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Helga P Sandoval,1 Richard Potvin,2 Kerry D Solomon1 1Carolina Eyecare Physicians / US Eye, Mt. Pleasant, SC, USA; 2Science in Vision, Frisco, TX, USACorrespondence: Kerry D Solomon, Carolina Eyecare Physicians, LLC, 1101 Clarity Road, Suite 100, Mt. Pleasant, SC, 29464, USA, Email ksolomon@cepmd.comPurpose: To evaluate relative visual performance and subjective outcomes after implantation of the TECNIS Eyhance™ intraocular lens (IOL) targeted for bilateral emmetropia or monovision.Methods: This was a prospective, single-center randomized, patient-masked trial. Patients were implanted with the enhanced IOL targeted for bilateral emmetropia or slight monovision (− 0.75 D in the non-dominant eye). At 3 months the binocular visual acuity (VA) was measured at distance, intermediate and near, along with low contrast VA in photopic and mesopic conditions, and the distance corrected defocus curve. Questionnaires related to spectacle independence, satisfaction, visual symptoms, and functional vision were administered.Results: Data from 71 subjects (34 Emmetropia, 37 Monovision) were analyzed. There was no difference in the mean uncorrected distance VA (p = 0.11), but uncorrected intermediate and near VAs were one line better in the Monovision group (p = 0.02 and 0.01, respectively). Mesopic and photopic low contrast VA were similar between groups. There was a trend for less difficulty and higher satisfaction with near and intermediate vision in the Monovision group, but no significant differences in any of the subjective questionnaires. Difficulty reading was the most reported concern in both groups, though 93% of all subjects reported “little” or “no” difficulty with daily activities. Overall, 82% of subjects were “completely” or “very” happy with their lens choice.Conclusion: Using this enhanced IOL with slight monovision in the non-dominant eye increased intermediate and near VA with no apparent effect on low contrast distance VA, subjective visual quality, or satisfaction.Keywords: Tecnis Eyhance, enhanced monofocal, monofocal plus, monovision

Shamik Bafna,1 Xiaolin Gu,2 Helene Fevrier,3 Mohinder Merchea2 1Cleveland Eye Clinic, Brecksville, OH, USA; 2Alcon Vision LLC, Fort Worth, TX, USA; 3Verana Health, San Francisco, CA, USACorrespondence: Shamik Bafna, Cleveland Eye Clinic, 7001 S Edgerton Road, Brecksville, OH, 44141, USA, Tel +1 216-287-2060, Email sbafna@midwestvision.comPurpose: To determine the incidence of pseudophakic monovision among patients bilaterally implanted with monofocal intraocular lenses (IOLs) and to characterize the distribution of myopic offsets achieved.Patients and Methods: This retrospective database study included data on patients receiving care from ophthalmologists who contributed to the Academy IRIS® (Intelligent Research In Sight) Registry. Anonymized data were collected, including patient age, ethnicity, procedure data (CPT code, date, laterality), and postoperative manifest refractive spherical equivalent (MRSE) in both eyes implanted with monofocal or monofocal toric IOLs. No data regarding IOL manufacturer, model, or power were collected. One primary outcome measure was the percentage of patients achieving monovision (defined as emmetropia within ± 0.25 diopters [D] in one eye and a myopic offset of ≥ 0.50 D in the fellow eye) among all patients receiving bilateral monofocal IOLs at the time of cataract surgery between January 1, 2016, and September 1, 2019, with at least 90 days of follow-up. Other primary outcomes included the distribution and frequency of myopic offsets (anisometropia) between eyes.Results: Of the 16,765 people receiving bilateral monofocal IOLs within the study period, 4796 (28.6%) achieved emmetropia in at least one eye, as defined by an MRSE within ± 0.25 D. The incidence of monovision among these patients was 34.2% (1638/4796). One-quarter (24.7%; 405/1638) of patients who achieved monovision had a myopic offset between 0.50 and 0.74 D, with more than one-third (35.2%; 576/1638) falling within 0.75– 1.24 D and 18.0% within 1.25– 1.74 D. A myopic offset ≥ 1.75 D was observed in 22.1% (362/1638) of patients who achieved monovision.Conclusion: Pseudophakic monovision for presbyopia correction was achieved in ~34% of patients in the IRIS Registry bilaterally implanted with monofocal IOLs, with myopic offsets typically ranging from 0.5 to 1.24 D.Keywords: presbyopia, monovision, monofocal IOLs, myopic offset, diopter correction

