Secondary IOL implantation for an aphakic patient with congenital cataract living in Bonin Islands; follow-up study.

Introduction: We previously reported a case of a patient with bilateral congenital cataract identified in the Ogasawara village, Bonin Islands, Japan, on a visit by an ophthalmologist and describe its course over 17 years from initial surgery. Here, we report on a secondary intraocular lens (IOL) implantation that was subsequently performed at 22 years and 5 months of age. Methods: After cataract surgery at 7 months, the aphakic patient began amblyopia treatment using extended-wear soft contact lenses (SCLs). After 10 years of age, SCLs were chosen to achieve crossed monovision considering the cosmetic appearance when facing other people. At 22 years of age, a secondary IOL implantation was performed. Secondary implant in the patient considered appearance and postoperative vision without glasses, we selected the crossed monovision method using a monofocal IOL. The postoperative targeted refraction for the right (non-dominant eye) and left eyes (dominant eye) planed - 0.33D and - 2.25D, respectively. Results: At 3 months after surgery, the corrected distance visual acuity (CDVA) with IOLs for the right and left eyes was 20/16 and 20/60, respectively, and the binocular visual acuity was 20/16 for distant vision and 20/25 for near vision. The CDVA for the right eye was: 20/13 × IOL = sph-0.25D and that for the left eye was: 20/13 × IOL = sph -1.75D D/cyl -0.50D/Ax170°. Although the exotropia was complicated by dissociated horizontal deviation and dissociated vertical deviation, there were no significant changes in ocular position before and after surgery. The patient was satisfied with achieving independence from spectacles and SCLs. Conclusion: The use of the crossed monovision method with monofocal IOLs in this patient and defective binocular function created a visual environment with no inconvenience in everyday life after secondary IOL implantation. In terms of secondary implant after amblyopia treatment, the IOL type or postoperative targeted refraction must be chosen to maintain or improve the visual environment obtained with the amblyopia treatment.

Clinical Outcomes and Patient Satisfaction of an Enhanced Depth of Focus Intraocular Lens Targeted for Mini-Monovision.

Purpose: To assess the clinical outcomes, the rate of spectacle independence, and patient satisfaction of an enhanced depth of focus (EDOF) LuxSmart™ IOL targeted for mini-monovision in patients who had undergone bilateral cataract surgery. Methods: Twenty patients underwent bilateral LuxSmart IOL implantation with the non-dominant eye targeted for -0.50 diopters. Best-corrected distance (CDVA) and uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA) at 66 cm, uncorrected near visual acuity (UNVA) at 40 cm, and defocus curve were assessed. Patient-reported visual function was inquired by Catquest-9SF, and the rate of spectacle independence in all daily-life activities was calculated. The presence of photic phenomena was evaluated. A p-value lower than 0.05 was considered statistically significant. Results: The mean IOL power was +21.50 ± 4D (16.5-26D), and all were non-toric. Thirty-seven (92.5%) eyes were within ±0.5D of predicted target. The postoperative MRSE was 0.06 ± 0.42D and -0.45 ± 0.22D in dominant and non-dominant eyes. Every patient achieved distance binocular vision better than 0.1 logMAR. The non-dominant eyes showed lower CDVA (p<0.001). The UIVA was higher in non-dominant eyes (p<0.001). Binocular uncorrected near visual acuity was 0.12 ± 0.1, and uncorrected near visual acuity was higher in non-dominant eyes (p<0.001). LuxSmart IOL provided a sustained visual acuity of 0.3 logMAR or better between +1.00D and -2.50D. A total of 25% of patients reported frequent halos and glare. Despite achieving higher degrees of satisfaction, seven patients (35%) denied total spectacle independence in their daily-life activities, particularly for activities requiring continuous near vision. Conclusion: This study shows that LuxSmart EDOF IOL in mini-monovision strategy performs well for distance and intermediate vision. Although visual acuity for near also achieved very good results, the considerable rate of spectacle dependence, in particular for near, and the rate of photic phenomena do not support this IOL to be safely implanted in patients desiring spectacle independence at time of cataract surgery.

