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Methods: Twenty subjects with presbyopia performed two standard methods of binary eye dominance identification (sensory with+ 1.50 diopters [D] and+ 0.50 D and sighting with “hole-in-the-card”) and two psychophysical methods of perceived visual quality:(1) the Preferential test, 26 natural images were judged with the near addition in one eye or in the other in a 2-interval forced-choice task, and the Eye Dominance Strength (EDS) defined as the proportion of trials where one monovision is preferred over the other;(2) the Multifocal Acceptance Score (MAS-2EV) test, the perceived quality of a natural images set (for 2 luminance levels and distances) was scored and EDS defined as the score difference between monovision in one eye or the other. Left-eye and right-eye dominance are indicated with negative and positive values, respectively. Tests were performed using a Simultaneous Vision Simulator, which allows rapid changes between corrections.

Results: Standard sensory and sighting dominances matched in only 55% of subjects. The Preferential EDS (ranging from− 0.7 to+ 0.9) and MAS-2EV EDS (ranging from− 0.6 to+ 0.4) were highly correlated. Selecting the eye for far in monovision with the MAS-2EV, sensory, or sighting tests would have resulted in 79%, 64%, and 43% success considering the Preferential test as the gold standard.

Conclusions: Tests based on perceptual preference allow selection of the preferred monovision correction and measurement of dominance strength.

Translational Relevance: The binocular visual simulator allows efficient implementation of eye preference tests for monovision in clinical use.