M0novision矫正方法在屈光手术中的应用

MV矫正(monovision)常用于老视和老视前期患者，即一眼矫正看远、另一眼矫正看近，可分为常规MV和交叉性MV两种类型，其机制是双眼间的模糊抑制。MV可应用于屈光手术(PRK、LASIK、人工晶状体植入)中。本文回顾有关文献，探讨MV矫正的视力效果、对双眼视功能的影响和影响矫正成功的因素。     

Monovision矫正方法在屈光手术中的应用

MV矫正 (monovision)常用于老视和老视前期患者 ,即一眼矫正看远、另一眼矫正看近 ,可分为常规MV和交叉性MV两种类型 ,其机制是双眼间的模糊抑制。MV可应用于屈光手术 (PRK、LASIK、人工晶状体植入 )中。本文回顾有关文献 ,探讨MV矫正的视力效果、对双眼视功能的影响和影响矫正成功的因素     

应用Monovision矫正老视的研究进展

Monovision矫正方法常用于老视和老视前期患者,即一眼矫正看远,另一眼矫正看近,其机制是双眼间的模糊抑制,MV可应用于单焦点角膜接触镜,并且还可应用于人工晶状体植入术和PRK,LASIK等激光屈光手术中,以及目前最新的非激光手术—传导性角膜成形术。本文就MV矫正的机制、对双眼视力功能的影响以及研究进展作一综述。     

手术治疗老视

随着人类社会的老龄化 ,老视的困扰给中老年人带来诸多不便 ,中老年人对老视的治疗有了更高的要求 ,人们希望不戴镜便能矫正老视。世界各地的学者已开始探讨通过手术矫正老视。一、Monovision矫正老视(一 )适应症与影响因素 :MV成功基于两眼间的模糊抑制 ,理想的MV双眼清晰视力范围应等于单眼之和 ,不受另一眼模糊影像干扰〔1〕。MV可通过CL实现 ,通过屈光手术诸如PRK ,LASIK ,RK ,PTK ,晶体摘除合并人工晶体植入〔1～ 4〕,以MV方式矫正老视也可行 ,一般认为以MVCL矫正 ,待确定其MV适应性后再作手术可提高成功率〔5〕。MV对于…     

老视的角膜矫正手术

老视是随着年龄增长、调节能力丧失出现视近物困难的一种生理现象,发病机制尚不明确。人口老龄化使老视人口及老视矫正的需求逐渐增多,老视的手术矫正方法正成为眼科医师关注的热点。随着技术和材料的不断发展,出现了多样化的老视矫正手术,包括经角膜老视矫正手术、晶状体老视矫正手术和巩膜老视矫正手术。尽管还没有一种完美的老视矫正手术能真正恢复眼的调节功能,现有的手术已取得一些临床效果。现对老视的角膜手术矫正方法做一综述。     

单眼视LASIK治疗伴有老视的屈光不正临床观察

目的:探讨单眼视准分子激光原位角膜磨镶术(单眼视LASIK)治疗伴有老视的屈光不正对患者视觉质量、生活质量的影响。方法:屈光不正伴老视的患者172例中124例施行单眼视LASIK(主视眼按最佳矫正远视力完全矫正,非主视眼近视者低矫-0.75~-2.00D,远视者过矫0.75~2.00D),35例放弃手术,13例患者双眼全部矫正。观察术后1d;1wk;3mo时的检查结果。结果:术后3mo单眼视LASIK组124例患者双眼远视力0.7~1.2,双眼近视力J1~J3。无因为难以耐受的不适而需要戴镜补充矫正或再次手术者。双眼完全矫正组术后双眼远视力0.7~1.2,双眼近视力J3~J6,8例(62%)视近困难,需配近用眼镜。结论:单眼视LASIK治疗伴有老视的屈光不正安全有效。单眼视治疗在设计手术方案时需根据患者年龄及调节能力、近附加度数、阅读距离、工作性质等综合考虑。     

Monovision的概念及其矫正老视的应用

Monovision（MV）概念已经有几十年的历史，应用于老视的矫正也有三十多年了，主要以接触镜应用最为广泛，近些年来随着屈光手术的广泛开展，应用MV技术设计手术矫正老视渐渐受到手术医生的青睐。     

