Rethinking Monofocal Performance: Expanding Functional Vision With Mini-Monovision And Crossed Mini-Monovision Using Non-Constant Aberration-Correcting Aspheric Intraocular Lens

To evaluate whether optimized refractive targeting strategies, mini-monovision and crossed mini-monovision can extend functional vision and binocular depth of focus using a new monofocal platform, non-constant aberration-correcting aspheric intraocular lens, compared with conventional bilateral emmetropia targeting.

This is a prospective comparative clinical study at a tertiary ophthalmic center.

This study represents an early prospective comparative evaluation of a newly introduced intraocular lens, conducted during the first months after clinical availability. The sample size reflects consecutive eligible cases during the initial adoption period.

In this prospective comparative study, 42 eyes of 21 patients undergoing bilateral phacoemulsification with implantation of the CT LUCIA 621P IOL were allocated into three refractive strategies:

• Bilateral emmetropia (0.00 D both eyes)
• Mini-monovision (dominant eye 0.00 D; non-dominant eye −0.75 to -1.00 D)
• Crossed mini-monovision (dominant eye −0.75 to -1.00 D; non-dominant eye 0.00 D)

Outcomes assessed at 3 months included binocular uncorrected visual acuity (distance, intermediate, near), defocus curve analysis, spectacle independence, and patient-reported functional vision.

All three strategies achieved excellent binocular distance vision (mean −0.02 ± 0.05 logMAR).

However, monovision strategies significantly improved intermediate and near performance.

Intermediate visual acuity (66 cm):

• Emmetropia: 0.19 ± 0.09 logMAR
• Mini-monovision: 0.06 ± 0.07 logMAR
• Crossed mini-monovision: 0.08 ± 0.09 logMAR (p = 0.004)

Near visual acuity (40 cm):

• Emmetropia: 0.42 ± 0.08 logMAR
• Mini-monovision: 0.20 ± 0.05 logMAR
• Crossed mini-monovision: 0.25 ± 0.09 logMAR (p =0.003)

Binocular depth of focus increased substantially:

• Emmetropia: 1.2 ± 0.5 D
• Mini-monovision: 2.4 ± 0.6 D
• Crossed mini-monovision: 2.2 ± 0.5 D

Spectacle independence rates were significantly higher:

• Emmetropia: 31%
• Mini-monovision: 76%
• Crossed mini-monovision: 70% (p =0.008)

Mini-monovision and crossed mini-monovision using the CT LUCIA 621P IOL significantly expand binocular functional vision and depth of focus without compromising distance visual acuity. Mini-monovision provided the most balanced visual performance across all distances, while crossed mini-monovision demonstrated comparable functional range with a distinct binocular adaptation profile. Optimized refractive targeting with a monofocal IOL may offer an effective and accessible strategy to achieve extended functional vision in modern cataract surgery.