Premium Monovision versus Bilateral Myopic Monovision, Hybrid Monovision and Bilateral Trifocal Implantation: A Comparative Study

Abstract

Purpose Contemporary monovision techniques use premium intraocular lenses (IOLs), either in both eyes or at least in the non-dominant one. Primary objective of this study was to compare the efficacy of premium monovision (implantation of the trifocal diffractive Panoptix IOL in the non-dominant eye and the bifocal hybrid refractive-diffractive Restor IOL in the dominant eye), against bilateral myopic monovision (implantation of the monofocal SN60WF IOL targeting −0.50 D in the dominant eye and −1.25 D myopia in the non-dominant one), hybrid monovision (implantation of Panoptix in the non-dominant eye and SN60WF in the dominant eye) and bilateral trifocal implantation (with bilateral Panoptix implantation). Methods This is a prospective, comparative, clinic-based trial. Cataract patients populated four study groups: Monovision Group (MoG), Multifocal Lens Group (MfG), Hybrid Monovision Group (HmG) and Premium Monovision Group (PmG). Binocular Uncorrected Distance Visual Acuity (UDVA), Uncorrected Reading Acuity and Critical Print Size at 60cm (UIRA, UICPS) and at 40cm (UNRA, UNCPS), contrast sensitivity, vision-related functional impairment, dysphotopsia symptoms and spectacle dependence were evaluated 6 months following the operation of the second eye. A mathematical model was constructed, which calculated the relative efficacy of each surgical intervention. Results A total of 120 participants were recruited and populated equally the study groups. Significant improvement of preoperative UDVA was observed in all study groups. No significant differences could be detected in postoperative UDVA and UIRA (p = 0.24) among study groups, while significant differences were noticed in UICPS (p = 0.04), UNRA (p = 0.02) and UNCPS (p = 0.01). Dysphotopic phenomena (glare and shadows) were significantly more in the MfG arm followed by the PmG group (p = 0.04 and p = 0.02, respectively), while perceived difficulty and spectacle independence rates were significantly better in PmG group. PmG presented the best overall relative efficacy. Conclusion All surgical techniques present satisfactory outcomes. Premium monovision seems to demonstrate the best outcomes. Trial Registration ClinicalTrials.gov, NCT04618380. Registered 05 November 2020, https://clinicaltrials.gov/ct2/show/NCT04618380 .

Impact of personality on the decision process and on satisfaction rates in pseudophakic presbyopic correction

“…Numerous surgical techniques, both conventional and laser-assisted are offered, and a series of IOL technologies have been introduced that attempt to restore the pre-presbyopic functionality of the optical system. [12][13][14][15] Despite the impressive collection of presbyopic IOLs, only trifocal ones are inherently designed to address distant, intermediate, and near vision needs. However, multifocality is not a physiological optical state for the human eye, which is a constantly variable monofocal optical medium that provides infinite focal points.…”

“…However, published reports suggested that potential candidates should be carefully selected because anatomical and psychological characteristics modify heavily the perceived success of the intervention. 15,16 In fact, there is growing evidence among cataract surgeons that the prevalent clinical indexes that reflect visual capacity and quality of vision (ie, visual acuity, contrast sensitivity, and glare) are only moderately associated with the postoperative satisfaction and nonclinical characteristics, such as the personality type and the lifestyle, might play a significant role.…”

Contrast Sensitivity and Patient Reported Outcomes After Bilateral Implantation of a Bi-Aspheric Hydrophobic Trifocal Diffractive Intraocular Lens

“…However, they concluded that these differences were lower than the levels required for clinical significance. Labiris et al 22 compared the efficacy of premium monovision (trifocal PanOptix IOL implantation in the non-dominant eye and bifocal AcrySof ReSTOR +2.50 D IOL in the dominant eye) against myopic monovision (monofocal SN60WF IOL [Alcon Labs, Fort Worth, TX, USA] in both eyes) targeting −0.50 and −1.25 D in the dominant and non-dominant eye, respectively, hybrid monovision (trifocal PanOptix IOL in the non-dominant eye and SN60WF IOL in the dominant eye), and bilateral PanOptix IOL implantation. They found no significant differences in photopic contrast sensitivity among these groups of patients, using the Pelli–Robson test.…”

Patient Satisfaction, Visual Outcomes, and Regression Analysis in Post-LASIK Patients Implanted With Multifocal, EDOF, or Monofocal IOLs

“…Labris 34 et al has been the only other group, to our knowledge, to use regression analysis to evaluate outcomes in patients receiving multifocal IOLs. They compared the overall satisfaction of four combinations of presbyopia-correcting IOLs.…”

“…Binocular uncorrected intermediate and near visual acuities were significantly better in the EDOF group (P,0.01). No significant differences in contrast sensitivity were observed.Labris34 et al has been the only other group, to our knowledge, to use regression analysis to evaluate outcomes in patients receiving multifocal IOLs. They compared the overall satisfaction of four combinations of presbyopia-correcting IOLs.…”