<p>Spectacle Independence And Patient Satisfaction With Pseudophakic Mini-Monovision Using Aberration-Free Intraocular Lens</p>

Abstract

PurposeTo assess spectacle independence and patient satisfaction with pseudophakic mini-monovision in patients undergoing routine bilateral cataract surgery with implantation of an aspherical aberration-free intraocular lens (Akreos AO, Bausch and Lomb, USA).MethodsThis study was a retrospective analysis that included 60 eyes of 30 consecutive patients between 2016 and 2018. The included patients had undergone sequential bilateral routine phacoemulsification after choosing the mini-monovision option. Test for ocular dominance was done using a sighting test. Emmetropia was aimed at in the dominant eye, while in the non-dominant eye the aim was myopia between −1 D and −1.5 D. The main outcome parameters were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and data reported from a questionnaire given to the patients at 3 months postoperative visit.ResultsThe study included 60 eyes of 30 consecutive patients. The mean binocular UDVA was 0.09 ± 0.07 logMAR. Twenty-eight patients (93%) had binocular UDVA of 0.2 logMAR or better. The mean binocular uncorrected intermediate distance visual acuity (at 65 cm) was 0.16 ± 0.12 logMAR. Twenty-six patients (87%) had binocular uncorrected intermediate distance visual acuity of 0.2 logMAR or better. The mean binocular UNVA (at 35 cm) was 0.30 ± 0.21 logMAR. Fourteen patients (47%) had binocular UNVA of 0.2 logMAR or better. The patients score in the questionnaire was significantly higher in far and intermediate vision than near vision (p = 0.022). The patients score was significantly higher in day vision than night vision (p = 0.031). The mean overall patient satisfaction was good (9.1 ± 1.54). Twenty-eight patients (93%) reported high spectacle independence for far vision (score 8, 9, or 10).ConclusionPseudophakic mini-monovision shows good results for spectacle independence and high patient satisfaction. It is a safe and inexpensive option after bilateral cataract surgery for correcting distance and intermediate vision. However, it might show lower results with near and night vision which is generally acceptable. Using aberration-free monofocal IOL allows for the residual normal positive corneal aberration that may augment the effect of monovision.

The Effect of Spectacle-Induced Low Myopia in the Non-Dominant Eye on the Binocular Defocus Curve with a Non-Diffractive Extended Vision Intraocular Lens

“…Results with this lens and the levels of monovision tested appear better than were achieved with an aberration free lens based on spherical aberration that included a higher level of monovision in the non-dominant eye (mean −1.38 D). 11 The defocus curves with −0.50 D and −1.00 D in the non-dominant eye both also appear better than results for the IC-8 small aperture lens with 0.75 D of monovision 17 and the Symfony lens with various levels of monovision. 9 , 18 These results may be in part a function of the longer range of vision with the Vivity IOL measured here when both eyes were corrected for emmetropia.…”

“…Modifying the spherical aberration (SA) of an IOL can also produce an extended depth of focus effect. Several different designs incorporating this technology have been developed, including an “aberration free IOL” that counts on the naturally occurring corneal SA to produce an EDOF effect, 11 and an IOL that alternates annular zones of positive and negative spherical aberration. 12 There are limits to the range of focus that can be produced in this manner, as higher levels of SA will reduce the overall quality of vision and result in halos.…”

Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia

“…According to reports, emmetropia in DE and slight myopia (À0.75 to À1.50 D) in the fellow NDE are welltolerated by patients because fusion, stereopsis, and contrast sensitivity are not compromised as previously suggested. 7,[14][15][16] According to our results, cataract surgery with minimonovision in hyperopic presbyopes is a low-cost approach that not only improves UDVA but also offers reduced spectacle dependence for near vision. Our rates of complete spectacle independence with pseudophakic minimonovision are similar to previous reported outcomes with extended depth of focus or bifocal IOLs (75% of the studied patients declared spectacle independence for all activities with extended depth of focus intraocular lenses and 73% with bifocal IOL implantation).…”

“…However, pseudophakic monovision remains the most popular surgical option for cataract patients with presbyopia. 6,7 To achieve a wide range of functional vision, the dominant eye (DE) is corrected for the distance vision targeting emmetropia, while the non-DE (NDE) is corrected for near-vision intended mild myopia; the principle is to increase the depth of focus while maintaining acceptable stereovision. Aiming for target myopia between À0.75 diopters (D) and À1.50 D in the NDE seems to be the best option (mini-monovision) because smaller degrees of anisometropia are associated with higher stereoacuity.…”

Correlation of Central Macular Thickness and the Best-Corrected Visual Acuity in Three Months After Cataract Surgery by Phacoemulsification and With Intraocular Lens Implantation

“…Cataract surgery using the phacoemulsification method and implantation of an intraocular lens within the capsular bag has been the most widely used surgical procedure by ophthalmologists during this decade [ 1 ]. Patients undergoing cataract surgery nowadays expect spectacle-free, functionally normal vision after surgery [ 2 ]. Therefore, any factor that could hamper the patient’s vision after successful modern cataract surgery must be identified through audit and addressed [ 3 ].…”