Monovision promising for presbyopia correction in cataract patients, surgeon says

BUENOS AIRES — Creating monovision using monofocal IOLs can be a viable alternative to multifocal lenses for correcting presbyopia in cataract surgery patients, according to a surgeon speaking here.

"Monovision is widely practiced in cataract surgery in pseudophakia, but surprisingly there is little published data in the literature," said Graham D. Barrett, FRACO, in a presentation at the Argentinean Society of Ophthalmology Congress. One study found that 92% of patients achieved 20/30 and J1 uncorrected visual acuity, with a 90% acceptance rate, he noted.

Dr. Barrett is conducting a prospective study evaluating monovision in presbyopic patients undergoing cataract surgery. In the study, each patient's dominant eye is corrected to emmetropia, while the nondominant eye is left with 1 D of myopia.

Initial results for 14 patients are "encouraging," Dr. Barrett said, noting that patients are reporting high levels of satisfaction.

Overall, 80% of patients achieved an unaided binocular near visual acuity of N6 or better, and all patients achieved N8 or better near visual acuity. Unaided distance vision was also "excellent," with 80% of patients achieving 20/20 distance visual acuity and all patients achieving at least 20/30, he said.

Dr. Barrett initiated the prospective study after a retrospective review of patients with residual myopia still had good distance and near vision, despite an intended emmetropic correction. Patients with close to –1 D could see 20/30 to 20/40, but could read small print, he said.

"The results suggest ... that pseudo-accommodation with monofocal implants does exist," he said.

Dr. Barrett noted that there is a significant reduction in the typical stereoacuity and incidence of anisometropia. Also, strong ocular dominance may result in asthenopia.

"Monovision should be considered as a viable alternative for improving unaided near vision in pseudophakia," he said. "I recommend aiming for 1 D of myopia in the nondominant eye as a useful strategy to avoid some of the limitations we have discussed."