Clinical Scorecard: Contact Lenses: Using 2 Tests of Dominance

At a Glance

Key Highlights

• Sighting dominance identifies the preferred 'lead eye' for focusing on a target but alone is insufficient for ocular dominance assessment.
• Sensory dominance test ('resistance to blur') measures strength of dominance by introducing +1.00 D blur over each eye binocularly.
• Combining both tests aids in confirming dominance, especially when eyes have unequal correctability or alternating dominance depending on task and distance.

Guideline-Based Recommendations

Diagnosis

• Use the hole-in-card test to determine sighting dominance.
• Perform sensory dominance test by adding +1.00 D over each eye alternately with best distance correction to assess dominance strength.
• Evaluate dominance at near to identify preferred eye for near visual tasks.

Management

• For monovision fitting, minimize disparity between eyes by prescribing most plus for best distance vision and least plus for best near vision.
• Consider dominant eye preference for near vision when near tasks are critical, fitting that eye for near correction.
• Use modified monovision approaches in multifocal rigid gas permeable lenses, such as adding +0.50 D to non-dominant eye distance correction to improve intermediate vision.
• Aim for full best-corrected visual acuity in dominant eye and no more than 2-line reduction in non-dominant eye when fitting multifocal lenses.

Monitoring & Follow-up

• Assess patient visual comfort under binocular conditions in normal room illumination.
• Monitor adaptation speed and visual performance with minimized interocular correction disparity.

Risks

• Monovision may reduce stereopsis and reading speed; best suited for part-time social wearers without high stereopsis demands.

Patient & Prescribing Data

Presbyopic contact lens wearers with varying ocular dominance and visual demands

Tailoring lens power based on combined dominance testing improves adaptation, visual comfort, and satisfaction, especially in monovision and multifocal fittings.

Clinical Best Practices

• Employ both sighting and sensory dominance tests to accurately determine ocular dominance.
• Consider task-specific dominance, especially near vision preference, when prescribing lenses.
• Aim for minimal correction disparity between eyes to enhance adaptation in monovision fittings.
• Use modified monovision strategies in multifocal rigid gas permeable lens fittings to optimize intermediate vision.
• Evaluate binocular visual comfort in typical lighting conditions before finalizing lens prescription.

References

• Robboy MW, Cox IG, Erickson P. Effects of sighting and sensory dominance on monovision high and low contrast visual acuity. CLAO J. 1990;16(4):299-301.