Monovision in Cataract Surgery: Targets and Patient Selection
Last updated: October 2026
Short answer: in monovision, the dominant eye is usually targeted for distance (plano) and the non-dominant eye for near or intermediate. "Mini-monovision" uses a near target of about −1.25 to −1.50 D; full monovision uses about −2.00 to −2.50 D. Larger differences give more reading vision but reduce depth perception and are harder to tolerate.
Common targets
| Strategy | Dominant eye | Non-dominant eye | What the patient gets |
|---|---|---|---|
| Mini-monovision | Plano | About −1.25 to −1.50 D | Good distance and intermediate (computer, phone); glasses for fine print |
| Full monovision | Plano | About −2.00 to −2.50 D | More reading independence; more loss of stereopsis and more risk of intolerance |
| Crossed monovision | Near target | Plano | Less commonly used; may suit patients whose occupation favours near vision in the dominant eye |
Who is a good candidate?
- The best predictor of success is previous successful monovision, for example with contact lenses.
- If the patient has never tried it, a contact lens trial before surgery is very helpful.
- Motivated patients who want to reduce dependence on reading glasses and accept some compromise.
- Patients unsuitable for, or unable to afford, presbyopia-correcting IOLs.
Be cautious in
- Patients with a strabismus history, a large phoria, or previous diplopia: anisometropia can break down fusion.
- Occupations that need excellent stereopsis or equal vision in both eyes (for example, some drivers and pilots).
- Patients with significant disease in one eye (such as amblyopia or macular disease), which changes which eye should be the distance eye.
- Patients who are very sensitive to visual quality.
Practical tips
- Test eye dominance (for example, with a hole-in-card test) and document it.
- Operate on the distance (dominant) eye first; if the patient is happy with distance vision and wants near, plan the second eye.
- Explain clearly that glasses may still be needed for night driving or prolonged reading.
- If the patient cannot adapt, laser refractive correction or an IOL exchange can reverse monovision.
Frequently asked questions
What is mini-monovision?
A smaller difference between the eyes, with the near eye targeted at about −1.25 to −1.50 D. It gives good intermediate vision with less loss of depth perception than full monovision.
Which eye is set for distance in monovision?
Usually the dominant eye. Crossed monovision (dominant eye for near) is used less often.
How do you know if a patient will tolerate monovision?
Previous successful monovision with contact lenses is the best predictor. Otherwise, a contact lens trial before surgery is the most practical test.
Related: IOL types guide, multifocal IOL selection and biometry rules of thumb.
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