1. Monovision for Presbyopia Insert name/ Practice name/ Logo here if desired

2. 2 How the eye works Light rays enter the eye through the clear cornea, pupil and lens. These light rays are focused directly onto the retina, the light- sensitive tissue lining the back of the eye. The retina converts light rays into impulses, sent through the optic nerve to your brain, where they are recognized as images. 70% of the eye's focusing power comes from the cornea and 30% from the lens.

3. 3 Refractive errors Inability to see clearly is often caused by refractive error. Four types of refractive error:  Myopia (nearsightedness)  Hyperopia (farsightedness)  Astigmatism  Presbyopia

4. 4 Refractive errors: myopia The distance between the cornea and the retina may be too long or the power of the cornea and the lens may be too strong. Light rays focus in front of the retina instead of on it. Close objects will look clear, but distant objects will appear blurred. Myopia, or nearsightedness

5. 5 Refractive errors: hyperopia In hyperopia (farsightedness), there is too little optical power. The distance between the cornea and the retina may be too short. Light rays are focused behind the retina instead of on it. In adults (but not children), distant objects will look clear, but close objects will appear blurred. Hyperopia, or farsightedness

6. 6 Refractive errors: astigmatism In astigmatism, the cornea is curved unevenly—shaped more like a football than a basketball. Light passing through the uneven cornea is focused in two or more locations. Distant and close objects may appear blurry. Astigmatism occurs when light passes through uneven cornea

7. 7 Refractive errors: presbyopia Presbyopia is a normal condition in which your eyes gradually lose the ability to focus things up close. When we are young, the lens in our eyes is flexible and is able to change focus easily between near and far objects, like an autofocus on a camera. At around age 40, this flexibility naturally begins to gradually decrease, making it more difficult to see objects up close.

8. 8 Non-surgical correction of presbyopia Presbyopia is often corrected with reading glasses, bifocals or contact lenses. People within the presbyopic age who have good vision at distance usually use reading glasses for close-up vision and remove them to see far- away objects.

9. 9 What is refractive surgery? A group of outpatient surgical procedures used to alter how your eye focuses light rays on the retina, thereby improving vision and reducing dependence on glasses and contact lenses. In most cases, refractive surgery affects the shape of your cornea to redirect how light is focused onto the retina. Popular procedures include LASIK, LASEK, PRK and CK. Refractive surgery procedure on the cornea

10. 10 What is refractive surgery? Most refractive surgery is performed on the cornea and affects only the front of your eye, while the rest of your eye will change naturally as you age. In some cases, refractive surgery procedures don’t reshape the cornea; instead, the eye’s natural lens is either replaced or enhanced by an implantable lens that helps correct vision.

11. 11 Monovision for presbyopia surgery Adjusting each eye for different focusing distances can reduce or eliminate the need for glasses or contacts. Monovision, sometimes known as blended vision, allows for different focusing distances in each eye separately.

12. 12 Monovision for presbyopia surgery With monovision, one eye is corrected surgically to allow clear distance vision…

13. 13 Monovision for presbyopia surgery …while the other eye is either not treated, or is partially treated, to allow clear vision close up.

14. 14 Monovision for presbyopia surgery Monovision for presbyopia yields clear vision, one eye for distance and one eye for near.

15. 15 Types of surgery Monovision can be achieved through these types of surgery: Laser In Situ Keratomileusis (LASIK) Epithelial Laser In Situ Keratomileusis (Epi-LASIK) Photorefractive Keratectomy (PRK) Laser Epithelial Keratomileusis (LASEK) Conductive Keratoplasty (CK) Phakic Intraocular Lenses (IOLs) Refractive Lens Exchange (RLE) Intrastromal Corneal Ring Segments (INTACS)

16. 16 Monovision for presbyopia surgery While the brain does get used to seeing with monovision, it can take up to six to eight weeks for your eyes to adjust. It may be useful to try monovision with contact lenses before having the monovision surgical procedure, as some patients may not be good candidates for the surgery.

17. 17 Considerations for monovision for presbyopia surgery Reduce or eliminate the need for both reading and driving glasses.

18. 18 Considerations against monovision for presbyopia surgery May not be recommended for people needing to see better than average and binocularly for certain activities at either distance or near (like pilots). May not be recommended for people requiring rapid improvement in vision, as it may take up to two months for your eyes to adjust to monovision. Night driving vision may be more difficult since there can be reduced depth perception.

19. 19 To be a candidate for monovision surgery, you should… Be over over 40 years of age. Have an appropriate, stable refractive error within a correctable range. Be free from eye disease. Understand and accept risks, limitations and side effects of the procedure.

20. 20 Risks and possible side effects of monovision for presbyopia surgery Infection. Over-correction or under-correction (with a possible need for a re- treatment). Visual aberrations, such as seeing halos around lights at night. Lack of depth perception. Inability to adapt to the monovision state, possibly requiring a re- treatment.

21. 21 Is refractive surgery right for you? Advanced surgical procedures, including monovision for presbyopia, are creating more opportunities for people who want to be less dependent on glasses or contacts. Surgery may not entirely eliminate your need for corrective lenses. Glasses/contacts may still be needed for activities such as fine or detailed work, reading and perhaps night driving. If an accommodating or multifocal IOL is used, then reading as well as distance vision may be improved.

22. 22 Is refractive surgery right for you? A large part of the success of any refractive surgery depends on your understanding of the procedure and your expectations. Since refractive surgery is an elective procedure, you have the opportunity and responsibility to become fully informed about its risks and benefits. Your ophthalmologist will explain the specific technique, its benefits, as well as possible risks and side effects associated with your case.

23. 23 Discuss options and questions with your ophthalmologist With the help of your ophthalmologist, it’s ultimately your responsibility to weigh the risks and side effects of a procedure with the benefits it has to offer. If you decide refractive surgery is right for you, you may join millions of people who have reduced their dependence on glasses or contacts.