Monovision vs Multifocal IOLs for Spectacle Independence After Cataract Surgery

William W. Culbertson, MD


March 03, 2014

In This Article

Randomized Trial of Multifocal Intraocular Lenses Versus Monovision After Bilateral Cataract Surgery

Wilkins MR, Allan BD, Rubin GS, et al; Moorfields IOL Study Group
Ophthalmology. 2013;120:2449-2455

Freedom From Glasses

When bilateral cataract surgery becomes necessary, many patients are faced with the alluring prospect of reducing or even eliminating the need to use spectacles for distance and near vision. Patients benefit not only from improving their vision by removing the cataract but also from escaping the burden of wearing glasses.

Some patients have enjoyed spectacle independence through the use of monovision contact lenses or refractive surgery during the presbyopic years preceding the development of their cataract. Others have read or heard about the chance to "throw away your glasses" after surgery, although they are usually not aware of the trade-offs and side effects associated with the different presbyopia-busting surgical options. Furthermore, even cataract surgeons have not had reliable comparative data with which to assess the course of action that might be best for their patients.

Study: Monovision vs Multifocal IOLs

In this valuable and insightful study, Wilkins and colleagues provide us with helpful information on the binocular visual performance for distance and near vision in 212 patients who had bilateral cataract surgery with either monofocal or multifocal intraocular lenses (IOLs). As expected, there was a high level of patient satisfaction in both groups, but with differing profiles of side effects and visual shortfall.

Patients undergoing bilateral sequential cataract surgery were randomly assigned preoperatively to receive bilateral monofocal aspheric IOLs (Akreos AO; Bausch & Lomb, Rochester, New York) with 1 eye targeted for near at -1.25 sphere (monovision group) or 3-piece multifocal IOLs (Tecnis ZM900; Abbott Medical Optics, Santa Ana, California) (multifocal group).

Patients were assessed at 4 months postoperatively for spectacle independence; patient satisfaction; subjective dysphotopsias; unaided binocular visual acuity at distance, intermediate, and near; contrast sensitivity; stereoacuity; light scatter; and higher-order aberrations.


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