Re: Grunwald et al.: risk of geographic atrophy in the comparison of age-related macular degeneration treatments trials (ophthalmology 2014;121:150-61).

Dear Editor: In comparing multifocal to monofocal intraocular lenses implanted to create monovision, Wilkins et al graciously recognized me as the first to publish on the use of full ( 2.75 diopters in the near eye) monovision. However, the statement that only 1 previous study of monovision in cataract surgery has reported overall spectacle independence as an outcome measure misses the point of my report. I found that implanting a lens measured for distance in the dominant eye followed, once the success of the distance correction was confirmed, by a second implantation of a lens measured to create a 2.75-diopter correction in the near eye resulted in 110 of 120 (91%) patients with cataract achieving 20/30 vision in their dominant distance eye, along with J1 or better vision in their near eye. Table 3 in my paper outlines the use of optical aids. Only 7 patients wore any distance correction postoperatively (5.8%), 10 wore near (8.4%), 7 of whom wore both (5.8%), for a spectacle independence rate of 91.6%. Wilkins et al noted a 71.3% rate of spectacle independence using multifocal lenses, after 4 patients had bilateral and 2 patients had unilateral intraocular lens exchanges. No intraocular lens exchange was required in the Wilkins group of monovision patients or in mine. The implantation of monofocal intraocular lenses to create full monovision is a useful operative technique for providing spectacle independence in a safe and cost-effective manner.