Earlier this year, the FDA approved Mono-vision LASIK with the VISX CustomVueExcimer Laser.  Mono-vision is a strategy to correct presbyopia without having to wear reading glasses.  Presbyopia is the aging process which reduces accommodation (adjusting the focusing power of the eye for near vision and reading).   The approval confirmed what New Jersey LASIK Surgeon, Dr. Daniel Goldberg, has known for years.

As we age, our ability to change focus for near vision diminishes because the crystalline lens inside the eye becomes less flexible.  If the eye is nearsighted it may still be possible to read without glasses as we get older, but if the eye is not nearsighted or if vision is corrected for distance with glasses, contact lenses or LASIK, then we generally begin to need reading glasses after 40 years of age.

Eyeglasses, bifocals or progressive lenses provide clear focus for both near and distance vision.   With contact lenses there are several options for reading including bifocal contact lenses or mono-vision fitting of contact lenses.  Mono-vision is a strategy to correct both distance and near vision without wearing glasses, and it can be achieved with contact lenses or with Laser Vision Correction such as LASIK . 

With mono-vision, the dominant eye is generally corrected for distance vision and the non-dominant eye is corrected for near vision creating 2 eyes with different focus.

Despite nearly 40 years of experience with contact lens mono-vision, Dr. Goldberg recalls that in the 1990’s “when refractive surgery evolved with excimer laser vision correction, such as LASIK, into a safe and accurate surgical alternative to glasses or contact lenses, there was great skepticism about mono-vision amongst both eye surgeons and patients.”  This is because mono-vision breaks our concept of binocular vision with both eyes having similar focusing power.  Patients wondered if mono-vision would cause headaches and dizziness, and eye surgeons doubted the success and viability of surgical mono-vision.

Daniel B Goldberg MD at the Atlantic Laser Vision Center in Little Silver New Jersey was one of the pioneers in New Jersey laser vision correction, and developed a successful practice in refractive eye surgery in the 1990’s.  As he recalls: “Most of the research in refractive surgery at that time related to the development of the laser technology. Prior to my clinical research on mono-vision there were very few reports on surgical mono-vision and no reports on LASIK mono-vision at all.” 

In Dr. Goldberg’s practice, the patients over 40 years of age were seeking answers about correcting their reading vision without glasses.  In his practice, up to 50% of the patients over 40 chose mono-vision and the level of success and satisfaction was even higher that patients with contact lens mono-vision.

In 2000, at the ASCRS(American Society of Cataract and Refractive Surgeons) national meeting, the first large scale study of LASIK mono-vision was presented by Goldberg and the published paper appeared in 2001 in the Journal of Cataract and Refractive Surgery.  Further research by Goldberg resulted in another large study of LASIK mono-vision which was published in 2003—this work compared results in far-sighted eyes as well as near-sighted eyes.  Based on this research, Goldberg made presentations at national meetings on “Succeeding with LASIK Mono-vision” and taught courses at the ASCRS meetings on “Surgical correction of Presbyopia.”

Since 2003, there have been several additional studies by other experts on LASIK mono-vision which have confirmed the success previously reported by Goldberg.  Several months ago, the FDA approved the use of the VISX CustomVueExcimer Laser for LASIK mono-vision.  The VISX CustomVueexcimer laser is part of the advanced iLASIK surgical platform distributed by American Medical Optics, and CustomVueMono-vision is part of the iLASIK program.  NASA and the US Navy and Air Force have recently chosen this technology for LASIK on their pilots.  The Atlantic Laser Vision Center in Little Silver New Jersey is one of several centers in New Jersey offering iLASIK.

In April, at the inaugural training sesseion for CustomVueMonovison in Chicago, Goldberg was honored to be recognized for helping to set the stage for the FDA approval of LASIK mono-vision.  Goldberg feels that it was an opportunity of a lifetime to make a substantial contribution to his field:  “It is gratifying to see that LASIK mono-vision is now an accepted option for the surgical correction of presbyopia, and the FDA approval will enable more of our patients to safely enjoy greater freedom from glasses.”

There are two organizations which provide certification of LASIK surgeons based on surgical skills and results.  Dr. Daniel Goldberg has a rare dual certification from both the Council for Refractive Surgery Quality Assurance (an independent, nonprofit, patient and consumer health organization that evaluates and verifies the quality of the surgeries provided by select refractive surgeons in the United States), and the ABES(American Board of Eye Surgeons).

