Visual outcomes comparing emmetropia versus mini-monovision following bilateral implantation of a non-diffractive extended vision intraocular lens:randomized trial

Purpose: To compare visual outcomes and patient satisfaction following bilateral implantation of a non-diffractive extended vision intraocular lens(IOL) when targeting emmetropia versus mini-monovision Setting: Iladevi Cataract & IOL Research Centre,India Design: Prospective,randomized controlled trial Methods: Patients undergoing bilateral cataract surgery with an extended vision IOL(Vivity, Alcon Laboratories, USA) randomized to: group I- IOL implantation with emmetropic target in both eyes, or group II- IOL implantation with mini-monovision of -0.5 diopters(D). Outcome measures evaluated 6 months postoperatively were: unaided and corrected near visual acuity(UNVA, CNVA) at 40 centimeters(cm), unaided and corrected distance(UDVA, CDVA) and intermediate (UIVA, CIVA) visual acuity at 66cm. Mesopic contrast sensitivity, binocular defocus curve, patient reported spectacle independence questionnaire and satisfaction on the McAlinden questionnaire were also assessed. Results: 70 patients enrolled in study. 34 and 33 patients in groups I and II completed follow-up. Binocular UNVA was significantly better in group II (0.26 + 0.05 vs 0.22 + 0.08 LogMAR, P=0.03). Reading add required in group II was significantly lower. UIVA (0.09 + 0.06 vs 0.07 + 0.08 LogMAR, P=0.15) and UDVA (0.02 + 0.04 vs 0.02 + 0.05 LogMAR, P=0.78) were not significantly different between groups. Mesopic contrast sensitivity was not significantly different between the groups. Binocular defocus curve showed significantly better mean visual acuities between -2.0 to -3.0 diopters in group II. Patients in both groups had high levels of spectacle independence, with no patient reporting dysphotopsia. Conclusion: Binocular UNVA was significantly better, with comparable UDVA and mesopic contrast sensitivity when targeting mini monovision with the non-diffractive extended vision IOL as compared to targeting binocular emmetropia.