COMMENTARY

Monovision vs Multifocal IOLs for Spectacle Independence After Cataract Surgery

William W. Culbertson, MD

Disclosures

March 03, 2014

In This Article

Study Results

The average postoperative refractive error was +0.08 diopters (D) (standard deviation [SD], 0.55 D) in the "distance" eye of the monovision group and -0.92 D (SD, 0.65 D) in the "near" eye. In the multifocal group, the residual refractive error averaged -0.22 D (SD, 0.58 D).

Total spectacle independence was achieved in 26% of the monovision patients and in 71% of the multifocal IOL patients, with monovision patients being more than 7 times more likely to need glasses at least some of the time.

Binocular unaided distance visual acuities were similar in the 2 groups. Intermediate vision was best in the monovision group, and near vision was best in the multifocal group. Contrast sensitivity was better in the monovision group, whereas near stereoacuity was better in the multifocal group. Forward light scatter and higher-order aberrations did not differ in the 2 groups.

Subjective dysphotopsia questioning revealed that multifocal patients reported far more "annoying" or "debilitating" glare or dazzle than monovision patients (43% vs 18%). IOL exchange (ie, multifocal out, monofocal in) was performed in 6 multifocal patients but no monofocal patients. The reason for IOL exchange was dissatisfaction with image quality in 5 of the 6 exchanged multifocal patients.

Patients in both groups reported high satisfaction levels (85% for monovision and 81% for multifocal), and satisfaction correlated with visual acuity and absence of dysphotopsia.

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