One-Year Experiences With Enhanced Monovision Concept In Cataract Surgery

Monovision (MV) is a commonly used technique for patients requiring an element of spectacle independence after cataract surgery. In ESCRS Survey 2016, 6% of cataract procedures involved a presbyopia-correcting IOL, while 43% were targeted for MV or mini-MV (0.75-1.25 was the most common offset). Our aim was to evaluate long-term real world usage of new aspheric monofocal IOL specifically optimised for MV (Rayner RayOne EMV). It is designed to provide up to 2.25D enhanced depth of vision with a 1.0 D offset by utilising positive spherical aberration in a patented smooth optical profile.

Department of Ophthalmology for Children and Adults, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.

Patients indicated for cataract surgery were informed about the possibility of choosing the new enhanced monovision concept. Patients with any other eye diseases were primary excluded. The IOL power was targeted to provide postoperative refraction of closest negative to zero in dominant eye with approximately 0.75 - 1.0D of offset in the non-dominant eye. Clinical evaluations, defocus curves and questionnaire of satisfaction, were performed during March 2022.

Twenty-three patients (46 eyes) were enrolled to the study. Median follow-up period was 9 months. On last visit, average refractive offset between eyes was -0.76 D (SD 0.32) and average difference between targeted and final subjective refraction was -0.11(SD 0.34). Binocular uncorrected distance visual acuity (UCDVA) was 1.0 in all patients. Median of UCDVA on non-dominant eye was 0.63 (range 0,5-1.0). Median of binocular uncorrected near visual acuity (UCNVA) was 0.63 (range 0.5 – 1.0). Median of UCNVA on dominant eye was 0.4 (range 0.32-1.0). None of the patients had significant complaints regarding to disturbing light phenomena or intolerance of MV.

The new concept of enhanced monovision using new IOL with positive spherical aberration shows good functional results with low risk of intolerance, regarding to low inter-ocular refractive offset and low risk of disturbing light phenomena. In our group of patients, it offered very good distance binocular vision with sufficient spectacle independence in everyday life. Further evaluations on large groups of patients are needed.