A Comparative Study Of Premium Monovision Versus Bilateral Myopic Monovision, Hybrid Monovision And Bilateral Trifocal Implantation.

To compare the efficacy of premium monovision (hybrid bifocal intraocular lens - IOL in the dominant and diffractive trifocal IOL in the recessive eye), against bilateral myopic monovision, hybrid monovision (monofocal IOL in the dominant and diffractive trifocal IOL in the recessive eye) and bilateral trifocal implantation.

Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece

Cataract patients were categorized into 4 study groups: Monovision Group, Multifocal Lens Group, Hybrid Monovision Group and Premium Monovision Group. 6 months following the second eye operation, binocular uncorrected distance visual acuity (UDVA), binocular uncorrected reading acuity (RA) and critical print size (CPS) at 60cm and 40cm, contrast sensitivity, subjective satisfaction, dysphotopsia symptoms and spectacle independence were evaluated in all study groups. A mathematical model was constructed with regression analysis, which calculated the «relative efficacy» of each surgical intervention based on the total Visual Function Index-14 (VF-14) score as a function of each measured clinical parameter score.

120 participants were recruited and populated equally the study groups. No significant differences were observed in postoperative binocular UDVA (p = 0.12) and binocular uncorrected intermediate RA (p = 0.24) among study groups, while significant differences were noticed in CPS at 60 cm (p = 0.04) and 60 cm (p = 0.01) and uncorrected RA at 40 cm (p = 0.02). Dysphotopic phenomena were significantly more in the multifocal patients followed by the premium monovision group (p = 0.04 & p = 0.02, respectively), while satisfaction and spectacle independence rates were significantly better in premium monovision group which also presented the best relative efficacy (92.18%).

All surgical techniques presented satisfactory outcomes. Premium monovision seems to demonstrate the best relative efficacy. Additionally, regression analysis and curve modeling revealed the relative impact of each parameter on the dependent variable of relative efficacy and allowed its overall estimation.