Truth or Myth:

The preferred sighting method is the best

way of measuring ocular dominance?
Answer: MYTH
Junghee Seo, OD, Kurt Moody, OD, FAAO

Introduction: Professional Belief Survey Results:

Soft contact lens options for presbyopes include A recent survey of 1028 Eye Care Professionals
monovision and multifocal (MF) contact lenses conducted in 2021 in Russia and in 2022 for the
(CLs). other markets, assessed the prescribing beliefs of
An international CL prescribing survey conducted ECPs in all six countries. This survey reported
in 2022 reported that these two lens modalities that 61% of eye care practitioners used the
accounted for 21% of all soft contact lens fittings.1 preferred sighting method to determine ocular
Looking specifically at presbyopic contact lens dominance.3 This method was largely used by all
wearers, 53% were fit in MF and 7% in the markets surveyed (Figure 1).3
monovision lenses.1 An interesting comparison
would be the country difference; the US mix is What the Evidence Shows:
30% multifocal and 31% monovision whereas
Preferred sighting—also known as the hole-in-
Greece is 80% multifocal and 0% monovision.1
card method—is a type of motor ocular
When fitting monovision contact lenses, the
dominance test typically conducted using the
dominant eye is optimally corrected for distance
patient’s hands. Some publications report that it is
and the non-dominant eye for near.
the preferred method used to determine ocular
At times to extend the depth of focus with MF
dominance as it is quick and simple.4,5 However,
lenses the fitter will add plus power or disparity to
most MF contact lens manufacturers’ guidelines
the non-dominate eye to optimize near vision. It
as well as other publications recommend using
has been noted that as the amount of disparity
the blur test to achieve a successful fitting. This is
increases binocular summation decreases and
a sensory ocular dominance test that uses a
this decease can be even greater when it is
+1.00DS or +1.50DS lens over each eye under
applied to the dominant versus the non-dominant
binocular viewing conditions to evaluate ocular
eye.2 Thus, determination of ocular dominance is
dominance. The blur test is preferred as it
an important component to assess during
provides a more accurate representation of
presbyopic contact lens fittings.

Figure 1. Results showing extent of agreement or disagreement with the statement “I use the
preferred sighting method to measure ocular dominance during soft multifocal fitting.”
Data is from 2022 for all markets except Russia which is from 2021.

Statement Agreement by Country (% ECPs):

Strongly disagree 1 2 3 4 5 Strongly agree

USA (n=284) UK (n=143) Russia (n=151) China (n=150) Japan (n=150) South Korea
(n=150)

17% 65% 31% 48% 7% 39% 1% 52% 9% 1%

61% 75%

© Johnson & Johnson Vision Care, Inc. 2023

presbyopic viewing conditions, as it simulates the
addition of disparity and determines which eye Conclusion:
has the greater sensitivity to plus defocus.4,5,6
While commonly used by practitioners, the
Studies comparing the preferred sighting and blur preferred sighting technique may not be an
tests have found ocular dominance agreement to accurate measure of true ocular dominance as
range from only 40% to 52.3% among it can vary depending on the angle of gaze.9 In
presbyopes,4,6 and 50% to 58% among non- one study, subjects demonstrated a reversal in
presbyopes.5,6 Therefore, there is no clinical ocular dominance when the horizontal gaze
correlation among these two types of tests.5-7 In angle was 15.5° away from primary gaze.9
fact, one study found a statistically significant Ocular dominance can also vary depending on
difference in dominance where 71% and 54% of factors like attention level and testing
the same subjects were determined to be right conditions.10 The blur test can mitigate many of
eye dominant by the preferred sighting test and these disadvantages as it is conducted with
blur test, respectively.6 Thus, the use of both both eyes open and simulates the addition of
sighting and sensory ocular dominance tests to disparity and is therefore the most commonly
measure dominance is not recommended due to recommended and preferred test for successful
the variability between them. It has been MF CL fitting.4,6
demonstrated that, even among different tests of
motor ocular dominance, there is low to
moderate agreement.8
Dr Junghee Seo is a Clinical Associate at the
Centre for Ocular Research & Education,
School of Optometry & Vision Science,
University of Waterloo. Dr. Kurt Moody is
Director of Professional Education
North America for Johnson & Johnson
Vision Care, Inc.

References:
1. Morgan PB, Woods CA, Tranoudis IG, et al. International contact lens prescribing in 2022. Contact Lens Spectrum. 2023;
38: 28-35.
2. Pardham S, Gilchrist J. The effect of monocular defocus on binocular contrast sensitivity. Ophthal. Physiol. Opt. 1990;
(10): 33-36.
3. Johnson & Johnson Vision Care. Online survey of 1028 Eye Care Professionals across United States, United Kingdom,
Russia, China, Japan and South Korea. Data on file 2021 (Russia) and 2022 (other markets).
4. Evans BJ. Monovision: a review. Ophthal. Physiol Opt. 2007; 27(5): 417-439.
5. Seijas O, Gómez de Liaño P, Gómez de Liaño R, Roberts CJ, Piedrahita E, Diaz E. Ocular dominance diagnosis and its
influence in monovision. Am J Ophthalmol. 2007; 144(2): 209-216.
6. Pointer JS. Sighting versus sensory ocular dominance. J Optom. 2021; 5: 52-55.
7. Lopes-Ferreria D, Neves H, Queiros A, Faria-Riberio M, Peixoto-de-Matos SC, González-Méijome JM. Ocular dominance
and visual function testing. Biomed Res Int. 2013; Article ID 238943.
8. Rice ML, Leske DA, Smestad CE, Holmes JM. Results of ocular dominance testing depend on assessment method.
J AAPOS. 2008; 12(4): 365-369.
9. Khan AZ, Crawford JD. Ocular dominance reverses as a function of horizontal gaze angle. Vision Research. 2001; 41:
1743-1748.
10. Ooi TL, He ZJ. Binocular rivalry and visual awareness: the role of attention. Perception. 1999; 28: 551-574.

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© Johnson & Johnson Vision Care, Inc. 2023