Clinical Outcomes after Bilateral Implantation of a Wavefront-Shaping Extended Depth of Focus (EDOF) IOL with Mini-Monovision.

Background: To compare the visual outcomes and optical quality of patients who underwent bilateral implantation of EDOF (AcrySof® IQ Vivity IOL, DFT015) for mini-monovision, trifocal (AcrySof® IQ PanOptix, TNFT00), or monofocal (AcrySof® IQ IOL, SN60WF) IOL. Methods: The monocular-corrected and uncorrected distance visual acuities (CDVA and UDVA, respectively) were evaluated postoperatively at 1 and 3 months. The binocular visual acuity by distance, the binocular defocus curve, contrast sensitivity, and patient satisfaction were examined 3 months postoperatively. All patients were asked to complete questionnaires regarding their satisfaction, visual symptoms, and spectacle dependency. Results: This study included 178 eyes from 89 patients. The postoperative binocular UDVA did not differ significantly among the three groups. In the defocus curve, the Vivity group showed better visual acuity over a range of far and intermediate (60 cm) than the other two IOLs groups. In near-vision, the PanOptix group showed the best near-vision, and the Vivity group showed significantly better vision than the IQ group. The Vivity group showed contrast sensitivity and optical quality comparable to the IQ group. Conclusions: The bilateral implantation of AcrySof® IQ Vivity IOL with the mini-monovision approach provided excellent distance and intermediate visual acuity with good near-vision, resulting in high satisfaction.

BCLA CLEAR Presbyopia: Definitions.

Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education.

BCLA CLEAR Presbyopia: Management with contact lenses and spectacles.

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike.

Long-term Results after Bilateral Implantation of Extended Depth of Focus Intraocular Lenses with Mini-Monovision.

PURPOSE: To assess long-term clinical results following bilateral Tecnis Symfony ZXR00 intraocular lens implantation with mini-monovision. METHODS: The medical records of cataract patients who underwent bilateral implantation of ZXR00 with intended mini-monovision (target refraction of -0.3 diopters [D] in dominant eye and -0.6 D in nondominant eye) between April 2019 and March 2021 were assessed. Postoperative uncorrected distance visual acuity (UDVA), corrected distance VA (CDVA), uncorrected intermediate VA (UIVA), uncorrected near VA (UNVA), and rate of spectacle dependence for near distance were investigated at 3 months and 2 years after surgery. RESULTS: This study included 61 patients (122 eyes) with average age of 61.8 ± 7.7 years. At 2 years postoperatively, binocular logarithm of the minimum angle of resolution UDVA, UIVA, UNVA, and CDVA were 0.086 ± 0.094, 0.056 ± 0.041, 0.140 ± 0.045, and 0.012 ± 0.024, respectively. The monocular manifest refraction spherical equivalent was -0.31 ± 0.38 in the dominant eye and -0.53 ± 0.47 in the nondominant eye at 3 months postoperatively, and -0.38 ± 0.43 in the dominant eye and -0.61 ± 0.54 in the nondominant eye at 2 years postoperatively. Eight out of 61 patients (13.1%) needed glasses 3 months after surgery, and nine out of 61 patients (14.8%) needed glasses 2 years after surgery. CONCLUSIONS: The bilateral implantation of ZXR00s with mini-monovision allows for a good VA at wide range of distance from far to near, thereby resulting in high rate of spectacle independence. These results have held up well even after 2 years after surgery.

Unilateral intraindividual comparison and bilateral performance of a monofocal spherical and diffractive extended depth of field intraocular lens mix-and-match approach.