The ABES(American Board of Eye Surgeons) promotes the highest possible quality ophthalmologic surgical care.  The ABES certification programs include a process through which a surgeon’s actual surgical skills and judgment are tested and observed by his or her peers.  The ABES tests surgical skills in cataract/intraocular lens surgery as well as LASIK and corneal transplantation.  In 1989, Dr Goldberg was the first eye surgeon in New Jersey to have surgical skills in cataract and intraocular lens surgery certified by ABES.  In 2002 he became one of 2 New Jersey LASIK surgeons to have surgical skills certified in LASIK by ABES.

The other organization to certify LASIK surgeons is the non-profit, patient advocacy CRSQA(Council of Refractive Surgery Quality Assurance).  According to CRSQA, certification is an important indication of the quality of a LASIK doctor, and once certified, results are re-evaluated every three months.  There are fewer than 250 doctors nationwide who have attained and maintain certification by CRSQA.

Nationwide, there are less than 10 LASIK surgeons with dual certification by ABES and CRSQA.  Daniel B.Goldberg MD of the Atlantic Laser Vision Center in Little Silver, NJ is the only NJ eye surgeon and one of only 10 eye surgeons nationwide to have dual certification in LASIK based on review of actual surgical skills and results.

Information on Dr. Daniel Goldberg and his practice is available at http://www.goldberg4lasik.com/

Laser Vision Correction, including LASIK and related procedures such as PRK(photorefractive keratectomy), and ASA(advanced surface ablation) have become the most common refractive surgical procedures with over 1.4 million procedures yearly in the US.  Steady advances in technology have contributed to the quality of results, and the safety of the procedure.

Consider the added safety of a femtosecond laser flap(e.g. Intralase all-laser LASIK or iLASIK) compared to blade LASIK with a microkeratome.  According to Dr. Goldberg, who is one of the first NJ eye surgeons to pioneer LASIK in New Jersey, and who also was one of the first to bring Intralase all-laser LASIK to the east coast:  “Safety is my top priority.  Using the best technology is part of the process, but proper patient selection and meticulous surgical technique is the key to success.”

The FDA scrutinizes and approves the safety of laser eye surgery technology.  Dr. Goldberg advises patients to seek the best combination of technology and an experienced surgical team.  He feels that surgical certification of actual surgical results is an important protection for patients:  “It demonstrates that the surgeon has the confidence to have their surgical skills and results evaluated.  I have always supported the principle that surgical skills and results should be evaluated objectively.”

Board certification by the American Board of Ophthalmology (ABO) is knowledge based but does not measure surgical skills.  Goldberg says:  “As a result, I continue to voluntarily validate my results thru ABES and CRSQA.  It is part of my service to patients to demonstrate our qualifications, and to protect their vision.”
About Dr. Goldberg

Abour Dr. Daniel Goldberg

Dr. Daniel B Goldberg is a comprehensive refractive surgeon – both a pioneer of LASIK surgery in the U.S. and an accomplished corneal and cataract surgeon.   Dr. Goldberg specializes in comprehensive refractive surgery including LASIK eye surgery and refractive intraocular lens and cataract surgery.  Based in Monmouth County, New Jersey, Dr. Goldberg has performed LASIK on patients worldwide and was a member of the elite team of doctors who performed clinical trials of LASIK in its early stages. This research led to FDA approval of LASIK.

This is an excerpt from a industry paper featuring the work of Dr. Daniel Goldberg.

Source: CATARACT & REFRACTIVE SURGERY TODAY – FEBRUARY 2006

FACTORS INFLUENCING MONOVISION’S SUCCESS

Patients’ Expectations

The goal of monovision is to increase patients’ functional vision for daily tasks without the aid of glasses.
This endpoint, however, does not preclude a person’s ability to use glasses for tasks requiring clear binocular distance vision (ie, night driving) or sharp binocular near vision (ie, prolonged reading). Although some patients are satisfied with monovision, they face disadvantages such as less-than-ideal distance vision; the possible need for glasses when driving at night; two eyes, each focusing differently; and the adjustment involved with this form of correction.1-4

Ocular Dominance and Interocular Blur Suppression

Interocular blur suppression is essential to successful monovision. In each person, the input from one eye or the other is usually dominant in influencing binocular cells in the cerebral cortex. Information from an individual’s dominant eye produces a greater response to a given stimulus than input from his nondominant eye. Correcting the dominant eye for distance and the nondominant eye for near is standard, because (1) correcting the dominant eye for the most commonly used viewing distance maximizes blur suppression and (2) the dominant eye maximizes the performance of visual tasks requiring spatial perception.4

Although this approach is the norm in the studies reviewed for this article, Jain et al 4 reported that 43% of 42 study patients were treated with crossed monovision (wherein the dominant eye is corrected for near), and subjects’ satisfaction ranged from 72% to 86%. Although this range was relatively high, it was the lowest rate of patient satisfaction among the studies reviewed herein.