Enhanced monofocal versus conventional monofocal intraocular lenses: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Objective: To evaluate the comparative effectiveness of enhanced monofocal (EM) versus conventional monofocal (CM) intraocular lenses (IOLs) in senile cataract surgery, focusing on uncorrected intermediate visual acuity (UIVA) and secondary outcomes.

Design: Systematic review and meta-analysis of randomized controlled trials (RCTs).

Methods: A systematic literature search was conducted in PubMed, EMBASE, and Cochrane Library on March 8, 2024. RCTs comparing EM IOLs with CM IOLs in senile cataract surgery were included. The primary outcome was postoperative photopic binocular and monocular UIVA. Secondary outcomes included distance-corrected intermediate visual acuity (DCIVA), spectacle-free intermediate vision, binocular reading speed, postoperative visual phenomena, and patient-reported outcomes. The risk of bias was assessed using the Cochrane RoB 2 tool. The study was registered with the international Prospective Register of Systematic Reviews (CRD42024508318).

Results: Six RCTs with 429 patients were included. EM IOLs (Tecnis Eyhance ICB00) were implanted in 422 eyes, and CM IOLs in 436 eyes. EM IOLs showed superior binocular UIVA (mean difference [MD]: -0.10 logMAR; 95% CI: -0.13 to -0.08) and monocular UIVA (MD: -0.09 logMAR; 95% CI: -0.11 to -0.06) compared to CM IOLs. EM IOLs also demonstrated superior binocular and monocular DCIVA. No broad significant differences were found between EM and CM IOLs in other secondary outcomes.

Conclusions: EM IOLs offer a modest, but significant, improvement in UIVA and DCIVA compared to CM IOLs in senile cataract surgery, with a comparable safety profile. The evidence underscores the potential benefit of EM IOLs in enhancing intermediate vision, although generalizability is subject to the limitations of the included studies.