BACKGROUND: To evaluate the intraindividual visual performance of a spherical and extended depth of field (EDOF) IOL used in a mix-and-match approach. METHODS: Single centre (tertiary care centre), retrospective consecutive case series. Included patients had uneventful cataract surgery with implantation of a spherical monofocal IOL (CT Spheris 204) in the dominant eye and a diffractive EDOF IOL (AT LARA 829) in the non-dominant eye. Monocular and binocular defocus curves and visual acuity at various distances were assessed. In addition, binocular reading speed, contrast sensitivity, and patient satisfaction using QOV, Catquest 9SF, and glare/halo questionnaires are reported. RESULTS: A total of 29 patients (58 eyes) were included. We observed significant intra-individual differences for monocular DCIVA, DCNVA, UIVA, and UNVA. There were no differences in monocular BCDVA or UDVA. The monocular defocus curves for the two IOLs significantly differed at defocus steps between -1.0 and -3.5 D. 93.10% of patients reported they would opt for the same combination of IOLs. CONCLUSION: Excellent uncorrected and corrected distance visual acuity was demonstrated in both groups. The mix-and-match approach described in this study yielded good intermediate vision and improved near vision with high-patient satisfaction.

Ocular dominance in cataract surgery: research status and progress.

Ocular dominance (OD), a commonly used concept in clinical practice, plays an important role in optometry and refractive surgery. With the development of refractive cataract surgery, the refractive function of the intraocular lens determines the achievement of the postoperative full range of vision based on the retinal defocus blur suppression and binocular monovision principle. Therefore, OD plays an important role in cataract surgery. OD is related to the visual formation of the cerebral cortex, and its plasticity suggests that visual experience can influence the visual system. Cataract surgery changes the visual experience and transforms the dominant eye, which confirms the plasticity of the visual system. Based on the concept and mechanism of OD, this review summarizes the application of OD in cataract surgery.

Comparing Visual Performance and Subjective Outcomes with an Enhanced Monofocal Intraocular Lens When Targeted for Emmetropia or Monovision.

Purpose: To evaluate relative visual performance and subjective outcomes after implantation of the TECNIS Eyhance™ intraocular lens (IOL) targeted for bilateral emmetropia or monovision. Methods: This was a prospective, single-center randomized, patient-masked trial. Patients were implanted with the enhanced IOL targeted for bilateral emmetropia or slight monovision (-0.75 D in the non-dominant eye). At 3 months the binocular visual acuity (VA) was measured at distance, intermediate and near, along with low contrast VA in photopic and mesopic conditions, and the distance corrected defocus curve. Questionnaires related to spectacle independence, satisfaction, visual symptoms, and functional vision were administered. Results: Data from 71 subjects (34 Emmetropia, 37 Monovision) were analyzed. There was no difference in the mean uncorrected distance VA (p = 0.11), but uncorrected intermediate and near VAs were one line better in the Monovision group (p = 0.02 and 0.01, respectively). Mesopic and photopic low contrast VA were similar between groups. There was a trend for less difficulty and higher satisfaction with near and intermediate vision in the Monovision group, but no significant differences in any of the subjective questionnaires. Difficulty reading was the most reported concern in both groups, though 93% of all subjects reported "little" or "no" difficulty with daily activities. Overall, 82% of subjects were "completely" or "very" happy with their lens choice. Conclusion: Using this enhanced IOL with slight monovision in the non-dominant eye increased intermediate and near VA with no apparent effect on low contrast distance VA, subjective visual quality, or satisfaction.

Comparison of bilateral implantation of an extended depth of focus lenses and a blend approach of extended depth of focus lenses and bifocal lenses in cataract patients.

