenses. The strength of the trial
lens will to suit your current need for reading glasses. This trial
will give you a sense of what Monovision will feel like.
Finding Your Dominant Eye
We all have a dominant eye in the same way we have a dominant hand
and dominant foot. Your dominant eye is the one you subconsciously
rely on and is usually has the better vision of the two. For
Monovision this is the eye that will be used for distance vision
and the weaker non dominant eye to be corrected for close up
vision. To determine which your dominant eye is, close one eye as
if to aim at an object, the eye remaining open is your dominant
eye. This will be confirmed on consultation.
Safety
LASIK is the most performed elective eye operation in the world
with almost 20 million procedures carried out since it was invented
about 10 years ago. However, no surgery is completely safe or
without complications. You will be told of all the potential
problems before you go ahead and a very detailed consent form is
signed before you can be accepted for treatment. As most Monovision
patients only have one eye treated the risks of sight threatening
complications to both eyes are eliminated.
Treatment Options
LASIK is our standard laser treatment which gives a permanent fixed
change to your prescription.
A surgical alternative to Monovision is RLE (Refractive Lens
Exchange). If you have a family history of cataracts or you are
severely long or short sighted you should consider lens implants.
The lenses inside the eye can be replaced with multi-focal lenses
which can give both good distance and close up vision.
Permanency
As you get older stronger glasses are needed and then quality of
close up vision will very gradually get worse as you near the limit
of your correction. LASIK is permanent and if you have full
correction of plus 2.5 to 3, the benefit of sharp reading
vision should last for ever. However, lower corrections may not
always give full reading correction permanently. Monovision can be
described as turning back the clock on your eyes and depending on
how far you turn back the clock, determines how long it lasts, i.e.
the level of your correction will determine how long you can read
without glasses. The advantage of treatment is not lost
completely; a treated eye will always have much better close
up vision than the dominant eye, even if the very fine sharpness of
close up work has diminished. Further treatment can be given if
desired at your request.
Optimax Medical Team
Treatment is performed by one of our highly experienced eye
surgeons who is a qualified doctor and who is registered with the
GMC. All Optimax Doctors are specialist LASIK surgeons who have
dedicated their careers to refractive surgery (surgery to eliminate
the need for glasses). They are passionate about their speciality
and this is combined with their experience of hundreds of thousands
of vision correction treatments.
Optimax Optometrists are similarly enthusiastic and are dedicated
to helping patients achieve their dream of natural sight without
glasses. The field of refractive surgery attracts a special and
academic profile of eye care professional.
Your Consultation
Your consultation is performed by an Optometrist who is experienced
in all aspects of vision correction which includes laser eye
surgery and Monovision. They will test your eyesight, examine your
eyes to ensure they are healthy, determine your dominant eye and
advise you on the strength of treatment recommended. They will also
offer to fit a contact lens for you to experience Monovision.
Optimax Optometrists work to guidelines of, and are supervised, by
Optimax Doctors in refractive surgery who will perform your
treatment.
Treatment Day
LASIK involves changing the shape of the front surface of the eye
to make focussing images more clearly. A very thin flap is created
by a laser and a second laser then re-profiles the underlying
tissue. This flap is replaced after treatment leaving little or no
surface wound and therefore recovery is rapid and your vision is
improved almost immediately. The eye may be weepy and blurred for a
few hours after treatment. LASIK to one eye takes about 10 minutes
and is pain free. For more detailed information, please see our
information pack on laser treatment, which is sent to all
enquirers.
Recovery
LASIK treatment is usually pain free with only minor discomfort in
the majority of cases. You should notice an immediate improvement
in reading vision and you can return to normal activities without
much delay. Because of the difference in your eyes, driving in
the first few weeks can be uncomfortable and you should not drive
if you are not confident to do so.
Free Lifetime Aftercare
You will need two to three visits in the three months following
treatment to ensure all is well before you are discharged.
Aftercare for life is included in our fees which means that should
any complication occur as the result of treatment at any time
you will be offered remedial treatment without charge. This does
not however cover the natural deterioration of your eyes with
age.
Practical Considerations
After treatment you should not rub your eyes and ladies should not
wear eye make up for five days. We recommend that you do not drive
after treatment while you get used to your new vision. Please see
our main leaflet on LASIK eye treatment as it will all apply to
you.
Optimax the Company
Optimax was established by Mr Russell Ambrose in 1992 in the very
early days of laser correction. His vision is to provide the very
best and safest laser eye treatment at an affordable price. Optimax
has specialised in the laser eye treatment, doing nothing else in
these 18 years and by and
by using the best equipment and keeping up to date with the latest
technology gets unbeatable results. As a result about half our new
patients come by personal recommendation. Optimax has since
provided over 300,000
laser treatments to correct the need for glasses. As at January
2009 this is the largest number of laser vision correction
treatments in the UK performed by any company. Optimax is
registered with the Healthcare Commission, a government
organisation which oversees and regulates all private medical
clinics.