单眼视角膜接触镜矫正老视对视功能的影响

单眼视(monovision)作为矫正老视的方法之一,其原理是用接触镜将一眼矫正为看远,而另1眼矫正为看近,因此使用单眼视方法会人为的造成双眼屈光参差并对视功能产生一定的影响。本文讨论了使用单眼视方法对视功能的影响,以期为临床应用提供参考。     

近视眼患者诱导屈光参差对视功能的影响

目的通过观察实验性屈光参差对40岁以上近视眼患者双眼视功能的影响,探讨老视患者的屈光手术治疗。方法对40岁以上近视患者48例用综合验光仪完全矫正其屈光不正后,在单眼前加不同度数正球镜,诱导单纯近视性( 0.5D、 1.0D、 1.5D、 2.0D、 2.5D和 3.0D)屈光参差。测定诱导屈光参差后的远视力、双眼同时视、融像功能、立体视情况。结果诱导的屈光参差超过 1.5D时,欠矫眼的远视力、立体视、融像功能和同时视随着屈光参差度数的增加逐渐下降。结论近视性屈光参差可引起中年近视患者双眼视功能异常,当屈光参差超过 1.5D时可引起双眼视功能急剧下降。大于40岁近视患者行屈光手术可留有小于 1.5D的近视性屈光参差,利于视近,且对高级视功能的影响不明显。     

Monovision与老视矫正手术

Monovision(MV)矫正是一种成熟的矫正老视的方法,近10 a来,老视矫正手术逐渐开展,一些准分子激光角膜屈光手术(PRK、LASIK等)、激光角膜热成形术和传导式角膜成形术、人工晶状体植入术也采用MV矫正方法治疗老视,取得很好的效果,本文就MV矫正在这些老视矫正手术中的应用进行综述.     

Monovision: a review

In presbyopia, patients can no longer obtain clear vision at distance and near. Monovision is a method of correcting presbyopia where one eye is focussed for distance vision and the other for near. Monovision is a fairly common method of correcting presbyopia with contact lenses and has received renewed interest with the increase in refractive surgery. The present paper is a review of the literature on monovision. The success rate of monovision in adapted contact lens wearers is 59-67%. The main limitations are problems with suppressing the blurred image when driving at night and the need for a third focal length, for example with computer screens at intermediate distances. Stereopsis is impaired in monovision, but most patients do not seem to notice this. These limitations highlight the need to take account of occupational factors. Monovision could cause a binocular vision anomaly to decompensate, so the pre-fitting screening should include an assessment of orthoptic function. Various methods have been used to determine which eye should be given the distance vision contact lens and the literature on tests of ocular dominance is reviewed. It is concluded that tests of blur suppression are most likely to be relevant, but that ocular dominance is not fixed but is rather a fluid, adaptive, phenomenon in most patients. Suitable patients can often be given trial lenses that allow them to experiment with monovision in real world situations and this can be a useful way of revealing the preferred eye for each distance. Of course, no patient should drive or operate machinery until successfully adapted to monovision. Surgically induced monovision is less easily reversed than contact lens-induced monovision, and is only appropriate after a successful trial of monovision with contact lenses.     

The Quest for Spectacle Independence: A Comparison of Multifocal Intraocular Lens Implants and Pseudophakic Monovision for Patients with Presbyopia

ABSTRACT

We performed a literature review comparing multifocal intraocular lens (IOL) implantation with pseudophakic monovision to treat presbyopia. Multifocal IOLs utilize refractive or diffractive principles to treat both distance and near vision, with a single lens implant. Monovision uses traditional monofocal lens implants to treat the dominant eye for emmotropia, and the non-dominant eye for myopia. This planned anisometropia is designed to enhance intermediate or near vision. Generally, distance vision was similar with both types of lens implantation, near vision was better with multifocal IOLs, and intermediate vision appeared to be better in the monovision group. For patients requiring cataract surgery, both multifocal IOLs and monovision appear to address presbyopia with a high level of patient satisfaction. More patients reported complete spectacle independence with multifocal IOLs, but more glare and halos were reported by multifocal IOL patients as well.     

