Enhanced Mini-Monovision With Extended Depth Of Focus Or Multifocal Lenses In One Or Both Eyes

Advances in intraocular lens (IOL) design have provided patients with a wide variety of options to consider when receiving cataract surgery. Various classes of IOLs offer a different balance between range of vision and risk of dysphotopsia. One way of balancing the properties of these lenses is to adopt a mix-and-match approach of implanting a multifocal/ extended depth of focus (EDOF) in the non-dominant eye, and a lens with lower risk of dysphotopsia in the dominant eye. Surgeon learning curve considerations were examined by comparing the group of standard bilateral mini-monovision cases using monofocal-plus lenses (Eyhance, Impress) against remaining consecutive cases adopting mix-and-match approach (LuxLife, LuxSmart, Galaxy, PureSee). 

Private practice with a single operating surgeon at two sites (private hospital and private wing of a public university hospital) in the United Kingdom. Outpatient clinical work up at the two surgical sites and an additional diagnostic centre were standardised, with optometrist refraction to evaluate refractive outcomes. 

Consent sought from patients for anonymised outcomes data to be examined followed by retrospective electronic case note review of cataract surgery between March 2024 to February 2026. All bilateral cataract surgeries with monofocal plus, EDOF or multifocal lenses were included in the review. They were subsequently divided into the group with monofocal-plus only, compared to EDOF/ multifocal in one or both eyes. 

157 patients (91 males, 66 females, mean age 64.8 years) were included. Analysis focused on uncorrected distance (UDVA) and near visual acuity (UNVA) in each eye, target refraction, degree of target monovision, post-operative refraction, and degree of post-operative monovision. Best UNVA is taken from the eye achieving best UNVA.

Group 1 (n= 80) with bilateral monofocal plus lenses achieved mean best UDVA of LogMar 0.04 ±0.038, UNVA of LogMar 0.075 ±0.027 (mean ±SD) and an average mini-monovision difference of 0.92D. Group 2 (n= 77) with EDOF/ multifocal IOLs achieved mean best UDVA of LogMar 0.06 ±0.035, UNVA of 0.060 ±0.095 logMAR and an average mini-monovisin difference of 0.55D. Kruskal-wallis test was done to compare best UDVA and UNVA between groups and found no significant difference (p= 0.675, p= 0.773 respectively). Analyses are on-going and additional results from time of abstract admission will be added to the report. IOP lowering was similar in both groups, but YAG capsulotomy higher for EDOF/ multifocal group. There was 0% posterior capsule rupture.

This case series shares experience of adopting a mix-and-match approach with premium IOLs and mini-monovision. Personalised prescribing of IOLs taking into account pre-operative refractive error, patient preferences and co-morbidity, and appropriate application of mini-monovision was able to achieve successful UDVA and UNVA by using monofocal plus lenses in both eyes, comparable to using multifocal and EDOF IOLs in one or both eyes. Continual audit and larger sample sizes will be required to fully evaluate patient reported outcome measures, and the optimal degree of mini-monovision when combining use of EDOF or multifocal IOLs to minimise risk of dysphotopisa using this approach. Patient satisfaction was high in both groups.