COMMENTARY

Does Mini-Monovision Measure Up to Multifocal IOLs?

William W. Culbertson, MD

Disclosures

March 19, 2015

Mini-monovision Versus Multifocal Intraocular Lens Implantation

Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, Kozobolis VP
J Cataract Refract Surg. 2015;41:53-57

A Clinical Trade-off

The goal of attaining high-quality, spectacle-free reading and distance vision after cataract surgery—without annoying optical side effects—has proved elusive to date. Although clinical studies of multifocal intraocular lenses (IOLs) have reported spectacle independence in 65%-90% of patients, satisfaction levels have been suboptimal because of associated optical side effects, such as halos, glare, shadows, waxy vision, and difficulty reading in dim light.

An alternative strategy has been the use of various levels of monovision, in which one eye is corrected for distance vision, whereas the other eye is intentionally focused at near. The amount of intended myopia can vary between full monovision, in which the reading eye has a residual refractive error of -2.50 diopters (D) or more, and mini-monovision, in which the near eye has -0.75 to -1.75 D of myopia. Obtaining less of a differential between the two eyes allows for less anisometropia and greater patient comfort.

However, as the level of myopia is decreased, the near focal point recedes and the reading capacity declines. The trade-off with any degree of monovision is that there are fewer of the annoying optical side effects usually associated with multifocal IOLs, but there may be more dependence on glasses, especially for prolonged near tasks, such as computer work, book reading, or knitting.

Study Summary

This study was performed by a team of investigators from Alexandroupolis, Greece, who compared levels of spectacle independence and visual symptoms in cataract surgical patients.

Two groups of age-matched patients with no ocular abnormality underwent cataract surgery performed by the same surgeon. One group received a refractive multifocal IOL (Isert PY60MV; Hoya Surgical Optics, Inc.) with both eyes targeted for plano, whereas the other comparative mini-monovision group received a monofocal aspheric IOL (SN60WF; Alcon Laboratories, Inc.) targeted for -0.50 D in the dominant eye and for -1.25 D in the other eye.

Pre- and postoperative evaluations were obtained with the Visual Function Index-14 (VF-14) to determine visual symptoms and general visual functionality. Uncorrected binocular near and distance vision were assessed, as well as the proportion of patients who were spectacle-dependent for near and distance vision.

Both the multifocal and mini-monovision groups achieved good binocular uncorrected distance vision. The multifocal lens provided better overall near vision than the -1.25 D target for mini-monovision. There were no differences between the two groups in contrast sensitivity, stereopsis, or VF-14 items pertaining to distance or near vision.

Approximately twice as many multifocal patients (66%) reported being spectacle free compared with mini-monovision patients (34%). However, dysphotopsia (shadows and glare) occurred much more frequently in multifocal patients than in mini-monovision patients.

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