Visual Outcomes and Patient Satisfaction with Extended Monovision—An Innovative Strategy to Achieve Spectacle Independence in Refractive Lens Exchange

<b>Background</b>: Spectacle independence is a key goal in refractive lens exchange (RLE), especially in younger, high-expectation patients. This study evaluates a novel extended monovision approach combining a monofocal aspheric intraocular lens (IOL) in the dominant eye with a rotationally asymmetric bifocal extended-depth-of-focus (EDOF) IOL in the non-dominant eye. The strategy aims to optimize full-range visual performance while minimizing photic phenomena. <b>Methods</b>: In this retrospective cohort study, presbyopic patients underwent bilateral RLE with a monofocal IOL (Hoya Vivinex XC1-SP; target: 0 diopters [D]) in the dominant eye and a rotationally asymmetric bifocal EDOF IOL (LENTIS LS-313 MF15; addition: +1.5 D; target: -1.25 D) in the non-dominant eye. Uncorrected distance visual acuity (UDVA, at 6 m), uncorrected intermediate visual acuity (UIVA, at 66 cm), and uncorrected near visual acuity (UNVA, at 36 cm) were assessed. Additional evaluations included binocular defocus curves, contrast sensitivity, stereoacuity, and photic phenomena. Spectacle independence and satisfaction were measured using the PRSIQ and NEI-RQL-42 questionnaires. <b>Results</b>: A total of 38 patients (76 eyes) were included. The mean postoperative binocular UDVA, UIVA, and UNVA were -0.03 ± 0.08, -0.08 ± 0.09, and 0.04 ± 0.08 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m) with a mean visual acuity of -0.03 ± 0.08 logMAR. Functional vision better than 0.2 logMAR extended over defocus steps from +1.00 to -3.25 D. All patients were spectacle-independent for distance and intermediate vision, and 84% reported complete spectacle independence. Contrast sensitivity was within normal limits for age. Minimal photic phenomena were reported, and stereoacuity was preserved in 97% of patients (≤100 arcseconds). <b>Conclusions</b>: This innovative extended monovision approach, combining two different IOLs in a mini-monovision setup, provides excellent uncorrected visual acuity at all distances, high spectacle independence, and minimal side effects. It represents a compelling alternative to multifocal IOL implantation in presbyopic RLE candidates.