Monocular and Binocular Visual outcomes of an Enhanced Monofocal (Mono-EDOF) Intraocular Lens and the Impact of Pre-Operative Parameters

Background: Enhanced monofocal Intraocular Lenses (IOLs) offer improved intermediate vision while maintaining high contrast sensitivity. The RayOne EMV and EMV Toric IOLs leverage controlled positive spherical aberration to enhance depth of focus, making them suitable for monovision strategies. This study evaluates the impact of preoperative parameters — corneal Spherical Aberration (SA), Higher-Order Aberrations (HOAs), and Chang Waring chord (CW-chord)-on monocular and binocular vision outcomes following implantation with primarily mini-monovision refractive targeting. Methods: This retrospective, single-center study analyzed 147 eyes of 74 patients implanted with RayOne EMV or EMV Toric IOLs. Patients were categorized into four refractive target groups (bilateral emmetropia, mini-monovision, modest monovision and full monovision). Preoperative SA, HOAs, and CW-chord were measured and classified as high or low. Uncorrected Distance (UDVA), Corrected Distance (CDVA), and Uncorrected Near Visual Acuity (UNVA) were assessed at one-month follow-up. Results: Mini-monovision patients achieved high levels of UDVA (80.4% at 6/6 or better) and UNVA (84% at N8 or better). Preoperative SA and CW-chord showed no significant correlation with postoperative UDVA, UNVA, or CDVA (p>0.05). However, higher preoperative HOAs were associated with reduced CDVA (correlation coefficient = +0.26, p<0.05), suggesting a mild impact on best-corrected visual acuity. Conclusion: SA and CW-chord had minimal influence on postoperative vision, while higher HOAs were linked to reduced CDVA. These findings support the effectiveness of enhanced monofocal IOLs and highlight the need for further research on preoperative predictors to refine patient selection and optimize outcomes. Clinical Relevance: Assessing certain preoperative parameters may enhance surgical planning and visual outcome predictability in patients receiving this enhanced monofocal IOL.