Monovision for Presbyopia Explained: Contact Lenses, Laser and Lens Surgery

Last reviewed: 8 November 2026

Monovision is a way of managing presbyopia by setting one eye for distance and the other for near. It can be created with contact lenses, laser vision correction, or lens surgery. This page explains how it works, what the research shows, and where the trade-offs are. It is general information, not advice for your eyes.

What is monovision and how does it help presbyopia?

Monovision sets one eye, usually the dominant eye, for clear distance vision and the other eye for nearer vision. Presbyopia is the age-related loss of near focusing, so the two eyes are deliberately given different focus. The brain learns to favour the clearer image for each task, which can reduce the need for reading glasses.

The dominant eye is usually set for distance, and that is my usual approach. One large laser series found about 85% of patients were set this way (Braun 2008). Setting the dominant eye for near is sometimes done, and two small studies of "crossed" monovision after cataract surgery found similar satisfaction (Zhang 2015, Fujita 2025).

How much difference between the eyes is used, and what is mini-monovision?

The difference in focus between the two eyes is the key decision. In my practice, larger monovision usually means the near eye is set about 1.75 dioptres more short-sighted than the distance eye. Mini-monovision uses a smaller difference, roughly 0.75 to 1.50 dioptres in published studies. Neither amount suits everyone.

It is a trade-off between range and quality. A larger monovision aim of about 1.75 D gives the widest range without reading glasses, but some patients then need glasses for prolonged reading or for night driving. A smaller aim gives less near range, so reading glasses are needed more often. The two eyes work together better, though, and some patients need distance glasses less often in certain situations. The more range you try to achieve, the more drawbacks are possible.

The research points the same way:

• In 35 pseudophakic patients with simulated monovision, a 1.5 D difference gave the best balance (Hayashi 2011). Near vision improved as the difference grew, but depth perception worsened: stereoacuity was 71 seconds of arc at baseline, 100 at 1.5 D and 158 at 2.0 D.
• A smaller 0.75 D difference gave better intermediate vision and better stereoacuity than 1.75 D, but poorer near vision (Hayashi 2015).
• A 2026 review of 35 studies found reading-glasses independence was higher with anisometropia and distance-glasses independence was higher with emmetropia (Skov 2026).

The near eye focuses sharply at roughly 100 divided by its dioptre setting, in centimetres. This is arithmetic, not a measurement, and real-world range is a little wider because the eye has some depth of focus.

At 1.75 D the best focus is about 57 cm, a little beyond usual book-reading distance. In my experience, that is why small print or prolonged reading can still need glasses.

Why try monovision with contact lenses first?

A contact lens trial lets you experience the planned difference between your eyes before anything permanent is done. If you have not tried monovision before considering surgery, a contact lens trial is advisable, in the situations that matter to you, such as reading, screens and driving. If it is not comfortable, we adjust the amount or choose a different approach.

The research on trials is mixed, so it is worth being honest about this:

• The American Academy of Ophthalmology describes a preoperative contact lens trial as useful for deciding the desired endpoint.
• A review of contact lens monovision recommends surgical monovision only after a successful contact lens trial (Evans 2007).
• In one laser series, none of 30 patients who had a trial reversed their monovision, compared with 2 of 52 who did not (Reilly 2006). Other laser studies found satisfaction unrelated to a preoperative trial (Jain 2001) or argued a trial should not be mandatory (García González 2025).
• In a case series of 12 patients who developed strabismus with monovision, most did so after about 2 years (Pollard 2011). A trial is helpful but not a guarantee.

Before cataract surgery a trial is harder, because a cloudy lens makes dominance and contact lens fitting difficult to assess. Past success with contact lens monovision is a good sign.

Can LASIK or PRK create monovision?

Yes. Laser vision correction can leave the near eye slightly short-sighted so it focuses closer, while the other eye is corrected for distance. Whether this suits you depends on your age and on your natural lens. I offer it, but the natural lens keeps changing, so a laser result can drift over time.

In one laser series, 67% of people aged 45 or older chose monovision, and 7% later had it reversed (Braun 2008). In another, further laser treatment was needed in 7% of near eyes and 21% of distance eyes (Reilly 2006). Natural lens change is slow but measurable. In the Blue Mountains Eye Study, people in their 50s and 60s drifted about 0.3 to 0.4 D towards long-sightedness over ten years, while eyes that had nuclear cataract at baseline drifted about 1 D towards short-sightedness (Fotedar 2008). That drift would change the balance between the eyes, but I am not aware of a published study measuring it in laser monovision.

If a patient has already had cataract surgery, the lens implant is stable, which makes laser monovision after cataract surgery a more settled fix. For patients who still have their natural lens, I explain this clearly.

How does monovision work with cataract surgery or lens exchange?

After cataract surgery or refractive lens exchange the new lens is permanent, so monovision can be planned precisely. Monofocal, enhanced monofocal and extended depth of focus lenses can all be used this way. The near eye is aimed slightly short-sighted and the other eye is aimed for clear distance vision.