BACKGROUND: To compare the visual outcomes, spectacle independent rate and stereopsis in patients who underwent bilateral implantation of extended depth of focus (EDOF) intraocular lens (IOL), or a blend approach of EDOF and bifocal IOL. METHODS: A total of 60 cataract patients, who were scheduled for phacoemulsification and intraocular lens implantation in both eyes in West China Hospital of Sichuan University, were enrolled and divided into Micro monovision group(-0.5D~-1.0D), Non-micro monovision group (< 0.5D) with Symfony IOL, and Mixed group with Symfony and ZMB00 IOLs. Three months postoperatively, we compared the visual acuity, modulation transfer function (MTF), defocus curve, stereopsis, spectacle independence, and photic phenomena among the three groups. RESULTS: Compared to the Non-micro monovision group (UNVA: 0.07 ± 0.04), Micro monovision group (UNVA: 0.00 ± 0.07, P < 0.001) and Mixed group (UNVA: -0.02 ± 0.06, P < 0.001) showed improvement in binocular uncorrected near visual acuity (UNVA). Additionally, Mixed group exhibited lower MTF10 (MTF10: 0.38 ± 0.24) and point spread function (PSF: 0.192 ± 0.269) results in their non-dominant eye compared to both Micro monovision group (MTF10: 0.56 ± 0.21, P = 0.027; PSF: 0.417 ± 0.282, P = 0.034) and Non-micro monovision group (MTF10: 0.55 ± 0.19, P = 0.038; PSF: 0.408 ± 0.285, P = 0.003). Spectacle independence for near vision were higher in both the Micro monovision (45%) and Mixed (55%) group compared to the Non-micro monovision group (40%). The Mixed group also reported higher incidence of photic phenomena (25%). However, there were no significant differences in stereoscopic function among the three groups. CONCLUSION: Both micro monovision and mix-and-match methods can help patients to obtain better visual outcomes at different distances. Mix-and-match method has better near visual acuity, while micro monovision method has better intermediate visual acuity. Non-micro monovision methods will affect patients' near vision outcomes. Binocularly implanted EDOF IOL has better contrast sensitivity. CLINICAL TRIAL REGISTRATION: Registration date:11/07/2023. TRIAL REGISTRATION NUMBER: ChiCTR2300073433. TRIAL REGISTRY: West China Hospital of Sichuan University retrospectively registered.

IRIS® Registry (Intelligent Research In Sight) Analysis of the Incidence of Monovision in Cataract Patients with Bilateral Monofocal Intraocular Lens Implantation.

Purpose: To determine the incidence of pseudophakic monovision among patients bilaterally implanted with monofocal intraocular lenses (IOLs) and to characterize the distribution of myopic offsets achieved. Patients and Methods: This retrospective database study included data on patients receiving care from ophthalmologists who contributed to the Academy IRIS® (Intelligent Research In Sight) Registry. Anonymized data were collected, including patient age, ethnicity, procedure data (CPT code, date, laterality), and postoperative manifest refractive spherical equivalent (MRSE) in both eyes implanted with monofocal or monofocal toric IOLs. No data regarding IOL manufacturer, model, or power were collected. One primary outcome measure was the percentage of patients achieving monovision (defined as emmetropia within ±0.25 diopters [D] in one eye and a myopic offset of ≥0.50 D in the fellow eye) among all patients receiving bilateral monofocal IOLs at the time of cataract surgery between January 1, 2016, and September 1, 2019, with at least 90 days of follow-up. Other primary outcomes included the distribution and frequency of myopic offsets (anisometropia) between eyes. Results: Of the 16,765 people receiving bilateral monofocal IOLs within the study period, 4796 (28.6%) achieved emmetropia in at least one eye, as defined by an MRSE within ± 0.25 D. The incidence of monovision among these patients was 34.2% (1638/4796). One-quarter (24.7%; 405/1638) of patients who achieved monovision had a myopic offset between 0.50 and 0.74 D, with more than one-third (35.2%; 576/1638) falling within 0.75-1.24 D and 18.0% within 1.25-1.74 D. A myopic offset ≥1.75 D was observed in 22.1% (362/1638) of patients who achieved monovision. Conclusion: Pseudophakic monovision for presbyopia correction was achieved in ~34% of patients in the IRIS Registry bilaterally implanted with monofocal IOLs, with myopic offsets typically ranging from 0.5 to 1.24 D.

