Blended Vision with Enhanced Monofocal IOL

Implanting an enhanced monofocal IOL using a blended vision approach provided good levels of spectacle independence for intermediate and near distances and improved functional performance in daily life, according to a recent study.

“Our study showed patients implanted with the Tecnis Eyhance lens (Johnson & Johnson Vision) experienced improved spectacle independence for intermediate and near vision when comparing patients targeted for blended vision using a mini-monovision to control patients targeted for emmetropia,” Dr Reem Aziz said.

Explaining the rationale for the study, Dr Aziz noted prediction errors could make monovision targets difficult to achieve. And even when outcomes do match refractive targets, adaptation to binocular visual function is not always easy for patients using standard monofocal lens technology.

“The problem is more than 25% of all cataract patients are affected by a prediction error of more than 0.5 D, and more than 7% by a prediction error of more than 1.0 D,” she said.

“With this in mind, we wanted to look at the possibility of using an IOL that would achieve a broader landing zone on the defocus curve and give some leeway in the prediction error.”

The Tecnis Eyhance is a non-diffractive monofocal IOL with a modified anterior surface and continuous power profile from the periphery to the centre of the lens, allowing for a wider range of vision without an increase in photic phenomena or a decrease in contrast sensitivity, Dr Aziz explained.

The retrospective multicentre study included 88 eyes of 44 patients who underwent cataract surgery or refractive lens exchange with implantation of the Tecnis Eyhance IOL between August 2020 and December 2022. The procedure aimed for blended vision in 29 patients with a target of emmetropia in the dominant eye and a target of myopia ranging from -0.5 D to -1.5 D in the non-dominant eye. Key outcomes assessed included three-month postoperative uncorrected visual acuities at distance, intermediate, and near, defocus curves, spectacle independence, and visual function as evaluated by the NEIVFQ questionnaire.

Based on the spectacle independence questionnaire, the frequency of all study participants who were spectacle-free for distance, intermediate, and near activities was 80%, 64%, and 34%, respectively.

“What was interesting was spectacle independence was achieved in 72% for intermediate vision and 38% for near vision in blended vision patients, compared to 47% and 27% for controls, respectively,” Dr Aziz noted. Moreover, the average subjective visual function score for those who completed the NEI-VFQ questionnaire was 74.6% preoperatively and 91.3% three months postoperatively.

“This reflected the fact that patients were very happy overall with the performance of the lens,” she concluded. “Spectacle independence is very important to patients, and those targeted for blended vision did better at intermediate and near distances.”

Dr Aziz gave this presentation at the 2023 ESCRS Winter Meeting in Vilamoura, Portugal.

Reem Aziz MD is a post-graduate research fellow at Precision Cornea Centre and an incoming ophthalmology resident at the University of Ottawa, Canada.

reem@precisioncornea.com