Visual Outcomes After Using The Micro-Monovision Approach With A Novel Extended Depth Of Focus Intraocular Lens Based On Wavefront Linking Technology

The demand for complete spectacle independence without any compromise in visual quality has been increasing recently. Although trifocal intraocular lenses (IOLs) offer spectacle-free vision, many patients complain about dysphotopsia. Extended depth of focus (EDoF) IOLs are less associated with unwanted photic sensations, however, these lenses are designed to enhance far and intermediate vision, while close-up activities often require additional correction. Our investigation aimed to assess the safety and efficiency of the binocular implantation of a new EDoF lens utilizing wavefront linking technology. We have tested the visual outcomes after targeting the dominant eye to emmetropia and the non-dominant eye to slight myopia.

Tygervalley Eye & Laser Centre, Cape Town, South Africa

Thirty-six eyes of 18 cataract patients (11 male, 7 female) were implanted with the Bi-Flex 877PEY Elon IOL (Medicontur, Hungary). IOL power calculations were performed using the Holladay 2 formula. Dominant eyes were targeted to emmetropia, while non-dominant eyes were to -0.25, -0.50, or -0.75 Diopters (D). In 2 patients there was no definite eye dominance. In these cases, both eyes were targeted to -0.25 D. Refractive outcomes, monocular and binocular uncorrected and corrected distance (UDVA, CDVA), intermediate (UIVA, DCVA) and near (UNVA, DCNVA) visual acuities were measured 1 month postoperatively. Binocular visual acuity and contrast sensitivity defocus curves were plotted using the Multifocal Lens Analyzer 3.0 by Qvisión, Spain.

No intraoperative or any further complication directly related to the intervention or the IOL itself could be observed. The majority of eyes achieved the refractive target. Binocular CDVA after the first postoperative month was -0.08 ± 0.15 logMAR, while DCIVA and DCNVA were -0.08 ± 0.10 and -0.01 ± 0.09, respectively. Distance-corrected intermediate and near vision were at least 20/20 in 81% of the patients. Visual acuity defocus curves taken 1 and 6 months postoperatively show a wide defocus range: patients achieved a 0.1 logMAR or better binocular vision between 0.00 and -3.00 D defocus values. Binocular contrast sensitivity defocus curves confirm excellent visual quality along the entire defocus range.

The hydrophobic, preloaded 877PEY EDoF IOL is a safe and efficient option for the treatment of cataracts and presbyopia. The refractive outcomes are predictable and accurate. The micro-monovision approach ensures excellent intermediate and near vision. Our patients are satisfied, daily visual tasks can be performed without or only with minor difficulties.