Exploring the Effect of Preoperative Stereopsis on Visual Outcomes in Hyperopic Presbyopes Treated with PresbyOND® Laser Blended Vision Micro-Monovision.

We investigated the effects of Laser Blended Vision (LBV) on binocular summation and stereopsis in the treatment of presbyopia and hyperopia. Using a unidirectional, retrospective longitudinal design, data from 318 patients who underwent the Zeiss PresbyOND® LBV surgical procedure at Tecnolaser Clinic Vision Ophthalmology Center in Seville, Spain, were analyzed. The findings indicate that stereopsis quality significantly influenced short-term post-operative visual outcomes in measures like Uncorrected Distance and Near Visual Acuity (UDVA and UNVA). However, the impact of stereopsis on visual outcomes appeared to diminish over time, becoming statistically insignificant at the 12-month post-operative mark. The study suggests that while stereopsis is a crucial factor in the short term, its influence on visual outcomes tends to wane in the long-term postoperative period. Future studies are essential to elucidate the enduring clinical ramifications of these observations.

Binocular imbalance in patients after implantable collamer lens V4c implantation or femtosecond laser-assisted in situ keratomileusis for myopia with presbyopia.

Aim: To investigate the long-term safety, efficacy, and binocular balance of monovision surgery using Implantable Collamer Lens (ICL) V4c implantation and Femtosecond Laser-Assisted in situ Keratomileusis (FS-LASIK) for the treatment of myopic patients with presbyopia. Methods: This case series study involved 90 eyes of 45 patients (male/female = 19/26; average age:46.27 ± 5.54 years; average follow-up time:48.73 ± 14.65 months) who underwent the aforementioned surgery to treat myopic presbyopes. Data on manifest refraction, corrected distance visual acuity, dominant eye, presbyopic addition, intraocular pressure, and anterior segment biometric parameters were collected. The visual outcomes and binocular balance at 0.4 m, 0.8 m, and 5 m were documented. Results: The safety index for the ICL V4c and FS-LASIK groups were 1.24 ± 0.27 and 1.04 ± 0.20 (p = 0.125), respectively. Binocular visual acuity (logmar) for 0.4 m, 0.8 m, and 5 m were -0.03 ± 0.05, -0.03 ± 0.02, and 0.10 ± 0.03 for the ICL V4c group, and -0.02 ± 0.09, -0.01 ± 0.02, and 0.06 ± 0.04 for the FS-LASIK group, respectively. The proportions of all patients with imbalanced vision at 0.4 m, 0.8 m, and 5 m distances were 68.89, 71.11, and 82.22%, respectively (all p > 0.05 between the two groups). There were significant differences in refraction between the balanced and imbalanced vision for patients at 0.4 m distance (for non-dominant eye spherical equivalent [SE]: -1.14 ± 0.17D and -1.47 ± 0.13D, p < 0.001), 0.8 m distance (for preoperative ADD:0.90 ± 0.17D and 1.05 ± 0.11D, p = 0.041), and 5 m distance (for non-dominant SE: -1.13 ± 0.33D and -1.42 ± 0.11D, p < 0.001). Conclusion: ICL V4c implantation and FS-LASIK monovision treatment demonstrated good long-term safety and binocular visual acuity at various distances. After the procedure, the imbalanced patients' vision is primarily related to the age-related presbyopia and anisometropia progression caused by the monovision design.

Case report of the evidence of a spontaneous Reverse Pulfrich effect in monovision after cataract surgery.

