Five-Year Refractive Stability And Visual Performance After Diffractive And Non-Diffractive Edof Iol Implantation With A Mini-Monovision Strategy

To evaluate refractive stability, spectacle independence, and visual phenomena five years after bilateral implantation of diffractive or non-diffractive extended depth of focus (EDOF) intraocular lenses using a mini-monovision strategy.

Tertiary academic center; long-term reassessment of a cohort from a prior prospective bilateral EDOF IOL study.

Five-year follow-up of patients who underwent bilateral implantation of a diffractive EDOF IOL (Symfony – SYM) or a non-diffractive EDOF IOL (Vivity – VIV), targeting −0.75 D in one eye and emmetropia in the fellow eye. The PRSIQ and QoV questionnaires were reapplied. Refractive stability was assessed by comparing spherical equivalent at 3 months (3M) and 5 years (5Y). In selected cases, Anterion and OPD-Scan III examinations were repeated to investigate postoperative IOL positioning; these data will be presented in a subsequent analysis.

Twenty of 126 original patients were re-evaluated (40 eyes). Spherical equivalent remained stable between 3 months and 5 years in both groups, with no significant group effect or time × lens interaction (P>0.05). In the SYM group, distance-targeted eyes shifted from −0.44 to −0.58 D and near-targeted eyes from −1.02 to −0.97 D. In the VIV group, distance eyes changed from −0.50 to −0.45 D and near eyes from −0.90 to −0.64 D. Uncorrected binocular visual acuity remained stable for distance and near (P>0.05). At 5 years, 79% maintained near acuity ≥J2. Most patients reported absent or minimal visual symptoms at both time points (SYM 88%, VIV 94%), with no intra- or intergroup differences.

Mini-monovision with diffractive or non-diffractive EDOF IOLs demonstrated sustained refractive and functional stability over five years, with high spectacle independence and a low incidence of visual symptoms, without clinically meaningful differences between optical designs.