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Am J Ophthalmol. 2011 Sep;152(3):479-482.e1. doi: 10.1016/j.ajo.2011.02.008. Epub 2011 Jun 12.

Strabismus precipitated by monovision.

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James Hall Eye Center and the Section of Ophthalmology, Children's Healthcare of Atlanta at Scottish Rite Children's Hospital, Atlanta, GA 30342, USA.



To present patients who had the onset of strabismus or the recurrence of strabismus after converting to a monovision system of seeing.


Retrospective interventional case series.


Clinical records of 12 patients from the private practice of the corresponding author of this paper (Z.F.P.) were reviewed. Patients obtaining monovision via contact lenses, LASIK, and cataract surgery with posterior chamber intraocular lenses were studied if their monovision produced a new strabismus or was related to the recurrence of a previous strabismus.


All patients were first treated by converting the monofixing near eye to distance vision and then using reading glasses for near work. Of the 12 patients, 7 regained their fusion by doing away with monovision and 5 required surgery to reestablish motor or sensory control. All of the surgery patients obtained an excellent alignment but 1 did not regain sensory fusion.


Monovision is successful for the far majority of patients who try it. However, in patients with a previous history of strabismus or those with significant phorias, caution should be used in recommending monovision, and if monovision is elected, keeping the anisometropia to small levels such as 1.25 to 1.50 diopters (D) might lessen the chance of producing strabismus post monovision. The majority of our patients developed strabismus after 2 years of monovision, telling us that while a trial of monovision with a contact lens prior to surgery may suggest that the patient could tolerate monovision, it is not a guarantee.

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