Binocular function and patient satisfactionafter monovision induced by myopic photorefractive keratectomy

Purpose:To measure binocular function and patient satisfaction with monovisioninduced by photorefract ve keratectomy (PRK) in myopic presbyopic patients.Setting:Refractive Department; Cleveland Clinic; Cleveland, Ohio, USA.Methods:This study comprised 21 myopic presbyopic patients with monovisioninduced by PRK. Sixteen emmetropic patients who had PRK served as a control group. Monovision was induced by undercorrecting the nondominant eye by 1.25 diopters for near vision and correcting, the dominant eye with emmetropia for distance vision. Monocular and binocular uncorrected Snellen visual acuities at 20 feet and 13 inches, manifest refraction, ocular dominance, stereopsis at 20 feet and 13 inches, Monocular and binocular contrast sensitivities, Worth-4-Dot test at 20 feet and ⅓ of a meter, and fusional convergence amplitudes were examined in each patient.Results:In the monovision group at near and distance, 20 patients (95.3%) had binocular visual acuity of 20/25 or better. No patient in the monovision group used reading glasses postoperatively; 4 of 16 patients (25.0%) in the control group used such glasses. All patients maintained binocular fusion and stereo acuity ranging from 40 to 800 seconds of arc. Mean patient satisfaction was 86% (range 40% to 100%). In the control group, 12 patients (75.0%) had binocular distance visual acuity of 20/25 or better and 11 (68.8%) had binocular near visual, acuity of 20/25 or better.Conclusion:Monovision PRK patients had better near vision than control PRKpatients, with minimal compromise in stereo acuity and overall high patient satisfaction.     

Monovision outcomes in presbyopic individuals after refractive surgery

PURPOSE: To characterize monovision outcomes and patient satisfaction with conventional monovision (dominant eye corrected for distance) and crossed monovision (dominant eye corrected for near) in presbyopic individuals after excimer laser photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK). DESIGN: Retrospective observational case series. PARTICIPANTS: One hundred forty-four consecutive patients, 45 years or older, who were treated with excimer laser refractive surgery between December 1995 and June 1998. METHODS: Patients in whom the surgical outcome was monovision (MV) (distance vision spherical equivalent [SE] -0.50 to +0.50 diopter (D), near vision SE -3.75 to -1.00 D and anisometropia 1.00 D or greater), crossed MV (dominant eye corrected for near vision and the nondominant eye for distance vision) and full correction (bilateral SE -0.50 to +0.50) were identified. Data were abstracted and analyzed statistically. MAIN OUTCOME MEASURES: Preoperative and postoperative visual acuity and refraction. Patient satisfaction with monovision RESULTS: Forty-two patients had surgical outcome of MV. In MV patients, the average distance vision SE, near vision SE, and anisometropia were -0.04 +/- 0.27 D, -1.95 +/- 0.70 D, and 1.92 +/- 0.74 D, respectively. Patient satisfaction was 88% with MV. Twelve patients attained crossed MV. All patients with crossed MV were satisfied with their vision. Patient satisfaction with MV showed no relationship to gender, age at initial surgery, preoperative trial of monovision, laterality of treatment, type of monovision, or predictability of outcomes. CONCLUSIONS: Monovision may be a valuable option for presbyopic individuals considering refractive surgery. Crossed monovision can result in satisfactory visual outcomes.     

大龄近视患者LASIK疗效分析

目的：探讨大龄近视患者LASIK特点及采用Monovision矫正方法设计的LASIK术后疗效。

方法：对104例186眼大龄近视患者(年龄≥40岁)采用Monovision矫正方法设计并进行LASIK手术,并对术前后视力、屈光度、手术疗效等进行统计分析。

结果：术后1mo,所有术眼的裸眼视力均明显提高(P<0.01),达到1.0的百分率分别为非主导眼83.7%(87/104),主导眼91.5%(75/82); 术后裸眼视力与术前最佳矫正视力比较,非主导眼差异不显著(P>0.05),而主导眼提高明显(P<0.01); 术后屈光度非主导眼为-0.70±0.12D,与术前欠矫设计量基本一致(P>0.05),主导眼为-0.04±0.28D,两组差异显著(P<0.01); 患者对远视力满意度100%、近视力满意度82.7%。

