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Monovision implantation corrects postop presbyopia with less dysphotopsia
Pseudophakic mini-monovision compared favorably with multifocal IOL implantation in the correction of presbyopia after cataract surgery, according to a study.
The prospective, randomized trial included 38 patients who underwent monovision correction and 37 who underwent multifocal IOL implantation.
Patients in the monovision group received an AcrySof IQ SN60WF foldable hydrophilic acrylic IOL (Alcon) in the capsular bag. Patients in the multifocal IOL group underwent bilateral implantation of an iSert PY60MV implant (Hoya Surgical Optics).
Researchers assessed uncorrected and corrected distance visual acuity, Visual Function Index-14 (VF-14) scores and spectacle independence preoperatively and at 6 months postoperatively.
Binocular uncorrected distance visual acuity improved from 0.28 to 0.95 in the monovision group, and from 0.31 to 0.92 in the multifocal IOL group. Both improvements were considered statistically significant, according to the researchers (P < .01).
Both groups had similar postoperative binocular uncorrected distance visual acuity, binocular uncorrected near visual acuity, contrast sensitivity and stereopsis. Additionally, VF-14 scores improved similarly in both groups, the researchers found.
Patients in the monovision group had fewer unwanted shadows and less glare than those in the multifocal IOL group. However, patients in the multifocal IOL group reported significantly less spectacle dependence for near vision (P < .01). Both groups had low rates of spectacle dependence for distance vision.
Disclosure: The authors have no relevant financial disclosures.
Perspective
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The authors compared visual outcomes in patients implanted with an aspheric refractive multifocal IOL versus mini-monovision with aspheric monofocal IOLs, with the dominant eye targeted at −0.5 D and the non-dominant eye at −1.25 D. The multifocal group showed better near vision and significantly higher spectacle independence, whereas the monovision cohort reported fewer visual disturbances and maintained reasonable overall spectacle independence. Each strategy, therefore, has associated strengths and weaknesses, which should be discussed with patients, along with assessing specific ocular characteristics that may exacerbate side effects inherent to either strategy.