Mini-Monovision Evaluation With Enhanced Monofocal Iols Using A Visual Simulatore

To assess the binocular visual performance of two enhanced monofocal intraocular lenses (EM-IOL) (RayOne EMV and Acunex Quantum) under mini-monovision using a visual simulator.

Group of Applied Optics and Image Processing, Department of Optics and Optometry, Universitat Politècnica de Catalunya, Barcelona Tech, Spain.

The David J. Apple Center for Vision Research, Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.

The subjective visual quality of two enhanced monofocal intraocular lenses (EM-IOL) was evaluated with the SimVis Gekko visual simulator under mini monovision conditions. This methodology allows patients to experience simulated postoperative vision, providing a preoperative tool for personalized IOL design selection. Six healthy subjects participated in a pilot experiment. Ocular dominance was determined using the "hole in the hand" test. Mini-monovision was induced by applying -0.5 D and -1.0 D of myopia to the non-dominant eye. Monocular and binocular defocus curves were measured from +0.5 D to -2.5 D in 0.5 D steps under photopic conditions. Binocular visual acuity (VA) was assessed using standard logMAR charts.

The preliminary results show than under emmetropic conditions, both EM-IOLs mini-monovision performance was very similar for both EM-IOLs. Inducing a myopic deviation of -0.5 D in the non-dominant eye produced no perceptible effect at intermediate/near distances. However, a -1.0 D myopic target in the non-dominant eye extended the functional binocular visual range by approximately 1.0 D. Specifically, the near limit improved from -1.5 D (67 cm) to -2.5 D (40cm) with both EM-IOLs. Both lenses benefited from mini-monovision without significantly compromising distance VA. These results support the mini-monovision strategy as a means of extending the functional visual range while preserving good distance VA in the dominant eye.

Simulated mini-monovision with EM-IOLs expands the functional range of vision, improving intermediate and near VA while maintaining good distance vision. A -1.0 D myopic target in the non-dominant eye can provide good visual quality at all distances, improving spectacle independence in pseudophakic patients, with a small but noticeable difference between both eyes. However, a myopic deviation of -0.5 D in the non-dominant eye did not prove to be advantageous.
The use of mini-monovision combined with EM-IOLs can be strategy for presbyopia correction. The use of SimVis Gekko enabled preoperative simulation, allowing patients to better understand their postoperative vision.These results support further research with a larger patient sample.