Patient-Reported Outcomes And Visual Function After Four Refractive Strategies In Cataract Surgery: A Randomized Controlled Trial

To evaluate patient-reported outcomes and visual function following pseudophakic emmetropia, mini-monovision, monovision and Extended Depth of Focus (EDF) intraocular lenses (IOLs) in a public cataract population.

Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark.

This randomized controlled trial included consecutive bilateral symptomatic cataract patients, who were randomized to implantation with monofocal IOLs with target refraction of 1) emmetropia (emmetropia in both eyes), 2) mini-monovision (emmetropia in the dominant eye, -1.25 diopters (D) in the non-dominant), 3) monovision (emmetropia in the dominant eye, -2.50 D in the non-dominant), or 4) EDF (+0.01 to +0.25 in the dominant eye, -0.01 to -0.25 in the non-dominant eye). Assessment included four patient-reported outcomes measures (PROMs), binocular uncorrected distance, intermediate and near visual acuity (VA), aniseikonia, stereoacuity, and safety.

188 patients were randomized equally to the four groups. High levels of improvement in postoperative PROM scores were observed across all groups, with no significant differences between groups. All patients achieved binocular best corrected distance VA of logMAR 0.12 or better (range 0.12 to -0.26). Mini-monovision and EDF yielded comparable outcomes across visual performance, spectacle independence, and safety. Monovision provided superior uncorrected near VA and the lowest spectacle use but was associated with increased aniseikonia, impaired stereoacuity, worse binocular uncorrected distance VA, more frequent halos, lower recommendation rates, and a 6.7% reoperation rate due to binocular visual complaints.

All four groups achieved high levels of improvement in visual function and PROM scores. There was no statistically significant difference in PROM scores between the groups.