Clinical and refractive outcomes of bilateral enhanced monofocal intraocular lens implantation with targeted mini-monovision

PURPOSE: To evaluate visual and refractive outcomes, as well as patient satisfaction after bilateral implantation of an enhanced monofocal intraocular lens (IOL) with targeted mini-monovision. METHODS: We retrospectively reviewed the medical records of patients who underwent bilateral RayOne EMV IOL implantation during cataract surgery with targeted mini-monovision (-0.50 diopters [D] in the non-dominant eye). Patients' monocular and binocular uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), distance-corrected intermediate visual acuity (DCIVA), and manifest refraction were assessed at the 1st and 6th months postoperatively. Binocular uncorrected and corrected near visual acuities, defocus curves, contrast sensitivity, spectacle independence, dysphotopsia, and patient-reported outcomes were evaluated at Month 6. Patient-reported visual function and satisfaction were assessed using the CatQuest-9SF questionnaire, while spectacle independence and dysphotopsia were evaluated separately using study-specific questions. RESULTS: Fifty eyes of 25 patients were included. Mean age was 63.64 ± 10.53 years (range: 29-78 years), and the mean follow-up period was 14.52 ± 5.6 months (range: 6-24 months). At 6 months postoperatively, the mean spherical equivalent in dominant eyes was - 0.37 ± 0.29 D (range: -1.00 to + 0.38 D), whereas in non-dominant eyes, it was - 0.78 ± 0.46 D (range: -1.75 to + 0.25 D). The mean binocular UDVA was 0.02 ± 0.03 logMAR (range: 0.00- 0.10 logMAR), while binocular UIVA acuity was 0.21 ± 0.09 logMAR (range: 0.00- 0.40 logMAR) at month 6. Mean binocular uncorrected near visual acuity (UNVA) at 6 months was 0.24 ± 0.12 logMAR, whereas corrected near visual acuity (CNVA) was 0.14 ± 0.08 logMAR (P < 0.001). Binocular UDVA was 0.04 logMAR or better in 96% of patients, UIVA was 0.20 logMAR or better in 64%, and uncorrected near visual acuity was 0.3 logMAR or better in 80% of patients. All patients were spectacle independent for distance and intermediate vision; 10/25 patients (40%) were also spectacle independent for near vision, whereas 15/25 (60%) required a near addition. Twenty-four patients (96%) reported being very satisfied with their vision. CONCLUSION: Bilateral implantation of an enhanced monofocal IOL with targeted mini-monovision was associated with excellent visual outcomes at intermediate and distance vision with a high level of satisfaction.