Selecting the myopic target for an enhanced monofocal IOL in highly myopic eyes: -2.0 D versus − 3.0 D

To determine the optimal myopic target refraction for enhanced monofocal IOL implantation in highly myopic cataract patients. A retrospective comparative study was conducted in Zhongshan Ophthalmic Center, China. Cataract patients with axial length (AL) ≥ 26 mm who underwent phacoemulsification with enhanced monofocal IOL implantation were included. Participants were divided into 2 groups by target refraction: Group 1 (-2 diopters [D]) and Group 2 (-3 D). Uncorrected distance (UDVA), intermediate (UIVA), near (UNVA) visual acuity, corrected distance visual acuity (CDVA), objective visual quality, and subjective satisfaction were evaluated 3 months postoperatively. Subgroup analyses were performed for 26 mm ≤ AL < 28 mm and AL ≥ 28 mm. A total of 94 eyes of 94 patients were analyzed. Group 1 showed superior UDVA (0.48 vs. 0.72 logMAR, P < .001), UIVA at 80 cm (0.17 vs. 0.32 logMAR, P < .001) and 60 cm (0.13 vs. 0.23 logMAR, P = .003), and higher spectacle independence at far distance (20.00% vs. 2.04%, P = .011) than Group 2. UNVA at 40 cm, CDVA, and other outcomes were similar between groups (all P > .05). Similar trends were observed across AL subgroups. An enhanced monofocal IOL targeted at -2.0 D provided superior UDVA and UIVA while maintaining comparable UNVA in highly myopic eyes. We recommend a target refraction of -2.0 D for eyes with AL < 28 mm, while a personalized approach is advised for eyes with AL ≥ 28 mm or for patients with shorter habitual reading distances.