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Visual performance with monovision correction based on ocular dominance and patient preference

1 November 2003


Monovision is a popular treatment modality for the refractive correction of presbyopia, where one eye is corrected for distance viewing and the other eye is corrected for near. Opinions differ among practitioners for the ideal method to select the eye to wear the distance correction, with the majority of practitioners correcting the dominant eye for distance. Twenty five pre-presbyopes participated in a study to investigate the relationship between patient preference for monovision correction and ocular dominance. The purpose of the study was to determine whether subject preference, or ocular dominance, or both, are predictable for optimum visual performance and success in a monovision correction. Each subject underwent a manifest refraction, followed by measurement of binocular distance visual acuity using both high-(100%) and low-(10%) contrast Bailey-Lovie visual acuity charts. Ocular dominance testing was performed using five different dominance tests, and subject preference of placement of distance and near correction was evaluated on the basis of visual clarity and comfort. Subjects' eyes were identified as either near-preferred or distance-preferred. High- and low-contrast distance visual acuity was re-measured once alternately with additional plus power over each eye. The results show that visual acuity was worse with the non-dominant eye corrected to the distance compared to the dominant eye corrected to the distance. Acuity was also worse with the near-preferred eye wearing the distance correction compared to the distance-preferred eye having the distance power. This was true for both high- and low-contrast visual acuity, but only statistically significant for high-contrast acuity. Among the different monovision scenarios studied, the one providing the best acuity (both high- and low-contrast) was that of distance-preferred eye wearing the distance correction. This indicates that patient preference for the placement of the near and far powers may be of clinical use in successfully assigning power with monovision correction.


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