BACKGROUND: Cataracts affect the optics of the eye in terms of absorption, blur, and scattering. When cataracts are unilateral, they cause differences between the eyes that can produce visual discomfort and harm binocular vision. These interocular differences can also induce differences in the processing speed of the eyes that may cause a spontaneous Pulfrich effect, a visual illusion provoking important depth misperceptions. Interocular differences in light level, like those present in unilateral cataracts, can cause the Classic Pulfrich effect, and interocular differences in blur, like those present in monovision, a common correction for presbyopia, can cause the Reverse Pulfrich effect. The visual system may be able to adapt, or not, to the new optical condition, depending on the degree of the cataract and the magnitude of the monovision correction. CASE PRESENTATION: Here, we report a unique case of a 45-year-old patient that underwent unilateral cataract surgery resulting in a monovision correction of 2.5 diopters (D): left eye emmetropic after the surgery compensated with a monofocal intraocular lens and right eye myopic with a spherical equivalent of -2.50 D. This patient suffered severe symptoms in binocular vision, which can be explained by a spontaneous Pulfrich effect (a delay measured of 4.82 ms, that could be eliminated with a 0.19 optical density filter). After removing the monovision with clear lens extraction in the second eye, symptoms disappeared. We demonstrate that, at least in this patient, both Classic and Reverse Pulfrich effects coexist after unilateral cataract surgery and that can be readapted by reverting the interocular differences. Besides, we report that the adaptation/readaptation process to the Reverse Pulfrich effect happens in a timeframe of weeks, as opposed to the Classic Pulfrich effect, known to have timeframes of days. Additionally, we used the illusion measured in the laboratory to quantify the relevance of the spontaneous Pulfrich effect in different visual scenarios and tasks, using geometrical models and optic flow algorithms. CONCLUSIONS: Measuring the different versions of the Pulfrich effect might help to understand the visual discomfort reported by many patients after cataract surgery or with monovision and could guide compensation or intervention strategies.

Bilateral simultaneous cataract surgery and intraocular lens implantation in an adult female chimpanzee (Pan troglodytes) inducing monovision.

BACKGROUND: Cataract is the major cause of visual impairment in humans. Phacoemulsification with intraocular lens (IOL) implantation is the standard technique for cataract treatment with a high success rate. In a few cases, the surgical cataract procedure and lens implantation have been applied in non-human primates. CASE DESCRIPTION: A +/- 40-year-old female chimpanzee (Pan troglodytes) in captivity was diagnosed with mature cataract optical density (OD) and posterior subcapsular cataract combined with cortical opacities OS after ophthalmic examination. To restore vision and facilitate far- and near sight, phacoemulsification OU with +22.5 diopter (D) IOL implantation OD and + 24 D OS were performed. Despite complicated surgery OD due to posterior capsular rupture, the outcome was successful during 1-year follow-up. The chimpanzee regained adequate vision, normal behavior, and was successfully re-introduced to her group of chimpanzees. CONCLUSION: This is the first case report of a simultaneous bilateral cataract surgery with IOL implantations in both eyes, targeting emmetropia OS and near vision OD resulting in monovision, in a chimpanzee. Vision was restored without postoperative complications.

Multifocal versus modified monovision corrections: A non-dispensing comparison of visual assessment in presbyopic neophytes.

Purpose: To compare the visual performance of two simultaneous-vision soft multifocal contact lenses and to compare multifocal contact lens and its modified monovision counterpart in presbyopic neophytes. Methods: A double-masked, prospective, comparative study was conducted on 19 participants fitted with soft PureVision2 multifocal (PVMF) and clariti multifocal (CMF) lenses in random order. High- and low-contrast distance visual acuity, near visual acuity, stereopsis, contrast sensitivity, and glare acuity were measured. The measurements were conducted using multifocal and modified monovision design with one brand and then repeated with another brand of lens. Results: High-contrast distance visual acuity showed a significant difference between CMF (0.00 [-0.10-0.04]) and PureVision2 modified monovision (PVMMV; -0.10 [-0.14-0.00]) correction (P = 0.003) and also between CMF and clariti modified monovision (CMMV; -0.10 [-0.20-0.00]) correction (P = 0.002). Both modified monovision lenses outperformed CMF. The current study did not show any statistically significant difference between contact lens corrections for low-contrast visual acuity, near visual acuity, and contrast sensitivity (P > 0.01). Stereopsis at near distance was significantly lower with both modified monovision (PVMMV: 70 [50-85]; P = 0.007, CMMV: 70 [70-100]; P = 0.006) and with CMF (50 [40-70]; P = 0.005) when compared to spectacles (50 [30-70]). Glare acuity was significantly lower with multifocal (PVMF: 0.46 [0.40-0.50]; P = 0.001, CMF: 0.40 [0.40-0.46]; P = 0.007) compared with spectacles (0.40 [0.30-0.40]), but no significant difference was noted between the multifocal contact lenses (P = 0.033). Conclusion: Modified monovision provided superior high-contrast vision compared to multifocal correction. Multifocal corrections performed better for stereopsis when compared to modified monovision. In parameters like low-contrast visual acuity, near acuity, and contrast sensitivity, both the corrections performed similarly. Both multifocal designs showed comparable visual performances.

