1. University of Florence Oto-Neuro-Ophthalmological Department
Eye Institute
Alessandro Franchini MD
Orsola Caporossi MD – Iacopo Franchini
“Monovision : what is the best target refraction in the dominant and non dominant eye? ”
Over the last few years the expectations of cataract patients
have increased and 85% of them whis to be glasses free
after surgery. Today to achieve this result we have three
options : multifocal IOLs , accomodative IOLs and monovision.
Even if multifocal and accomodative IOLs have represented
a great step forward we seem to be far from representing the final
solution for a number of reasons ( multifocal : influence of pupil
diameter, reduction of contrast sensitivity (halo,glare), not
suitable in ocular disease (glaucoma ,ARMD etc) – accommodative :
low reliability, risk of posterior capsule opacification etc.)
So the interest in monovision has increased.
I receive travel reimbursement from AMO
None of the authors have a financial interest in the products or materials mentioned in this poster

2. 25 emmetropia - 1.00 - 1.50 - 2.00 Material and Methods n° patients
In the monovision option , the dominant eye is focused for distance vision, and the non-dominant eye is focused for near to intermediate vision because correcting the dominant eye for the most commonly used viewing distance maximizes blur suppression. According to some authors the ocular dominance represents an important factor in the overall success of monovision but still more important seems to be the magnitude of ocular dominance. In fact for a successful monovision ,interocular blur suppression should flexibly change in each eye at all distances.
Material and Methods
In literature is not clear what is the best target refraction in the eye corrected for near vision . In fact a high anisometropia guaratees a good rate of spectacle independence but a loss of stereopsis, exactly the contrary of what happens with a low refractive difference between the two eyes.
n° patients
Target refraction dominant eye
Target refraction non dominant eye 25
emmetropia
- 1.00
- 1.50
- 2.00

3. % Binocular near UCVA 88% 75% 74% 48% 36% 36% J2 J1 Visual acuityD
Binocular near UCVA D D
88% 75% 74%
100 80
48% 36% 36% % 60 40 20 J2 J1

4. Patients satisfactionD D D
91% % %
100 80 60 % 40 20

5. % 80% 62% 51% Spectacle independence - 2.00 D - 1.50 D - 1.00 D 100 80
80% % %
100 80 60 % 40 20

6. Slow-fast reading test
Reading Speed D D
Slow-fast reading test
(Dr Giardini) D 26 24 40 27 30
Lines / minute 20 10

7. Functional Acuity Contrast
Contrast Sensitivity D
Scotopic conditions D
300 D
100
Functional Acuity Contrast
Test (F.A.C.T.) 30
Contrast sensitivity 10 3
0.5
1.0
2.0
4.0
8.0
16.0
Spatial Frequency (cycles per degree)

8. Conclusion Key point for monovision option success Mini Monovision
In our opinion a relatively low myopic shift in the non dominant eye (-1.00,-1.25 D) allows fusion and binocular vision without the need of suppression and produces an higher level of patient satisfaction and visual performance and a no significant reduction of spectacle independence
Questionnaire to identify appropriate candidates
Ocular dominance
Quantitative measurement of ocular dominance
depth
Conclusion
So today the so-called mini-monovison represents a considerable option for presbyopic patients who need cataract removal. In our opinion the most important point is the right selection of patients to identify appropriate candidates for this form of correction.
REFERENCES
Greenbaum S. Monovision pseudophakia.J Cataract Refract Surg 2002;28:
Handa T,Uozato H,Higa R,Nitta M et al. Quantitative measurement of ocular diinance using
binocular rivarly induced by retinometers. J Cataract Refract Surg 2006;32:
Handa T,Mukuno K,Uozato H,Niida T et al. Ocular dominance and patients satisfaction after
monovision induced by intraocular lens implantation .J Cataract Refract Surg 2004;30:
Evans B.J.W. Monovision : a review.Ophthal.Phisiol.Opt.2007 ,27: