Modified Monovision Using An Aspheric Non-Diffractive Monofocal Iol

To report the visual outcomes and higher order aberration analysis of modified monovision after cataract surgery using the Rayner EMV IOL.

Private Sector Cataract and Refractive Surgery Clinic in the United Kingdom

This was a retrospective analysis of the outcomes of consecutive patients undergoing cataract surgery or refractive lens surgery using the Rayner EMV lens.  EMV lenses were used to target plano in the dominant eye and -1.50 in the reading eye. Outcomes measured were pre and post op UDVA and CDVA, pre and post op UNVA and CNVA, pre and post op refractions, and pre and post op whole eye, internal and corneal spherical aberration levels (using Osiris aberrometer CSO).

70 eyes from 35 patients were included in the analysis. No eyes lossed any lines of CDVA. 71% of patients were 20/20 N5 or better unaided after surgery.  94% of patients were within +/- 0.5D of the intended Spherical Equivalent target and 100% were within +/- 1.0D. 4 of the 70 eyes (5.5%) required a LASIK enhancement to correct the post operative refraction. The average UDVA of eyes targetting plano was N10 and the average UNVA of eyes targetting -1.50 was 20/50.  All patients had positive corneal spherical aberration prior to surgery. The average whole eye spherical aberration post operatively was +0.10 microns.

This work was presented at the 2022 ESCRS with limited sample numbers. The work now has sufficient sample numbers to draw firmer conclusions. The visual outcomes of modified monovision using EMV lenses were excellent. Patients were offered a high degree of spectacle independence. The refractive accuracy of the lens is very good, with a low LASIK enhancement rate (5.5%). Wavefront analysis of these patients confirms that the EMV lens induces positive levels of spherical aberration, but the level of induction was not consistent across the cases.