Spectacle Independence And Patient Satisfaction With Pseudophakic Mini-Monovision Using Aberration-Free Intraocular Lens

Tarek Abdelrazek Hafez, Hany Ahmed Helaly, Tarek Abdelrazek Hafez, Hany Ahmed Helaly

Abstract

Purpose: To assess spectacle independence and patient satisfaction with pseudophakic mini-monovision in patients undergoing routine bilateral cataract surgery with implantation of an aspherical aberration-free intraocular lens (Akreos AO, Bausch and Lomb, USA).

Methods: This study was a retrospective analysis that included 60 eyes of 30 consecutive patients between 2016 and 2018. The included patients had undergone sequential bilateral routine phacoemulsification after choosing the mini-monovision option. Test for ocular dominance was done using a sighting test. Emmetropia was aimed at in the dominant eye, while in the non-dominant eye the aim was myopia between -1 D and -1.5 D. The main outcome parameters were uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and data reported from a questionnaire given to the patients at 3 months postoperative visit.

Results: The study included 60 eyes of 30 consecutive patients. The mean binocular UDVA was 0.09 ± 0.07 logMAR. Twenty-eight patients (93%) had binocular UDVA of 0.2 logMAR or better. The mean binocular uncorrected intermediate distance visual acuity (at 65 cm) was 0.16 ± 0.12 logMAR. Twenty-six patients (87%) had binocular uncorrected intermediate distance visual acuity of 0.2 logMAR or better. The mean binocular UNVA (at 35 cm) was 0.30 ± 0.21 logMAR. Fourteen patients (47%) had binocular UNVA of 0.2 logMAR or better. The patients score in the questionnaire was significantly higher in far and intermediate vision than near vision (p = 0.022). The patients score was significantly higher in day vision than night vision (p = 0.031). The mean overall patient satisfaction was good (9.1 ± 1.54). Twenty-eight patients (93%) reported high spectacle independence for far vision (score 8, 9, or 10).

Conclusion: Pseudophakic mini-monovision shows good results for spectacle independence and high patient satisfaction. It is a safe and inexpensive option after bilateral cataract surgery for correcting distance and intermediate vision. However, it might show lower results with near and night vision which is generally acceptable. Using aberration-free monofocal IOL allows for the residual normal positive corneal aberration that may augment the effect of monovision.

Keywords: Akreos AO; mini-monovision; patient satisfaction; presbyopia; pseudophakia; spectacle independence.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Abdelrazek Hafez and Helaly.

Figures

Figure 1
Figure 1
Cumulative binocular uncorrected visual acuities at 3 months postoperative.
Figure 2
Figure 2
Contrast sensitivity testing under photopic and mesopic conditions with no glare.
Figure 3
Figure 3
Contrast sensitivity testing under photopic and mesopic conditions with glare.

