"The overall clinical trial results from 149 CustomVue Monovision patients are that after 12 months 86% see 20/20 or better at both distance and near (Figure 1), 93% are seeing 20/20 or better at distance (Figure 2), 87% see 20/20 or better at intermediate range and 92% see 20/20 or better at near," says Mitchell Weikert, M.D., of BaylorVision in Houston.
Though the FDA approval is for a LASIK procedure, it can also be performed as either PRK or epi-LASIK depending on surgeon preference and evaluation of what is best for the patient.
But the surgeons emphasize that monovision is not for every myopic presbyope and that considerable time must be spent in patient education.
"I think if the patient is highly selective in regard to his
visual expectations, such as a competitive golfer, an engineer or someone who does a lot of night driving, then monovision may not be the best choice," says Dr. Weikert
"That's why it's important to spend a lot of time explaining the procedure and what the patient should expect from it.
In our practice, the preop process involves the surgeon, the refractive coordinator and educational materials about monovision that we provide to the patient."
says that patients who are comfortable with monovision will have the visual function to participate in almost any type of activity.
prefers the CustomVue Monovision procedure to refractive lens exchange, which he
says is more invasive, more expensive and involves a slight risk of retinal detachment.
"You have to decide how much to undercorrect between 1.25 D and 2.00 D," says Dr. Weikert
"Typically, the younger the patient the less undercorrection and the older the patient, the more toward the 2 D upper end of the range.
has successfully performed CustomVue Monovision on patients up to 60 years of age.
As many refractive surgeons will be shifting from performing off-label laser monovision to the new CustomVue Monovision, Dr. Kraff and Dr. Weikert
are able to offer some helpful pearls based on their extensive experience with this procedure.
"If the patient hasn't already been wearing monovision contact lenses, you may want to do the monovision contact lens trial to determine if he
is a good candidate for this procedure," says Dr. Weikert
"Do not do a monovision trial with eyeglasses.
"Don't overshoot on the undercorrection of the non-dominant eye," he
"It is usually better to move more toward the 1.25 D undercorrection than toward 2.00 D."
emphasizes the amount of preoperative education that CustomVue Monovision requires.
Both Dr. Kraff and Dr. Weikert
are avid proponents of CustomVue Monovision, offering it to patients between 40 and 60 years of age who fit the candidate profile.