Monovision Contact Lenses: How One Eye Near, One Eye Far Works

Presbyopia is the age-related stiffening of the eye’s crystalline lens, which takes away close-up focus. Monovision handles it by correcting one eye for far and its partner for near. It is a compromise, and night driving is a known weak spot. Before any surgical monovision, a trial with monovision contact lenses comes first.

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What presbyopia is

Presbyopia is the age-related loss of close-up focus that happens as the crystalline lens stiffens. For how near focus is measured, see near point and reading add.

How monovision works

Monovision is one contact lens option for presbyopia. Instead of a bifocal design, each eye gets a single vision correction: one eye is set for far, its partner for near.

Which eye gets distance

Stanford’s guidance is to give the dominant eye the far correction. A 1996 literature review by Jain and colleagues (PMID 8724641) found that putting the distance correction on the dominant eye was linked with monovision success.

Tradeoffs to explain to the wearer

Monovision involves some compromise compared with having both eyes focused at the same distance. Driving, especially at night, is one task where wearers may notice it. Explaining this before the fit helps the wearer judge whether it suits their work and hobbies; the prescriber makes the call.

Why a contact lens trial comes first

Some people get monovision through refractive surgery. Before choosing that route, a trial with monovision contact lenses is advised.

Add power and accommodation

Presbyopia means the eye can no longer add enough focusing power of its own for near work. Near correction makes up for it with plus power: positive lenses supply what accommodation no longer can. In monovision, that plus goes into the near eye’s lens. Explore how focusing demand rises as the target moves closer with the accommodation calculator.

Practice set

Original problems.

1. A presbyopic patient is fitted with monovision. Their right eye is dominant. Under Stanford’s guidance, which eye gets the distance lens?

   Show answer

   The right (dominant) eye, per Stanford’s guidance, which gives the dominant eye the far correction. The left eye is set for near.

2. How much focusing does an eye need to see clearly at 40 cm?

   Show answer

   1 ÷ 0.40 = 2.50 D.

3. And at 33 cm?

   Show answer

   1 ÷ 0.33 ≈ 3.00 D.

4. A patient wants surgical monovision but has never tried it. What step comes first?

   Show answer

   A trial with monovision contact lenses.

5. Does the near eye in monovision need extra plus or extra minus power compared with its distance correction?

   Show answer

   Extra plus, standing in for focusing ability lost with age.

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