Monovision with a Bifocal Diffractive Multifocal Intraocular Lens in Presbyopic Patients: A Prospective, Observational Case Series.

Published on Apr 1, 2020in American Journal of Ophthalmology4.013
· DOI :10.1016/J.AJO.2019.11.010
John S.M. Chang2
Estimated H-index: 2
John S M Chang7
Estimated H-index: 7
+ 1 AuthorsPak Ling Ma1
Estimated H-index: 1
Abstract Purpose To report the visual outcomes and patient satisfaction after bilateral implantation of a bifocal diffractive intraocular lens with monovision. Design Prospective, observational case series. Methods Twenty-one subjects underwent cataract surgery or refractive lens exchange with bilateral implantation of the ZMB00 IOL, with the dominant eye and non-dominant eye targeted for plano and -1.25 to -1.00 diopters, respectively. Postoperative assessments included visual acuity (VA) at various distances under photopic and mesopic conditions; defocus curve, contrast sensitivity, and stereopsis; and Visual Function Questionnaire-25 and supplementary questionnaire. Results Mean binocular uncorrected VA at distance, intermediate (67 cm), and near (30 cm) were -0.03±0.06, 0.12±0.18, and 0.11±0.05, respectively. No eyes lost >1 line of corrected distance VA. Binocular intermediate VA was significantly better in the uncorrected condition (P=.004) whereas binocular distance VA was better in the distance-corrected condition (P=.014). Near VA was similar in both conditions (P>.05). Stereoacuity and contrast sensitivity were within normal limits. All subjects had a composite score of ≥90 for vision-targeted items in VFQ-25. Halos, glare, and starbursts occurred in 52%, 29%, and 24% of the subjects, respectively. All subjects reported a satisfaction score of ≥3.5/5 and required no spectacles postoperatively. No IOL exchange was required. Conclusions Monovision with bilateral bifocal MIOL was safe and provided satisfactory vision at various distances, with good stereopsis and contrast sensitivity. Complete spectacle independence and high satisfaction score were achieved. In comparison with bilateral emmetropic bifocal MIOL, it provided better vision at intermediate and at very near distances without inducing more dysphotopsia.
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