Purpose: To determine the incidence of pseudophakic monovision among patients bilaterally implanted with monofocal intraocular lenses (IOLs) and to characterize the distribution of myopic offsets achieved.Patients and Methods: This retrospective database study included data on patients receiving care from ophthalmologists who contributed to the Academy IRIS® (Intelligent Research In Sight) Registry. Anonymized data were collected, including patient age, ethnicity, procedure data (CPT code, date, laterality), and postoperative manifest refractive spherical equivalent (MRSE) in both eyes implanted with monofocal or monofocal toric IOLs. No data regarding IOL manufacturer, model, or power were collected. One primary outcome measure was the percentage of patients achieving monovision (defined as emmetropia within ± 0.25 diopters [D] in one eye and a myopic offset of ≥ 0.50 D in the fellow eye) among all patients receiving bilateral monofocal IOLs at the time of cataract surgery between January 1, 2016, and September 1, 2019, with at least 90 days of follow-up. Other primary outcomes included the distribution and frequency of myopic offsets (anisometropia) between eyes.Results: Of the 16,765 people receiving bilateral monofocal IOLs within the study period, 4796 (28.6%) achieved emmetropia in at least one eye, as defined by an MRSE within ± 0.25 D. The incidence of monovision among these patients was 34.2% (1638/4796). One-quarter (24.7%; 405/1638) of patients who achieved monovision had a myopic offset between 0.50 and 0.74 D, with more than one-third (35.2%; 576/1638) falling within 0.75– 1.24 D and 18.0% within 1.25– 1.74 D. A myopic offset ≥ 1.75 D was observed in 22.1% (362/1638) of patients who achieved monovision.Conclusion: Pseudophakic monovision for presbyopia correction was achieved in ~34% of patients in the IRIS Registry bilaterally implanted with monofocal IOLs, with myopic offsets typically ranging from 0.5 to 1.24 D. [ABSTRACT FROM AUTHOR]

Georgios Labiris,1 Eirini-Kanella Panagiotopoulou,1 Asli Perente,1 Panagiota Ntonti,1 Konstantinos Delibasis,2 Ioannis Fotiadis,1 Aristeidis Konstantinidis,1 Doukas Dardabounis1 1Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece; 2Department of Computer Science and Biomedical Informatics, University of Thessaly, Lamia, 35131, GreeceCorrespondence: Georgios Labiris, Department of Ophthalmology, University Hospital of Alexandroupolis, Dragana, 68100, Alexandroupolis, Greece, Tel +306977455027, Email labiris@usa.netPurpose: Contemporary monovision techniques use premium intraocular lenses (IOLs), either in both eyes or at least in the non-dominant one. Primary objective of this study was to compare the efficacy of premium monovision (implantation of the trifocal diffractive Panoptix IOL in the non-dominant eye and the bifocal hybrid refractive-diffractive Restor IOL in the dominant eye), against bilateral myopic monovision (implantation of the monofocal SN60WF IOL targeting − 0.50 D in the dominant eye and − 1.25 D myopia in the non-dominant one), hybrid monovision (implantation of Panoptix in the non-dominant eye and SN60WF in the dominant eye) and bilateral trifocal implantation (with bilateral Panoptix implantation).Methods: This is a prospective, comparative, clinic-based trial. Cataract patients populated four study groups: Monovision Group (MoG), Multifocal Lens Group (MfG), Hybrid Monovision Group (HmG) and Premium Monovision Group (PmG). Binocular Uncorrected Distance Visual Acuity (UDVA), Uncorrected Reading Acuity and Critical Print Size at 60cm (UIRA, UICPS) and at 40cm (UNRA, UNCPS), contrast sensitivity, vision-related functional impairment, dysphotopsia symptoms and spectacle dependence were evaluated 6 months following the operation of the second eye. A mathematical model was constructed, which calculated the relative efficacy of each surgical intervention.Results: A total of 120 participants were recruited and populated equally the study groups. Significant improvement of preoperative UDVA was observed in all study groups. No significant differences could be detected in postoperative UDVA and UIRA (p = 0.24) among study groups, while significant differences were noticed in UICPS (p = 0.04), UNRA (p = 0.02) and UNCPS (p = 0.01). Dysphotopic phenomena (glare and shadows) were significantly more in the MfG arm followed by the PmG group (p = 0.04 and p = 0.02, respectively), while perceived difficulty and spectacle independence rates were significantly better in PmG group. PmG presented the best overall relative efficacy.Conclusion: All surgical techniques present satisfactory outcomes. Premium monovision seems to demonstrate the best outcomes.Trial Registration: ClinicalTrials.gov, NCT04618380. Registered 05 November 2020, https://clinicaltrials.gov/ct2/show/NCT04618380.Keywords: cataract, presbyopia, monovision, multifocal intraocular lens, premium lens, trifocal lens, bifocal lens, diffractive lens

