Fine-Tuning The Micro-Monovision Concept With An Enhanced Monofocal

To compare binocular uncorrected distance visual acuity (UDVA), uncorrected intermediate visual acuity (UIVA), and uncorrected near visual acuity (UNVA) after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with an optimized intermediate central zone using two refractive strategies: emmetropia and micro-monovision.

Prospective multicenter clinical study conducted at three ophthalmic centers in the Czech Republic.

This prospective study included 61 patients undergoing bilateral implantation of the enhanced monofocal enVista Aspire IOL. Patients were allocated by intended refractive target into an emmetropia group (27 patients) or a micro-monovision group (34 patients; target refraction −0.56 ± 0.25 D in the non-dominant eye). The enVista Aspire IOL uses higher-order aspheric coefficients on the posterior surface to extend depth of focus while maintaining monofocal optics. Postoperative follow-up up to 3 months included spherical equivalent, UDVA, UIVA at 66 and 80 cm, and UNVA. Photic phenomena and patient-reported outcomes (Catquest-9SF) were assessed. The primary endpoint was binocular uncorrected visual acuity at 3 months.

At 3 months, excellent binocular UDVA was achieved in both groups (−0.03 ± 0.08 logMAR in the emmetropia group and −0.04 ± 0.05 logMAR in the micro-monovision group). The micro-monovision group demonstrated superior binocular UIVA at 66 cm (0.01 ± 0.11 vs 0.14 ± 0.10 logMAR) and 80 cm (−0.05 ± 0.08 vs 0.05 ± 0.11 logMAR), as well as improved UNVA (0.28 ± 0.11 vs 0.35 ± 0.15 logMAR), while maintaining comparable distance vision. The majority of patients in both groups reported none or only mild photic phenomena. Mean spherical equivalent at 3 months was −0.29 ± 0.30 diopters in the emmetropia group and −0.24 ± 0.17 diopters (dominant eye) and −0.72 ± 0.38 diopters (non-dominant eye) in the micro-monovision group.

The enhanced monofocal enVista Aspire IOL provides excellent binocular uncorrected distance vision with a low incidence of photic phenomena using both emmetropia and micro-monovision strategies. Fine-tuned micro-monovision further improves intermediate and near visual performance without compromising distance vision and represents an effective option for patients seeking an extended range of vision without multifocal optics.