Refractive And Binocular Visual Outcomes With An Enhanced Monofocal Iol In Cataract Patients: A Real-World Clinical Audit In Western Australia

Purpose:

This retrospective clinical audit investigates the refractive and binocular visual outcomes of the RayOne EMV (Rayner) intraocular lens (IOL) in cataract surgery, addressing the escalating demand for presbyopia-correcting options. The study aims to assess the lens's real-world performance, examining refractive targeting, binocular visual acuity, and patient satisfaction.

Setting:

Conducted at a single centre, the retrospective audit included patients undergoing bilateral cataract surgery with the RayOne EMV or EMV Toric lens between November 2022 and December 2023.

Methods:

The study focuses on short-term outcomes, with a follow-up period of 4 to 6 weeks postoperatively, binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity UIVA (66cm) and uncorrected near visual acuity UNVA (40cm) were recorded and a manifest refraction was completed. This study systematically analysed demographic data, pre-operative biometry, and IOL power calculation accuracy for 84 patients (168 eyes). Three refractive groups were defined: bilateral emmetropia (Group A), mini-monovision (-1.0D Group B), and modest monovision (-1.5 D Group C). Exclusion criteria ensured a homogeneous sample, eliminating confounding variables.

Across the three refractive groups, the mean refractive spherical equivalent  was -0.52D postoperatively. In Group A, UDVA was -0.002 +/- 0.07 logMAR, while UIVA was 0.19 +/- 0.095 and UNVA was 0.086 +/-0.11. In Group B, UDVA was 0.033 +/- 0.12, UIVA was 0.25 +/- 0.12, UNVA was 0.13 +/- 0.14. In Group C, UDVA was 0.008 +/- 0.072, UIVA was 0.28 +/-0.13, and UNVA was 0.14 +/- 0.12. 

Two patients in Group A and one patient in Group B were not satisfied with compromised reading vision. Three patients from Group C could not adapt to monovision anisometropia. All cases were successfully corrected with LASIK or sulcus IOL implants. There was no dysphotopsia reported in this study cohort. Capsular block occured in 4 patients 

The RayOne EMV IOL demonstrated outstanding refractive outcomes and visual acuity in a real-world clinical setting, with minimal complications.  PCO was observed early on but in most cases not visually significant.  The study also emphasizes the significance of individualized refractive targeting to achieve the best patient satisfaction. Overall, a myopic tendency was observed in this study with the manufacturer estimated constant (A constant = 118.6), and fine optimization may be required. The research highlights the RayOne EMV's potential for increased range of vision with minimal dysphotopsia and calls for continued research to refine and optimize outcomes. Excellent spectacle independence was observed in all 3 groups.