In a multicentre randomised trial of 212 patients, monovision was targeted at -1.25 D (achieved near eye about -0.92 D). No patient in the monovision group had a lens exchange in the first year, compared with 5.7% in the multifocal group (Wilkins 2013). In a 10-year study of long-sighted presbyopic patients (463 enrolled) using mini-monovision with monofocal lenses, self-reported and measured near independence was about 72% at 10 years (Wróbel-Dudzińska 2023). In another series with near-eye targets of -0.75 to -1.75 D, about 9% used glasses for reading and 18% for night driving (Goldberg 2018). Dissatisfaction was more common with larger differences: half of 12 dissatisfied patients in one report had 2.5 D or more (Kato 2018).

See also: monofocal lens implants, lens implant options and refractive lens exchange.

Can an extended depth of focus lens be combined with monovision?

Sometimes. Extended depth of focus lenses are occasionally aimed with a small difference between the eyes, called mini-monovision, to add near range to a lens that already extends focus. Published studies are small and short, and results differ between lens designs, so this is a decision to make case by case.

• Vivity. A randomised trial of 70 patients compared -0.5 D mini-monovision with emmetropia. The authors reported better near acuity with mini-monovision, comparable distance acuity and no dysphotopsia reported (Vasavada 2024).
• Symfony. A study of 70 patients reported better intermediate and near acuity and higher spectacle independence with micro-monovision than with emmetropia, with similar photic symptoms (Tan 2019).
• RayOne EMV (enhanced monofocal). In 86 patients, a near eye of -1.0 D or more gave better near and intermediate acuity and higher spectacle independence (89.1% vs 55%) (McNeely 2025).
• Three-lens comparison. In 105 patients with -0.5 D mini-monovision, most still needed near correction at least occasionally (Vandekerckhove 2026).
• TECNIS PureSee. In one randomised trial of 60 patients, a -0.75 D offset did not significantly change measured near acuity. Patients reported slightly less need for near glasses but more glare, and low-contrast acuity was lower at 5% and 1.25% contrast (Zeilinger 2026). A small retrospective study of a -0.5 to -1.0 D target reported better near acuity than an Eyhance lens (Lee 2026). I have not found published evidence for larger offsets with this lens. A planned trial of PureSee mini-monovision (NCT07860567) had not started recruiting when this page was last reviewed.

So the answer to whether offsetting these lenses improves reading is: sometimes a little, with a cost in glare or contrast, and the evidence varies by lens.

How does monovision compare with multifocal lenses?

Multifocal lenses split light between several focal points, while monovision uses a different focus in each eye. Research suggests multifocal lenses more often give complete freedom from glasses, while monovision is associated with less glare. Both involve trade-offs, and the better choice depends on your eyes, your priorities and your tolerance of night-time symptoms.

• A 2025 network meta-analysis of 32 studies found complete spectacle independence was more likely with bilateral multifocal lenses (relative risk 2.06, 95% CI 1.34 to 3.15) and glare was less likely with monovision (RR 0.34, 0.18 to 0.65) (Hong 2025).
• In the randomised trial above, 25.8% of monovision patients never wore glasses, compared with 71.3% with multifocal lenses (Wilkins 2013).
• A Cochrane review found low-certainty evidence of little difference in near spectacle independence between laser monovision and a bifocal lens exchange (Alvarado-Villacorta 2025).

More on lenses: lens implant options and premium lens options.

What are the trade-offs for depth perception, night driving and adaptation?

Monovision trades some binocular balance for range. Depth perception and contrast sensitivity can fall, especially with larger differences between the eyes, and night driving can be harder because one eye is deliberately blurred at distance. Most people adapt over weeks, but some do not. These effects tend to increase as the difference grows.

• Depth perception. Stereoacuity falls as the difference between the eyes grows (Hayashi 2011, Durrie 2006).
• Night driving. Suppressing the blurred image when driving at night is a recognised limitation (Evans 2007). The Academy notes that glasses may help, especially in dim light, and that many patients with low monovision drive without difficulty. In my experience, patients with larger monovision can need glasses for night driving.
• Eye alignment. Monovision can bring on double vision or strabismus in people with previous strabismus or significant phorias (Kushner 1995, Pollard 2011).
• Falls. One study that included 241 patients with monovision found it was not associated with fall risk (Rosenblatt 2023).

Can monovision be adjusted or reversed?

It depends on how monovision was created. With contact lenses you simply stop wearing them. After laser, further laser treatment can change the balance between the eyes. After lens surgery, the result is more stable, and glasses can fine-tune it. Planning the amount carefully and trialling it first reduces the chance of needing changes.

In one laser series, 7% later reversed monovision (Braun 2008). In a small series of a multifocal laser profile with micro-monovision, 3% did (Luger 2020). Wearing a glasses lens over the near eye for distance tasks, particularly night driving, is a recognised option. The light adjustable lens, which can be fine-tuned after surgery, is not currently available in Australia but may become a possible option.

Who is suited to monovision?

