Comparison of visual performances of enhanced monofocal versus standard monofocal IOLs in a mini-monovision approach

Abstract

Purpose: To compare visual performance and quality of life in patients who received either monofocal intraocular lenses (IOLs) or an enhanced monofocal IOL in a mini-monovision target approach.

Background: Monofocal lenses are the most common intraocular IOLs employed during cataract surgery because of their relatively low cost and good performance for distance sight. However, these lenses, generally, do not exonerate patients from spectacle use for near or intermediate tasks. On the other hand, enhanced monofocal IOLs (e.g., Tecnis Eyhance®) feature optical properties providing patients with good intermediate visual outcomes. Satisfactory near visual acuity results, regardless of IOL type, may be achieved through mini-monovision. We assessed visual performance outcomes between these IOLs, in a mini-monovision approach.

Methods: Retrospective case series of patients who underwent bilateral cataract surgery at our institution with implantation of Alcon SN60WF, J&J Tecnis DCB00 or J&J Tecnis Eyhance® DIB00 with a pre-operative mini-monovision target. The postoperative spherical equivalent was measured by a Nidek® auto-refractometer. Best-uncorrected binocular visual acuity (BUBVA) at far (3 m), intermediate (66 cm), and near (40 cm) distance and binocular contrast sensitivity (100%, 25%, and 5%, all at 1 m) were measured using Snellen and Pelli-Robson charts, respectively. Visual performance in daily life was evaluated with the Cataract VF-14 quality of life survey.

Results: 71 patients (35 in the monofocal IOL and 37 enhanced IOL group) were enrolled. Patients implanted with enhanced IOL exhibited statistically significant better BUBVA results at 66 cm and 40 cm distances compared to patients in the monofocal group. Additionally, patients in the enhanced IOL group presented a better contrast sensitivity in lower contrast conditions (5%) than patients with monofocal IOL. The quality of life survey showed statistically significant higher scores in daily activities without spectacles for patients with enhanced IOL.

Conclusion: Enhanced monofocal IOLs, combined with a mini-monovision approach, provided patients with good visual performance at all tested distances, with superiority of enhanced monofocal IOLs at near and intermediate distances.

Keywords: Cataract surgery; IOL; Mini-monovision; Tecnis Eyhance.

Fig. 1

A) Histograms of patient age distribution. Data shown as mean ± S.E.M. Test by unpaired t test; p-value = 0.36 B) Pie charts of patient gender distribution in both groups C) Boxplots of measured post-operative spherical equivalent for dominant and non-dominant eyes in both groups. Table shows data as mean ± S.E.M D) Difference in refractive post-operative spherical equivalent compared to pre-operative target for dominant and dominant eye in both groups. Data shows as mean ± S.E.M (left) and range (right)

Fig. 2

A) Histograms of logMAR best uncorrected visual acuities at near (40 cm) distance. Test by Mann-Whitney; p-value < 0.0001 B) Histograms of logMAR best uncorrected visual acuities at intermediate (66 cm) distance. Test by Mann-Whitney; p-value < 0.0001 C) Histograms of logMAR best uncorrected visual acuities at far (3 m) distance. Test by Mann-Whitney; p-value = 0.81 D) Contrast sensitivity measure (1 m) plot. Data shown as number of letter at each contrast percentage tested. Test by 2-way ANOVA with Sidak multi comparison test. P-values (100% = 0.98; 25% = 0.99; 5% = 0.007) E) Histograms of VF-14 quality of life survey results in uncorrected tasks. Test by Mann-Whitney; p-value = 0.009 F) Histograms of VF-14 quality of life survey results in spectacle-corrected tasks. Test by Mann-Whitney; p-value = 0.09