Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost

Abstract

BackgroundCataract surgery with pseudophakic mini-monovision has lower out-of-pocket patient expense than premium multifocal intraocular lenses (IOL). The purpose of this study was to evaluate patient-reported satisfaction and spectacle dependence for key activities of daily living after cataract surgery with pseudophakic mini-monovision. The study also examined statistical relationships between patient demographic variables, visual acuity and satisfaction.MethodsProspective cohort study of 56 patients (112 eyes) who underwent bilateral cataract surgery with pseudophakic mini-monovision. Mini-monovision corrects one eye for distance vision and the other eye is focused at near with − 0.75 to − 1.75 D of myopia. All patients with 1 diopter or greater of corneal astigmatism had a monofocal toric IOLs implanted or limbal relaxing incision. The main study outcomes were assessed at the last follow-up appointment and included refraction, visual acuity, patient reported spectacle use, and patient satisfaction. Descriptive statistics, correlation matrixes and Pearson’s chi-square tests were examined.ResultsUncorrected visual acuity was significantly better post-operatively. Most patients reported the surgery met their expectations for decreased dependence on spectacles (93%). Most patients report little or no use of spectacles post-operatively for computer use (93%), distance viewing (93%) and general use throughout the day (87%). A small number of patients report spectacle use for reading (9%) and night driving (18%). There were no relationships detected between demographic variables and visual acuity or patient satisfaction.ConclusionsAging of the population presents one of the biggest challenges in the health sector, which includes a rising number of individuals with chronic vision impairment and increased demand for accessible treatment strategies. Cataract surgery with pseudophakic mini-monovision results in high patient satisfaction and considerable reduction in spectacle dependence. Pseudophakic mini-monovision technique is a low-cost, valuable option for patients who would like to reduce dependence on spectacles post-operatively and should be considered along with premium multifocal IOLs in options available for patients based on their needs, preferences and clinical indicators. Reducing spectacle dependence with the pseudophakic mini-monovision technique could improve the functionality, independence and quality of life for many patients who are unsuitable or are unable to pay additional fees associated with premium multifocal IOLs.

<p>Subjective Perception Of Trifocal IOL Performance, Including Toric Models</p>

“…Comparison with previous studies concerned with the same trifocal IOL would not be effectively achieved 11,16,18,20,21,26. The same was concluded when revised other works not dealing with the current IOL 11,13,14,29–31. There are no standards in methodology-assessing subjective perception for vision after multifocal IOL implantation, not to mention results retrieved from this assessment.…”

“…Questions vary in number and contents. Most of the studies simply represented the answers in term of percentage of 3–4 levels of satisfaction 10–14,16,29–31. Those which chose to use scoring, used it in a descending manner (0 being the best),18,20,21,26 or ascending (0 being the worst).11 The final score also varied from 4,20 618,21,26 and 10.11…”

<p>Evaluation of Visual and Subjective Outcomes with Mix-and-Match of Three One-Piece Tecnis Multifocal IOLs of Varying Add Powers</p>

“…4,5 Previous research has shown that MIOLs or monovision techniques can provide patients with good visual acuity at various distances and spectacle freedom. [7][8][9][10] Mix-and-match of IOLs with different add powers is an approach that has been used to individualize visual correction. [11][12][13] Combinations of near add MIOLs and low add MIOLs, such as +4.0 D add and +2.75 D IOLs have shown good visual acuities for near and distance performance, however less has been reported about the combination of +2.75 D with a +3.25 D IOL.…”

Pseudophakic Approaches for Addressing Presbyopia

“…Monovision is achieved typically by correcting the dominant eye to emmetropia for best results regarding distance visual acuity, while the nondominant eye is corrected for near visual acuity. The amount of myopia in the near eye can be varied according to the patient's needs, with targets of À0.75 to À1.00 selected for those who desire intermediate vision and less loss of distance acuity and À1.50 to À1.75 for those seeking the ability to read [63]. We do not recommend near correction more myopic than this, as it can result in significant loss of stereopsis and is often not well tolerated.…”

“…The advantages of monovision are spectacle independence [63] combined with less risk for optical phenomena [66], and, if not well tolerated, the ability to correct the myopia with laser corneal surgery. The disadvantages of monovision are the loss of uncorrected visual acuity in the near corrected eye and as noted above, some loss of stereopsis.…”