The Personal Experience of the Owner of
Optimax
I, Russell was the first Optimax patient in 1992 and in those
early days (in the interest of safety) we did treatment to one
eye at a time, with a six month wait before treating the second
eye. Being in my forties and short sighted, treatment would have
meant swapping distance glasses for reading glasses but I had never
heard of Monovision at that time. It became obvious that on having
my second eye treated I would need reading glasses
immediately. By six months I was getting used to Monovision but
unfortunately because Monovision was not planned my non dominant
eye had been treated first so I had to get used to my left eye
taking over domination as well as Monovision. It took me a year or
more to get to the point where I did not notice the difference
between my eyes but it has been worth it many times over. I will
not say it is easy, but in those days I had no choice. Because I
did not want to wear a contact lens in my untreated eye I got used
to it.
It becomes automatic and seamless that one eye is used for close up
vision and the other takes over for far distance. I have
completely forgotten the difference in my eyes and I never think or
realise my eyes are working independently. It’s fantastic; at
almost 60 and being -3 in one eye I can see the tiniest print in
the smallest of fonts and being 20:20 in my treated eye it means I
can see the leaves on the trees far away. I have not worn glasses
since 1992 and I should never need glasses ever again and I can
state that laser treatment and Monovision has changed my life and
lifestyle.
Because it is time consuming and complicated to explain and in an
age when patients expect instant results, eye care professionals
and patients do not give Monovision proper consideration. It is not
practical to give glasses for Monovision and bifocal lenses and
reading glasses are prescribed. Contact lens wearers on the other
hand are routinely given Monovision using different powered lenses.
Because lenses are easily interchanged it does not cause
expensive changes of glasses when the patient is impatient or
dissatisfied. Those who enjoy Monovision have found this
wonderful secret from the insight of a caring optician who makes a
special effort with contact lenses. Because it is invisible
and a silent advantage it is not widely known about, but if you ask
your friends it is usual that one of them who wears contact lenses
already enjoys Monovision, so please ask around.
What happens if I don’t like
Monovision?
Some people do have the patience to forget about the
difference between their eyes and and give up before adjusting. If
you were short sighted prior to laser treatment it is simple to go
back and make both eyes for distance vision, but then you will need
reading glasses. If you were long sighted or wore no distance
glasses prior to treatment (and you were made deliberately
short sighted in one eye) you will need to have this reversed by
further Laser Treatment. Because we have to leave six months before
any laser re-treatments you must be prepared for this period
of disturbance but it is most likely that you will be used to it by
then and not bother. There is no charge for a reversal treatment if
you do not like Monovision.
Cost
Because consultation is very thorough and time consuming a charge
of £60 is made. We make a special price for Monovision to cover
costs and possible re-treatments involved. LASIK treatment
costs between £1000 and £1500 per eye. We have a range of easy
payment plans to suit you and no one with a bank account is refused
our non status in house credit. Many patients remark that it is the
best money they have ever spent.
The Next Step
To discuss treatment or book a consultation call our customer
services department today on 08705 14 33 14. If you have been
prescribed glasses by an optician please have your prescription
details handy. If you have bought your reading glasses off the
shelf look on the inside of the arm where the strength is
usually written. It will be a number like +1.5 or +2.5.
Independent Advice
If you wish to talk to some of Optimax’s previous patients you are
welcome to have some telephone numbers of people who have given
their permission to give out their details. Please call customer
services on 08705 14 33 14.
It is a big decision to have Monovision and we advise you to
research it as much as you can. Some of your friends
probably already have Monovision, so please ask around. The
following links have useful independent information:-
Reasons for not having Monovision (Contra
Indications)
Some professions such as HGV drivers and Airline Pilots require
good distance sight in both eyes. This will mean that glasses may
need to be worn to reach these standards after treatment.
About 20% of the population are unsuitable for any LASIK
treatment because of underlying medical conditions. LASIK
absolute contra indications include:-
Amblyopia; Partially sighted; Chrons disease; Compulsive disorders;
Collagen disease: Glaucoma; Herpes in the eye; Lupus; Prism;
Rheumatoid Arthritis; Squint, SLE
Conditions which might be reasons not to have treatment
(relative contra indications) usually depend on degree and whether
the conditions are under good control. A consultation is
required:-
Blepharitis; Depression; Diabetes; Dry eyes; Epilepsy; Eye
infections; MS; Raised internal eye pressure;
RLE may be an option if you are not suitable for LASIK.
Contact Lenses can give Monovision, please ask your contact
lens practitioner.