In my nineteen years of practice at Milwaukee Eye Care, I continue to be surprised by mature patients who think or were told they are too old to wear contact lenses. Many of these people have either never been offered contact lenses or were dissuaded from trying them. One of the most successful ways to free yourself from glasses for most activities is with monovision contact lenses.

Monovision has been employed since the days of the monocle. One would have a single lens on a cord that they would place in front of one eye to facilitate close work. How effective, yet dreadful that was. At the time, other options were limited. Reading glasses and bifocals or

multifocals are fine and many people enjoy good vision with them, however, there may be a better way to rid yourself of the hindrance of spectacles.

Soft contact lenses have been available for nearly three decades. The early designs were limited and did not correct astigmatism. We now have multiple options in disposable contacts that correct nearsightedness, farsightedness and astigmatism. Some lenses are replaced on a daily basis while others can be worn for thirty continuous days.

The first step in determining whether or not you are a good candidate for wearing contacts is to have a thorough eye examination. Your eye doctor will perform a test called a refraction to determine the prescription for glasses. Next, a health evaluation will be conducted to detect any diseases of the eye including glaucoma, cataracts and macular degeneration. If you have dry eyes, steps may be taken to improve the lubrication of the eyes with drops or even small plugs to improve the quality of the tear layer.

Once it is determined that you have healthy eyes, a fitting for contact lenses can be performed. Your eye doctor or technician will measure the curvature of the front surface of the eye. A review of the refraction, dominant eye and eye health status will help in the selection of an initial trial contact lens. Fortunately, we have such a large assortment of trial contact lenses that we are able to fit your eyes with a pair of lenses on the same day. Our contact lens technicians instruct each patient about proper insertion, removal and care of the contacts. Complimentary solutions are also provided at the fitting.

The contacts are selected for correction of the distance vision in the dominant eye and the near vision in the non-dominant eye (The eye dominance does not necessarily coincide with being right/left handed). Some people ask whether that will cause a problem with their vision. Fortunately, about seven out of ten who try monovision are successful with it. Our visual cortex of the brain receives a signal from the eye and creates the perception of vision. For many people, the brain is very adaptable and is good at ignoring the slightly out of focus image from one eye, while creating good visual perception from the other. For instance, when a person with monovision is driving, the brain pays more attention to the sight from the dominant distance eye and uses only the gross vision from the non-dominant near eye. The opposite occurs when a person with monovision would pick up a map to read. In that instance, the brain will filter out the blur from the distance eye and pay more attention to the non-dominant near eye.

Commonly, people ask if that will cause one eye to become weak or lazy. The good news is a resounding 'No.' Each eye will contribute to overall sight, one more than the other, depending on whether the activity requires distance or near vision. The limitation of monovision is knowing where to hold reading material or place a computer monitor. You would want to have these things in the field of view favoring the eye for near vision.The contact lens fitting exam is usually completed when the best combination of lenses and lens strength is determined. Sometimes, the prescription strength of the contacts needs to be adjusted slightly to achieve the optimal combination for distance and near vision. This may take only two visits, but occasionally it can take several. The majority of monovision patients are functioning well by two weeks. They report good vision while driving or watching a show and the ability to read most things with good lighting. If about two weeks elapse and no success is achieved, monovision may not work. In that case, there are multifocal contact lens options that are worth trying, or there’s the option of using reading glasses over the contacts. Sometimes, however, the prescription strength of the contacts simply needs to be adjusted slightly to achieve the optimal combination for distance and near vision.

The first ingredient for success with monovision is a healthy eye that can support the wearing of a contact lens. Second, there needs to be good comfort of the contact lens on the eye. And finally, the quality of vision must be adequate to perform most activities without being aware of monovision. Some people elect to use a special pair of glasses for night driving to improve distance vision in the reading eye. Others choose to use a low powered pair of reading glasses over the contacts for reading in very dim light or to see the smallest things. Monovision enjoys the highest success rate of any contact lens correction of most visual needs for individuals who would otherwise need bifocal or reading glasses.

When you are ready to pursue monovision, set up an appointment for a thorough eye examination and contact lens fitting. With some patience and persistence the process should go smoothly and success with be achieved.

If there is a lack of success with monovision due to the inability to wear the contacts comfortably yet the vision was acceptable, surgical options such as LASIK may still be an option.

Jay A. Heilmann, O.D. is a comprehensive eye care specialist at Milwaukee Eye Care Associates. Dr. Peter S. Foote is the medical director. To schedule an appointment with Dr. Heilmann, please contact Milwaukee Eye Care Associates at 414-271-2020.