Neurosensory binocular vision after bilateral implantation of an extended depth of focus intraocular lens with micro-monovision: a prospective cohort study.

Background: The goal of this study was to evaluate the presbyopia-correcting performance, binocular visual quality and neurosensory binocular vision of bilateral implantation of an extended depth of focus (EDOF) intraocular lens (IOL) with micro-monovision and compare this IOL with two multifocal IOLs.

Methods: This prospective cohort study enrolled patients with bilateral implantation of diffractive EDOF IOL (Tecnis Symfony ZXR00, Abbott Medical Optics, Inc.), diffractive trifocal IOL (AT LISA tri 839MP, Carl Zeiss Meditec AG) and refractive rotationally asymmetric bifocal IOL (SBL-3, Lenstec, Inc.). Monocular outcomes including visual acuity and refraction status, binocular outcomes including visual acuity at different distances, defocus curve and contrast sensitivity, neurosensory binocular vision outcomes including simultaneous perception, fusion and stereoscopic vision, and questionnaire results including spectacle independence, photic phenomena and satisfaction were assessed three months after surgery. One-way ANOVA and Kruskal-Wallis H test were used to compare the mean of three groups. Chi-square test and Fisher exact test were used to compare the proportions.

Results: The efficacy, safety and accuracy of the EDOF group reached a similar level to the trifocal group. The bilateral EDOF IOL with micro-monovision performed better in intermediate visual acuity (versus the bifocal group, P = 0.031) and far stereoscopic vision (versus the other two groups, P < 0.05), but there were disadvantages in binocular visual acuity with the -3.0 ~ -4.0D addition (versus the other two groups, P < 0.05), binocular contrast sensitivity (versus the other two groups, P < 0.05), near spectacle independence (versus the trifocal group, P = 0.030) and photic phenomena (versus the bifocal group, P < 0.05). No significant difference was found in simultaneous perception, fusion and satisfaction at different distances (all P > 0.05).

Conclusion: Bilateral EDOF IOL implantation with micro-monovision successfully treated cataract, provided reliable binocular far and intermediate visual acuity, good neurosensory binocular vision and patient satisfaction. It achieved better far stereoscopic vision than multifocal IOLs, but lagged behind in near visual acuity, near spectacle independence and binocular contrast sensitivity.

Trial Registration: This study was retrospectively registered and posted on clinicaltrials.gov at 12/02/2020 (NCT04265846).