Comparison of visual performances of enhanced monofocal versus standard monofocal IOLs in a mini-monovision approach.

PURPOSE: To compare visual performance and quality of life in patients who received either monofocal intraocular lenses (IOLs) or an enhanced monofocal IOL in a mini-monovision target approach. BACKGROUND: Monofocal lenses are the most common intraocular IOLs employed during cataract surgery because of their relatively low cost and good performance for distance sight. However, these lenses, generally, do not exonerate patients from spectacle use for near or intermediate tasks. On the other hand, enhanced monofocal IOLs (e.g., Tecnis Eyhance®) feature optical properties providing patients with good intermediate visual outcomes. Satisfactory near visual acuity results, regardless of IOL type, may be achieved through mini-monovision. We assessed visual performance outcomes between these IOLs, in a mini-monovision approach. METHODS: Retrospective case series of patients who underwent bilateral cataract surgery at our institution with implantation of Alcon SN60WF, J&J Tecnis DCB00 or J&J Tecnis Eyhance® DIB00 with a pre-operative mini-monovision target. The postoperative spherical equivalent was measured by a Nidek® auto-refractometer. Best-uncorrected binocular visual acuity (BUBVA) at far (3 m), intermediate (66 cm), and near (40 cm) distance and binocular contrast sensitivity (100%, 25%, and 5%, all at 1 m) were measured using Snellen and Pelli-Robson charts, respectively. Visual performance in daily life was evaluated with the Cataract VF-14 quality of life survey. RESULTS: 71 patients (35 in the monofocal IOL and 37 enhanced IOL group) were enrolled. Patients implanted with enhanced IOL exhibited statistically significant better BUBVA results at 66 cm and 40 cm distances compared to patients in the monofocal group. Additionally, patients in the enhanced IOL group presented a better contrast sensitivity in lower contrast conditions (5%) than patients with monofocal IOL. The quality of life survey showed statistically significant higher scores in daily activities without spectacles for patients with enhanced IOL. CONCLUSION: Enhanced monofocal IOLs, combined with a mini-monovision approach, provided patients with good visual performance at all tested distances, with superiority of enhanced monofocal IOLs at near and intermediate distances.

Clinical Outcomes of a New Non-Diffractive Extended Depth-of-Focus Intraocular Lens Targeted for Mini-Monovision.

