Nagyova Dana, Tappeiner Christoph, Blaha Andrej, Goldblum David, Kyroudis Dimitrios
Department of Ophthalmology, Pallas Kliniken, Olten/Bern/Zürich/Dübendorf, Switzerland.
Department of Ophthalmology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Klin Monbl Augenheilkd. 2025 Apr;242(4):372-378. doi: 10.1055/a-2479-9041. Epub 2025 Jan 13.
Extended monovision is a novel mix-and-match approach that has been recently introduced. It involves implanting an aspherical monofocal intraocular lens (IOL) for distance vision in the dominant eye, and a bifocal extended depth-of-focus (EDOF) IOL in the nondominant eye. The target refraction for the nondominant eye is - 1.25 diopters (D), and provides good intermediate vision at 80 cm, with an additional 1.5 D power for near vision at 36 cm. This study evaluates the visual outcomes and patient-reported experiences with this extended monovision strategy in cataract patients.
Patients underwent uneventful conventional or femtosecond laser-assisted cataract surgery and implantation of an aspherical monofocal IOL (Hoya Vivinex XC1-SP, Hoya Surgical Optics, Tokyo, Japan) in the dominant eye [with a target refraction closest to the spherical equivalent (SE) of 0 D] and a rotationally asymmetric refractive bifocal EDOF IOL with an additional power of + 1.5 D (Lentis Comfort-LS-313 MF15, Teleon Surgical B.V, Spankeren, Netherlands) in the nondominant eye (target refraction closest to SE - 1.25 D). These patients were included in this retrospective study. Uncorrected distance, intermediate and near visual acuity (UDVA, UIVA, and UNVA, respectively), and binocular defocus curves were determined. Additionally, uncorrected contrast sensitivity, stereoscopic depth perception, and halometry were measured. Patient satisfaction was evaluated using the PRSIQ and NEI-RQL-42 questionnaires.
A total of 26 eyes from 13 patients were included in the study. The mean postoperative binocular UDVA, UIVA, and UNVA were 0.05 ± 0.09, - 0.08 ± 0.11, and 0.06 ± 0.07 logMAR, respectively. The defocus curve peaked at 0.0 D (6 m), with a mean visual acuity of 0.04 ± 0.09 logMAR. Functional vision above the cutoff value of 0.3 logMAR extended across the defocus steps from + 1.0 to - 3.5 D. The mean dependence on correction score reached a mean of 89.4 ± 23.9, with an overall satisfaction rate of 83.1 ± 13.2.
To our knowledge, this is the first study to describe the combination of a monofocal IOL for distance vision and a rotationally asymmetric refractive bifocal EDOF IOL for intermediate and near distances, with the aim of achieving extended monovision. This approach demonstrated good visual acuity for all distances and a high patient satisfaction. It may be considered a promising alternative to multifocal IOLs.
扩展单眼视力是一种最近引入的新型混合匹配方法。它包括在优势眼植入一个用于远距离视力的非球面单焦点人工晶状体（IOL），在非优势眼植入一个双焦点扩展焦深（EDOF）IOL。非优势眼的目标屈光度为-1.25 屈光度（D），可在 80 厘米处提供良好的中间视力，并在 36 厘米处为近视力额外提供 1.5 D 的屈光度。本研究评估了白内障患者采用这种扩展单眼视力策略后的视觉效果和患者报告的体验。
患者接受了顺利的传统或飞秒激光辅助白内障手术，并在优势眼植入一个非球面单焦点 IOL（日本东京豪雅外科光学公司的 Hoya Vivinex XC1-SP）[目标屈光度最接近 0 D 的球镜等效度（SE）]，在非优势眼植入一个旋转不对称屈光双焦点 EDOF IOL，额外屈光度为+1.5 D（荷兰斯潘克伦 Teleon 外科公司的 Lentis Comfort-LS-313 MF15）（目标屈光度最接近 SE -1.25 D）。这些患者被纳入这项回顾性研究。测定了未矫正的远、中、近视力（分别为 UDVA、UIVA 和 UNVA）以及双眼散焦曲线。此外，还测量了未矫正的对比敏感度、立体深度感知和眩光测量。使用 PRSIQ 和 NEI-RQL-42 问卷评估患者满意度。
该研究共纳入了 13 名患者的 26 只眼。术后双眼平均 UDVA、UIVA 和 UNVA 分别为 0.05±0.09、-0.08±（此处原文可能有误，按照上下文推测应为-0.08±0.11）0.11 和 0.06±0.07 logMAR。散焦曲线在 0.0 D（6 米）处达到峰值，平均视力为 0.04±0.09 logMAR。高于 0.3 logMAR 截止值的功能性视力在从+1.0 到-3.5 D 的散焦步骤中均有体现。平均矫正依赖评分达到 89.4±23.9，总体满意度为 83.1±13.2。
据我们所知，这是第一项描述用于远距离视力的单焦点 IOL 与用于中近距离的旋转不对称屈光双焦点 EDOF IOL 相结合以实现扩展单眼视力的研究。这种方法在所有距离上都显示出良好的视力，且患者满意度高。它可能被认为是多焦点 IOL 的一种有前景的替代方案。
