Patient-reported Outcome Measures for Assessing Spectacle Independence after Implantation of Monofocal or Extended Depth of Focus (EDOF) Intraocular Lenses with Various Degrees of Monovision.

Abstract

Purpose: Cataract surgery aiming for emmetropia in one eye and various degrees of myopia in the contralateral eye (monovision) is a popular strategy to improve spectacle independence. The aim of this study was to use patient-reported outcome measures to assess spectacle independence after implanting aspheric monofocal or extended depth of focus (EDOF) intraocular lenses (IOLs) with various degrees of monovision.

Methods: All patients with bilateral cataract surgery between 2021 and 2024 aiming for micromonovision (- 0.5 to - 0.75 D), mini monovision (- 1.0 to - 1.5 D) or full monovision (- 1.75 to - 2.5 D) after cataract surgery with implantation of either aspheric monofocal IOLs (Tecnis ZCB00, Johnson & Johnson) or EDOF-IOLs (Tecnis Eyhance, Johnson & Johnson) were included in this study. Patients were implanted with either a monofocal IOL or an EDOF IOL in both eyes, and were aiming for emmetropia in the dominant eye. Six months postoperatively, all patients were contacted by telephone and asked to report their outcomes using a structured questionnaire investigating their spectacle usage for various daily activities and their overall satisfaction.

Results: Thirty-two patients in the monofocal group and 88 patients in the EDOF group completed the questionnaire. In both groups, 22% of patients reported that they were entirely spectacle independent for all daily activities. However, the proportion of patients who used spectacles for at least 50% of the time was 41% in the monofocal group and 16% in the EDOF group. The percentages of patients who were able to perform computer work without spectacles with micro-, mini-, or full monovision were 27%, 67%, and 77% in the monofocal group and 61%, 60%, and 90% in the EDOF group, respectively. Spectacle-free reading of a smartphone or tablet was possible for 17%, 75%, and 71% of all patients with monofocal IOL and for 38%, 50%, and 90% with EDOF IOL, depending on the degree of monovision. Patient satisfaction was generally high with a maximum score of 4.9 out of possible 5.0 points in the full monovision EDOF group.

Conclusion: Patients aiming for spectacle independence with monovision achieve better results when implanted with EDOF IOLs than with aspheric monofocal IOLs. Even with EDOF IOL, it is necessary to aim for full monovision (- 1.75 to - 2.5 D) in order to achieve spectacle independence for computer work.