Monovision pseudophakia

PURPOSE: To evaluate distance and near binocular visual acuities and patient acceptability after sequential posterior chamber intraocular lens (PC IOL) implantation for pseudophakic monovision correction. SETTING: Private practice and the Manhattan Eye Ear and Throat Hospital, New York, New York, USA. METHODS: This study comprised 140 binocular patients with less than 2.00 diopters (D) of astigmatism. Preoperatively, all patients expressed a desire to be independent of optical correction; 120 presented for removal of visually significant cataract and 20, for correction of high ametropia (+8.00 to -14.00 D). Phacoemulsification and implantation of a PC IOL calculated to achieve emmetropia were performed in the dominant eye. Ocular dominance was confirmed on multiple preoperative visits using a sighting technique. Implantation of a PC IOL calculated to yield a spherical equivalent of -2.75 D was performed in the nondominant eye. Seven postoperative examinations were performed during the 1-year follow-up, with 96 patients completing all evaluations. At each examination, interviews were conducted on patient acceptance and ability to perform near and distance tasks without correction. RESULTS: In the entire study group, 129 patients (92%) achieved 20/30 or better uncorrected distance acuity, J1 or better uncorrected near acuity, or both. One hundred ten patients (91%) in the cataract group and 19 (95%) in the clear lens group achieved this level. Patient acceptance was 90% in the cataract group and 100% in the clear lens group. CONCLUSIONS: In a diverse group of self-selected patients from 1 metropolitan-area ophthalmology practice who were motivated to be free of spectacles, pseudophakic monovision provided a high level of satisfaction. No morbidity was associated with monovision as those who were dissatisfied with their uncorrected state did well with spectacle or contact lens correction.