References

    1. Leaming DV. Practice styles and preferences of ASCRS members – 2003 survey. J Cataract Refract Surg. 2004;30:892–900. doi:10.1016/j.jcrs.2004.02.064
    1. Pick ZS, Leaming DV, Elder MJ. The fourth New Zealand cataract and refractive surgery survey: 2007. Clin Exp Ophthalmol. 2008;36:604–619. doi:10.1111/j.1442-9071.2008.01869.x
    1. Farhoudi DB, Behndig A, Montan P, Lundström M, Zetterström C, Kugelberg M. Spectacle use after routine cataract surgery: a study from the Swedish National Cataract Register. Acta Ophthalmol (Copenh). 2018;96(3):283–287. doi:10.1111/aos.13554
    1. Mahrous A, Ciralsky JB, Lai EC. Revisiting monovision for presbyopia. Curr Opin Ophthalmol. 2018;29(4):313–317. doi:10.1097/ICU.0000000000000487
    1. Rosa AM. Presbyopia monovision correction and cortical adaptation. J Physiol. 2018;596(2):135. doi:10.1113/JP276586
    1. Steinwender G, Schwarz L, Böhm M, et al. Visual results after implantation of a trifocal intraocular lens in high myopes. J Cataract Refract Surg. 2018;44(6):680–685. doi:10.1016/j.jcrs.2018.04.037
    1. Khandelwal SS, Jun JJ, Mak S, Booth MS, Shekelle PG. Effectiveness of multifocal and monofocal intraocular lenses for cataract surgery and lens replacement: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2019;10:1–3.
    1. Akella SS, Juthani VV. Extended depth of focus intraocular lenses for presbyopia. Curr Opin Ophthalmol. 2018;29(4):318–322. doi:10.1097/ICU.0000000000000490
    1. Brady D, Silvestrini T, Rao R, inventors; Lensgen Inc, assignee. Two-part accommodating intraocular lens device. United States patent application US 10/159,564 2018. December 25.
    1. Boerner CF, Thrasher BH. Results of monovision correction in bilateral pseudophakes. Am Intra-Ocular Implant Soc J. 1984;10:49–50. doi:10.1016/S0146-2776(84)80077-4
    1. Greenstein S, Pineda R. The quest for spectacle independence: a comparison of multifocal intraocular lens implants and pseudophakic monovision for patients with presbyopia. Semin Ophthalmol. 2017;32(1):111–115.
    1. Hayashi K, Yoshida M, Manabe S, Hayashi H. Optimal amount of anisometropia for pseudophakic monovision. J Refract Surg. 2011;27(5):332–338. doi:10.3928/1081597X-20100817-01
    1. Jain S, Ou R, Azar DT. Monovision outcomes in presbyopic individuals after refractive surgery. Ophthalmology. 2001;108(8):1430–1433. doi:10.1016/s0161-6420(01)00647-9
    1. Hayashi K, Ogawa S, Manabe SI, Yoshimura K. Binocular visual function of modified pseudophakic monovision. Am J Ophthalmol. 2015;159(2):232–240. doi:10.1016/j.ajo.2014.10.023
    1. Evans BJ. Monovision: a review. Ophthalmic Physiol Opt. 2007;27(5):417–439. doi:10.1111/j.1475-1313.2007.00488.x
    1. Xiao J, Jiang C, Zhang M. Pseudophakic monovision is an important surgical approach to being spectacle-free. Indian J Ophthalmol. 2011;59(6):481. doi:10.4103/0301-4738.77010
    1. Buckhurst PJ, Naroo SA, Davies LN, Shah S, Drew T, Wolffsohn JS. Assessment of dysphotopsia in pseudophakic subjects with multifocal intraocular lenses. BMJ Open Ophthalmol. 2017;1(1):e000064. doi:10.1136/bmjophth-2016-000064
    1. Mu J, Chen H, Li Y. Comparison study of visual function and patient satisfaction in patients with monovision and patients with bilateral multifocal intraocular lenses. Zhonghua Yan Ke Za Zhi. 2014;50(2):95–99.
    1. Osher RH, Golnik KC, Barrett G, Shimizu K. Intentional extreme anisometropic pseudophakic monovision: new approach to the cataract patient with longstanding diplopia. J Cataract Refract Surg. 2012;38(8):1346–1351. doi:10.1016/j.jcrs.2012.04.029
    1. Rocha KM, Soriano ES, Chamon W, Chalita MR, Nosé W. Spherical aberration and depth of focus in eyes implanted with aspheric and spherical intraocular lenses: a prospective randomized study. Ophthalmology. 2007;114(11):2050–2054. doi:10.1016/j.ophtha.2007.01.024
    1. Yi F, Iskander DR, Collins M. Depth of focus and visual acuity with primary and secondary spherical aberration. Vision Res. 2011;51(14):1648–1658. doi:10.1016/j.visres.2011.05.006
    1. Ye PP, Li X, Yao K. Visual outcome and optical quality after bilateral implantation of aspheric diffractive multifocal, aspheric monofocal and spherical monofocal intraocular lenses: a prospective comparison. Int J Ophthalmol. 2013;6(3):300.
    1. Wilkins MR, Allan BD, Rubin GS, et al; Moorfields IOL Study Group. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013;120(12):2449–2455. doi:10.1016/j.ophtha.2013.07.048
    1. Goldberg DG, Goldberg MH, Shah R, Meagher JN, Ailani H. Pseudophakic mini-monovision: high patient satisfaction, reduced spectacle dependence, and low cost. BMC Ophthalmol. 2018;18(1):293. doi:10.1186/s12886-018-0963-3
    1. Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, Kozobolis VP. Mini-monovision versus multifocal intraocular lens implantation. J Cataract Refract Surg. 2015;41(1):53–57. doi:10.1016/j.jcrs.2014.06.015
    1. Kim J, Shin HJ, Kim HC, Shin KC. Comparison of conventional versus crossed monovision in pseudophakia. Br J Ophthalmol. 2015;99(3):391–393. doi:10.1136/bjophthalmol-2014-305449

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться