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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 Laser Eye Surgery 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 Laser Eye Surgery

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 treatment 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 treatment 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.
 

Treatment 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 for Monovision Laser Eye Treatment

You should be suitable for treatment 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 the Monovision Laser Eye 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 of Monovision Laser Eye Surgery
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 laser eye 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 laser eye surgeon 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 laser eye surgery 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 Laser Eye Surgery Information Pack, which is sent to all enquirers.
 
Monovision Treatment 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.
 
Comprehensive Aftercare
You will need two to three visits in the three months following treatment to ensure all is well before you are discharged.Aftercare is included in our fees which means that should any complication occur as the result of treatment you will be offered remedial treatment without charge in order to achieve the best possible visual outcome. This does not however cover the natural deterioration of your eyes with age.
 
Practical Considerations
After Monovision laser eye surgery 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 Laser Eye Surgery Specialists - the Company
Optimax was established by Mr Russell Ambrose in 1992 in the very early days of laser eye 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 350,000 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 Laser Eye Surgery 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 laser eye treatment 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 Eye 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.
 
Monovision Treatment Cost
Because consultation is very thorough and time consuming a refundable deposit of £30 is required. We make a special price for Monovision to cover costs and possible re-treatments involved. LASIK treatment cost starts from £995. 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 0800 093 1110. 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 Laser Eye Surgery 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 0800 093 1110.
 
It is a big decision to have Monovision Laser Eye Treatment 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 Laser Eye Surgery (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.