Purpose: To assess visual acuity, binocular defocus curve, spectacle independence, and photic phenomena after bilateral same-day cataract surgery with implantation of an extended depth-of-focus intraocular lens (IOL) with mini-monovision. Methods: Single-center retrospective study including 124 eyes from 62 patients who underwent bilateral implantation of an isofocal EDOF lens [Isopure® (BVI)] with mini-monovision (-0.50 D). Refraction, visual acuity at different distances, binocular defocus curves, spectacle independence, and subjective ratings of picture-referenced photic phenomena were assessed one to two months postoperatively. Results: The mean postoperative refractive spherical equivalent was -0.15±0.41D in the dominant eyes and -0.46±0.35D in the mini-monovision eyes (p<0.01). Overall, 98.4% and 87.7% of the eyes were within ±1.00D and ±0.50D of the target refraction, respectively. Postoperative monocular corrected distance visual acuity was -0.04±0.07 logMAR. Binocular uncorrected visual acuity was -0.02±0.07, 0.13±0.11and 0.40±0.20 logMAR for far, intermediate and near, respectively. At the visual acuity threshold of 0.20 logMAR (or better) the defocus curve ranged from -1.6D to +0.9D. Reported spectacle-independence was 96% for far distance, 95% for intermediate, and 34% for near. Five percent of patients reported halos, 16% starburst, and 16% glare. Only 7% of all patients considered them bothersome. Conclusion: In patients undergoing same-day bilateral cataract surgery, an isofocal EDOF lens provided an extended range of functional vision, up to 63 cm, resulting in useful uncorrected near vision, good uncorrected intermediate vision, and excellent uncorrected distance vision. Subjective patient satisfaction in terms of spectacle independence and photic phenomena was high.

Effectiveness of SMILE Combined with Micro-Monovision in Presbyopic Patients: A Pilot Study.

Binocular summation along all defocus range after a micro-monovision procedure has scarcely been studied. The aim of this pilot study was to evaluate the efficacy of SMILE combined with different levels of micro-monovision in presbyopic patients and to assess the binocular summation effect on contrast sensitivity defocus curves (CSDC) at the 6-month follow-up. Efficacy was assessed on the basis of visual acuity (VA) and stereopsis at far, intermediate, and near distances. Patient-reported outcomes (PROs) and binocular CSDC were also evaluated. Six patients completed the study with a programmed median anisometropia of 0.81 Diopter. The median binocular uncorrected VA was better than 0 logMAR at the three evaluated distances, and stereopsis was not impaired in any patient, achieving a median of ≤119 arcsec at any distance. CSDC increased binocularly after surgery, significantly in the range of -2 to -3 D (p < 0.05). No clinically relevant changes were observed in PROs compared with the preoperative period, and all patients achieved spectacle independence at intermediate/near distance and were likely or very likely to undergo the same surgery. In conclusion, micro-monovision with SMILE could be an effective procedure, with results that might be comparable to other laser correction techniques specifically designed for presbyopia correction.

Intolerance of a non-diffractive extended-depth-of-focus IOL with mini-monovision.

Purpose: The use of a non-diffractive extended-depth-of-focus (EDOF) intraocular lens (IOL) with slight myopia of -0.5 D on the non-dominant eye increases the spectacle independence and has good subjective tolerance with optical phenomena comparable to those of a monofocal IOL. This case report describes the course of a myopic patient who underwent refractive lens exchange, didn't tolerate mini-monovision and received IOL exchange therefore. Observations: A healthy, 62-year-old male with myopia of approximately -5 D underwent refractive lens exchange with a non-diffractive EDOF-IOL on both eyes with slight myopia on the non-dominant left eye (mini-monovision). The operation was performed without any complications, postoperative treatment was due to the clinic's standard procedure. Two weeks postoperative the patient presented with uncorrected distance visual acuity of 0.0 logMAR, a subjective refraction of -0.25/-0.25/142° and corrected distance visual acuity of 0.1 logMAR on the right eye. On the left eye, distance visual acuity was 0.4 logMAR with a subjective refraction of -0.5/-0.75/9° (intended mini-monovision) and corrected distance visual acuity of 0.0 logMAR. Binocular distance visual acuity was 0.0 logMAR. The patient complained about the occurrence of optical phenomena at dim light while driving a car and subjective reduced visual acuity. After an IOL exchange on the left eye with the implantation of the same type of non-diffractive EDOF-IOL aimed for emmetropia, the patient was symptom-free and reported no more subjective complaints. Conclusions: Despite the satisfying subjective and objective visual outcome which is proven in multiple studies, the subjective perception of a mini-monovision with a non-diffractive EDOF-IOL can vary individually. A preoperative assessment of the patient's needs and tolerance of a mini-monovision is crucial for a satisfying postoperative outcome.