Patient‐reported outcomes and visual function after four refractive strategies in cataract surgery: A randomized controlled trial

PURPOSE: To evaluate patient-reported outcome measures (PROMs) and visual function across four groups of public cataract patients: emmetropia, mini-monovision, monovision with partial-range of field (RoF) narrow intraocular lenses (IOLs) and patients implanted with partial-RoF extended IOLs. METHODS: This randomized controlled trial included consecutive patients with bilateral symptomatic cataract randomized to implantation of partial-RoF narrow IOLs targeting (1) emmetropia (both eyes), (2) mini-monovision (emmetropia in the dominant eye, -1.25 diopters (D) in the non-dominant), (3) monovision (emmetropia in the dominant eye, -2.50 D in the non-dominant) or (4) implantation of partial-RoF extend IOLs (+0.01 to +0.25 D in the dominant eye, -0.01 to -0.25 D in the non-dominant eye). Assessment included four PROMs, binocular uncorrected distance, intermediate and near visual acuity (VA), aniseikonia, stereoacuity and safety. RESULTS: 188 patients were randomized to the four groups. High levels of improvement in postoperative PROM scores were observed across all groups, with no significant differences between groups. All patients achieved binocular best corrected distance VA of logMAR 0.12 or better (range 0.12 to -0.26). Mini-monovision and partial-RoF extend yielded comparable outcomes across visual performance, spectacle independence and safety. Monovision provided superior uncorrected near VA and the lowest spectacle use but was associated with increased aniseikonia, impaired stereoacuity, worse binocular uncorrected distance VA, more frequent halos, lower recommendation rates and a 6.7% reoperation rate for binocular visual complaints. CONCLUSION: All four groups achieved high levels of improvement in visual function and PROM scores. There was no statistically significant difference in PROM scores between the groups.