结论：大龄近视患者行LASIK治疗以高度、超高度近视患者为主,大屈光参差(>2.50D)患者占比例较高; 采用Monovision矫正方法设计的LASIK术对改善大龄患者术后视近功能、缓解视疲劳以及提高其视觉满意度是切实有效的,将这一临床经验用于个体化手术方案的设计可以使其更为完善。     

Pseudophakic monovision: optimal distribution of refractions

Purpose: To determine the optimal distribution of refractions in monofocal, pseudophakic monovision. Methods: A previously reported mathematical method for describing defocus for a single eye (Acta Ophthalmol, 89, 2011, 111) is expanded to the binocular situation. The binocular distribution of refractions yielding the least defocus over the most extended fixation intervals is identified by mathematical optimization. The results are tested in a group of 22 pseudophakic patients. Results: For the fixation interval 0.25–6.0 m, the optimal refractions are pure spheres of ?0.27 D for the distance eye and ?1.15 D for near eye. The mathematically derived defocus structure is confirmed in the clinical series. Conclusions: The reported mathematical method enables identification of the optimal distribution of refractions over any fixation interval. Monovision with refractions of approximately ?0.25 and ?1.25 D may lead to spectacle independence for distance and intermediate vision. Binocular problems – such as monovision suppression, reduced stereoacuity and binocular inhibition – are likely to be minimal with the suggested anisometropia of 1.0 D. This moderate monovision is fully reversible with spectacle correction, as the induced aniseikonia is minimal and it therefore represents a safe alternative to multifocal intraocular lenses (IOLs).     

Monovision and LASIK.

BACKGROUND: Many LASIK patients are early and mid-presbyopes. Monovision is commonly targeted for these patients because of demographics. Considerations are reduced stereopsis, reduced acuity, night driving, and liability. CASE REPORTS: Case studies are used to illustrate contact lens and alternative trials for presbyopic and prepresbopic monovision LASIK patients. CONCLUSION: A preoperative monovision contact lens trial can be used to demonstrate monovision effects to the candidate for refractive surgery. Selection of add power, selection of distance and near eye, residual astigmatism, management, and gradual transistioning with regards to adaptation are discussed.     

Surgical monovision and monovision reversal in LASIK

PURPOSE: This study was designed to assess the success of surgical monovision in presbyopic patients. METHODS: A university refractive surgery center retrospective chart review of 82 patients who elected to undergo surgical monovision with laser in situ keratomileusis (LASIK) between January 2000 and January 2003 was conducted. Specific factors included for analysis included preoperative and postoperative defocus spherical equivalent, whether the patient underwent enhancements, whether the patient underwent a preoperative monovision trial with contact lens, and whether the patient underwent monovision reversal. RESULTS: Eighty-two patients who underwent LASIK for monovision were analyzed. Mean preoperative spherical equivalent in the distance-corrected eye was -4.07 (standard deviation (SD), 2.49); for the eye corrected for near vision, mean preoperative spherical equivalent was -4.10 (SD, 2.56). Postoperative spherical equivalent in the distance eyes was -0.01 (SD, 0.38) and in the near eyes -1.24 (SD, 0.91). There were 6 enhancements in the near eyes (7%) and 17 enhancements in the distance vision eyes (21%). This difference was statistically significant (P = 0.007). Thirty patients underwent a contact lens trial of monovision before LASIK, and none of those patients elected monovision reversal. There were 52 patients who did not undergo a contact lens monovision trial before LASIK monovision, and 2 of these patients underwent monovision reversal. Monovision success in this population was 97.6%. CONCLUSION: Surgical monovision can help presbyopic patients achieve their goal of reduced dependence on spectacles. A trial of monovision contact lenses or spectacles may be important in helping surgeons select patients for successful surgical monovision.     

Short term responses to soft contact lens corrections for presbyopia

Eleven subjects were each fitted with five different soft contact lens corrections for presbyopia. The correction types were distance contact lenses with lookover spectacles, concentric bifocals, monovi-sion, modified monovision and progressive bifocal contact lenses. Subjects were asked to rate each contact lens correction in terms of distance, intermediate, near and peripheral vision, confidence when walking and climbing stairs, eye-hand co-ordination, performance on work tasks, vision difficulties in bright and dim ambient illumination and the correction most preferred for daily wear. There were few significant differences between ratings for the different corrections. Monovision, modified monovision and the concentric bifocal corrections were the preferred options for daily wear.