Monovision tends to suit people who want less dependence on reading glasses and accept that distance sharpness, night vision or depth perception may be slightly reduced. It needs careful screening. Previous strabismus, significant phorias, a strong sighting preference and tasks needing precise depth perception call for particular caution.

The Academy describes the best candidates as people over 40 who value freedom from glasses and accept some loss of distance stereoacuity. A strong sighting preference is linked to poorer tolerance (Farid 2009). Assessment should include eye alignment and dominance. There is no formal consensus contraindication list. Anyone with monovision should not drive until adapted (Evans 2007). Suitability is decided at an assessment, not from a web page.

What does the research not tell us?

Published research has gaps that matter for this decision. No randomised surgical trial has compared several monovision amounts, and I am not aware of a study measuring how laser monovision changes as the natural lens ages. Evidence for offsetting newer extended depth of focus lenses is small and short-term.

My usual larger monovision aim of about 1.75 D has not been tested head-to-head in trials. The published literature leans towards differences of about 1.5 D or less as the best balance for depth perception. I choose the amount with each patient, guided by the contact lens trial.

Sources

• American Academy of Ophthalmology. Refractive Surgery Preferred Practice Pattern. 2022 (updated 2024).
• Alvarado-Villacorta R et al. Surgical interventions for presbyopia. Cochrane Database Syst Rev. 2025.
• Hong ASY et al. Monovision versus multifocality for presbyopia during primary phacoemulsification: systematic review and network meta-analysis. Eye (Lond). 2025.
• Skov AG et al. Tolerance to surgically induced anisometropia: a systematic review. Acta Ophthalmol. 2026.
• Hayashi K et al. Optimal amount of anisometropia for pseudophakic monovision. J Refract Surg. 2011.
• Hayashi K et al. Binocular visual function of modified pseudophakic monovision. Am J Ophthalmol. 2015.
• Durrie DS. The effect of different monovision contact lens powers on the visual function of emmetropic presbyopic patients (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc. 2006.
• Wilkins MR et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013.
• Evans BJ. Monovision: a review. Ophthalmic Physiol Opt. 2007.
• Braun EH et al. Monovision in LASIK. Ophthalmology. 2008.
• Reilly CD et al. Surgical monovision and monovision reversal in LASIK. Cornea. 2006.
• Jain S et al. Monovision outcomes in presbyopic individuals after refractive surgery. Ophthalmology. 2001.
• García González M et al. Incidence and causes of retreatments after monovision induced by LASIK in myopic patients without a previous trial of contact lens induced monovision. Arch Soc Esp Oftalmol (Engl Ed). 2025.
• Pollard ZF et al. Strabismus precipitated by monovision. Am J Ophthalmol. 2011.
• Kushner BJ. Fixation switch diplopia. Arch Ophthalmol. 1995.
• Luger MHA et al. Long-term outcomes after LASIK using a hybrid bi-aspheric micro-monovision ablation profile for presbyopia correction. J Refract Surg. 2020.
• Fotedar R et al. Relationship of 10-year change in refraction to nuclear cataract and axial length findings from an older population. Ophthalmology. 2008.
• Wróbel-Dudzińska D et al. Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia. J Cataract Refract Surg. 2023.
• Goldberg DG et al. Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost. BMC Ophthalmol. 2018.
• Kato S et al. Etiology and outcomes of secondary surgical intervention for dissatisfied patients after pseudophakic monovision. Int Ophthalmol. 2018.
• Zhang F et al. Crossed versus conventional pseudophakic monovision: patient satisfaction, visual function, and spectacle independence. J Cataract Refract Surg. 2015.
• Fujita Y et al. A comparative study of mini-monovision, crossed mini-monovision, and emmetropia with enhanced monofocal intraocular lenses. Sci Rep. 2025.
• Rosenblatt TR et al. Fall risk in patients with pseudophakic monovision. Can J Ophthalmol. 2023.
• Farid M et al. Patient selection for monovision laser refractive surgery. Curr Opin Ophthalmol. 2009.
• Vasavada V et al. Visual outcomes comparing emmetropia vs mini-monovision after bilateral implantation of a nondiffractive extended vision intraocular lens: randomized trial. J Cataract Refract Surg. 2024.
• Tan J et al. Visual quality and performance following bilateral implantation of TECNIS Symfony intraocular lenses with or without micro-monovision. Clin Ophthalmol. 2019.
• McNeely RN et al. The influence of the level of monovision upon early outcomes following the bilateral implantation of an enhanced monovision intraocular lens. Vision (Basel). 2025.
• Vandekerckhove K et al. A prospective, randomized comparison of three partial range of field intraocular lenses using a mini-monovision strategy. J Refract Surg. 2026.
• Zeilinger J et al. Visual performance of a refractive extended depth of field intraocular lens in monovision and emmetropic settings. Am J Ophthalmol. 2026.
• Lee H et al. Higher-order aberrations and visual outcomes of a new refractive extended depth-of-focus intraocular lens with a target of slight myopia. Sci Rep. 2026.
• PureSee mini-monovision and mix-and-match study, NCT07860567, ClinicalTrials.gov