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Mini-monovision reduces spectacle dependence, glare after cataract surgery
Satisfaction rates were high among patients who underwent monovision or received multifocal IOLs.
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Pseudophakic mini-monovision compared favorably with bilateral multifocal IOL implantation after cataract surgery, according to a study.
Monovision yielded less dysphotopsia than multifocal IOLs, but multifocal IOLs reduced spectacle dependence more than monovision, the study authors said.
Overall, mini-monovision is the procedure of choice, especially for patients with limited finances, according to Georgios Labiris, MD, PhD, the corresponding author.
Georgios Labiris
“Taking into account the overall cost of the procedure, we consider mini-monovision with myopic defocus as the most cost-efficient approach for a spectacle-free way of living for the majority of tasks that require distant, intermediate and non-demanding near vision,” Labiris said in an interview with Ocular Surgery News.
Labiris and colleagues set out to take a novel approach to monovision that would not impede binocular vision.
“Actually, we wanted to rethink pseudophakic mini-monovision,” he said. “Our main difference from relevant studies was that both eyes received a predetermined, variable, myopic defocus with a maximal inter-eye difference of 1 D. Our therapeutic algorithm, which targeted –0.5 D in the dominant eye and –1.25 D in the recessive one, resulted in highly satisfied patients since it did not interfere with the binocular summation mechanism and with stereoacuity perception.”
The study was published online ahead of print in the Journal of Cataract and Refractive Surgery.
Methods and measures
The prospective, randomized trial included 75 patients who underwent cataract surgery. Thirty-eight patients underwent monovision, and 37 were implanted with multifocal IOLs.
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).
Investigators assessed uncorrected and corrected distance visual acuity, Visual Function Index-14 (VF-14) scores and spectacle independence preoperatively and 6 months postoperatively.
Patient selection was challenging because it involved various demographic and clinical factors, Labiris said.
“As a general rule, mini-monovision can provide excellent outcomes even in suboptimal foveal and optic nerve conditions, while multifocal lens implantation is more demanding in terms of the overall optic system functionality,” he said. “Moreover, mini-monovision with bilateral myopic defocus is a safer approach. … However, mini-monovision cannot address demanding near vision tasks; therefore, those patients should be directed to multifocal lens implantation.”
Results and analysis
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 statistically significant (P < .01).
Both groups had similar postoperative binocular uncorrected distance visual acuity, binocular uncorrected near visual acuity, contrast sensitivity and stereopsis.
Patients in the multifocal IOL group had significantly more shadows and insignificantly more glare than those in the monovision group.
“We have long-term experience in multifocal lens implantation; therefore, we have personal experience on dysphotopic perceptions from our patients,” Labiris said. “However, these phenomena have been minimized in modern lenses, and significantly fewer patients complain of glare and shadows. On the other hand, patients should be warned about dysphotopsia, and certain professional backgrounds (ie, professional drivers) should not be treated with multifocal lenses.”
Postoperative spectacle independence was 31.4% in the monovision group and 65.7% in the multifocal IOL group.
“However, both the monovision and multifocal groups were spectacle-free for about 90% of their tasks,” Labiris said. “It becomes obvious that complete spectacle independence demonstrates weak correlation with patient satisfaction. On the other hand, the preoperative counseling of the patients on the objectives of the therapeutic approach, management of their expectations and delivering what is promised are the most important factors for impressive satisfaction scores.”
Mean VF-14 scores were 91.61 in the monovision group and 90.14 in the multifocal IOL group. – by Matt Hasson
Reference:
Labiris G, et al. J Cataract Refract Surg. 2014;doi:10.1016/j.jcrs.2014.06.015.
For more information:
Georgios Labiris, MD, PhD, can be reached at Ophthalmology Department, University of Alexandroupolis 68100, Dragana, Alexandroupolis, Greece; email: labiris@usa.net.
Disclosure: Labiris has no relevant financial disclosures.
Perspective
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Jay S. Pepose, MD, PhD
The authors compared visual outcomes in patients implanted with an aspheric refractive multifocal IOL vs. mini-monovision with aspheric monofocal IOLs, with the dominant eye targeted at –0.5 D and the nondominant 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 that should be discussed with patients, along with assessing specific ocular characteristics that may exacerbate side effects inherent to either strategy.Click Here to Manage Email Alerts