COMMENTARY

Does Mini-Monovision Measure Up to Multifocal IOLs?

William W. Culbertson, MD

Disclosures

March 19, 2015

Viewpoint

"Mini-monovision" is not precisely defined in the literature, although the concept of providing some reading/intermediate vision to cataract patients without compromising distance vision is generally understood by clinicians.

By using aspheric monofocal IOLs, an acceptable range of everyday vision for casual reading and distance is achieved with lessor dysphotopsias, and at a lower cost, than with multifocal IOLs. In mini-monovision, a residual level of intended myopia of -0.75 to -1.50 D is targeted in the "reading eye." This would in theory provide a near focal point at a computer working distance or for grocery shopping, for example, especially if the depth of focus is enhanced by some IOL-induced negative spherical aberration.

It is understood that these lower levels of myopia in the "reading eye" do not afford crisp focus at traditional desk reading distances of 14-16 inches. However, patients typically tolerate lower degrees of disparity between the myopic reading eye and the dominant emmetropic distance eye.

In this study, the difference was further reduced by intentionally targeting the distance eye to also be slightly myopic (-0.50 D). We would expect this arrangement to be ideal for casual around-the-house visual needs ranging from 20 inches to 6-10 feet, with high levels of patient satisfaction if they understand their optical limitations. For extended desk reading or for driving, especially at night, appropriate spectacles would then provide near-perfect binocular vision, unaffected by the well-known optical compromises of multifocal IOLs.

Although two thirds of the multifocal group was "spectacle-free" in this study, spectacles are not expected to provide relief from dysphotopsias in multifocal emmetropic patients; therefore, patients would be "spectacle-free" no matter what their visual function.

An additional question that could be posed in these studies comparing multifocal IOLs with monovision would be, "Is your vision adequate to do everything that you want to do with ease, including if you wore glasses when you need to?" If the occasional need to wear glasses is included, the excellent vision without dysphotopsias afforded by monofocal monovision would reflect a very high level of visual satisfaction in virtually all patients.

In conclusion, although the term "mini-monovision" could be better defined for study purposes, the concept of providing proximal-range, convenient, and usually spectacle-free vision with simple monofocal IOLs is very appealing. It maintains justifiable advantages over more expensive, and sometimes problematic, multifocal IOLs.

Abstract

Suggested Reading

Boerner CF, Thrasher BH. Results of monovision correction in bilateral pseudophakes. J Am Intraocul Implant Soc. 1984;10:49-50.

Jain S, Arora I, Azar DT. Success of monovision in presbyopes: review of the literature and potential applications to refractive surgery. Surv Ophthalmol. 1996;40:491-499.

Pager CK. Expectations and outcomes in cataract surgery: a prospective test of 2 models of satisfaction. Arch Ophthalmol. 2004;122:1788-1792.

Wilkins MR, Allan BD, Rubin GS, et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013;120:2449-2455.

Xiao J, Jiang C, Zhang M. Pseudophakic monovision is an important surgical approach to being spectacle-free. Indian J Ophthalmol. 2011;59:481-485.

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