T Hunter Newsom,1 Richard Potvin2 1Newsom Eye & Laser Center, Sebring, FL, USA; 2Science in vision, Bend, OR, USACorrespondence: T Hunter Newsom, Email hunter@newsomeye.netPurpose: To assess the visual outcomes and quality of vision of patients receiving the AcrySof® IQ Vivity™ non-diffractive extended vision intraocular lens (NDEV IOL) after uneventful cataract surgery when the non-dominant eye is targeted for slight myopia.Design: Single site, prospective, single-arm study.Methods: Eligible subjects interested in reducing their dependence on spectacles over a range of working distances were enrolled and followed for 3 months after the second eye surgery. Subjects were bilaterally implanted with this NDEV IOL, with a target of emmetropia in the dominant eye and a myopic refraction of − 0.75D in the non-dominant eye. At 3 months postoperative, the uncorrected and distance-corrected (with monovision) visual acuity at 40 cm, 66 cm and 4 m were recorded, along with the manifest refraction. Questionnaires related to spectacle independence, patient satisfaction and quality of vision were also administered.Results: Data from 33 subjects were analyzed. The mean difference between eyes by subject was 0.80 ± 0.37 D. Twenty-nine of 33 (88%) subjects had a binocular uncorrected near VA of 0.2 logMAR or better. Twenty-five of 33 eyes (76%) had a binocular distance-corrected (− 0.75 D in the non-dominant eye) VA of 0.2 logMAR or better at all three test distances. Satisfaction with vision at all distances was high. The reported level of spectacle independence was higher than for the same lens without monovision. Visual disturbances were higher than has been previously reported for this lens but were not correlated to the level of monovision.Conclusion: A target of − 0.75 D of myopia in the non-dominant eye of patients bilaterally implanted with this NDEV IOL improved near vision, increasing the rate of spectacle independence in patients relative to those targeted for bilateral emmetropia, with no correlated increases in visual disturbances.Keywords: wavefront shaping, spectacle independence, presbyopia correction, EDOF, extended depth of focus, extended depth of vision, non-diffractive, monovision

Helga P Sandoval,1 Stephen Lane,2 Stephen G Slade,3 Eric D Donnenfeld,4 Richard Potvin,5 Kerry D Solomon1 1Carolina Eyecare Physicians, LLC, Mt. Pleasant, SC, USA; 2Associated Eye Care, Stillwater, MN, USA; 3Slade & Baker Vision, Houston, TX, USA; 4Ophthalmic Consultants of Long Island, Long Island, NY, USA; 5Science in Vision, Akron, NY, USACorrespondence: Kerry D SolomonCarolina Eyecare Physicians, LLC, 1101 Clarity Road, Suite 100, Mt Pleasant, SC 29464, USAEmail kerry.solomon@carolinaeyecare.comPurpose: To evaluate the defocus curve and patient satisfaction after implantation of an extended depth of focus (EDOF) toric IOL when both eyes were targeted for emmetropia and when the non-dominant eye was targeted for mini monovision (− 0.50D).Methods: A prospective unmasked randomized clinical trial in three clinical practices in the USA. Subjects presenting for routine cataract surgery were assigned to one of two groups, both receiving bilateral toric EDOF lenses. One group had the non-dominant eye targeted for slight myopia (− 0.50D). Measures of interest were the postoperative defocus curve and reported patient satisfaction and visual disturbances.Results: Questionnaire and defocus curve data were available from 37 subjects in the Emmetropia group, while the mini monovision group included questionnaire data from 39 subjects and valid defocus curve data from 14 subjects. Mini monovision subjects had significantly better VA (a half line to a line better, p < 0.05), from a defocus of − 1.50 D to − 3.00 D. Reported spectacle wear and satisfaction were not significantly different between groups at any distance, but more patients in the mini monovision group reported the ability to function comfortably without glasses at near and overall (near p = 0.02, overall p < 0.01). Halos and starbursts were the two phenomena reported most often for both groups, with reported starbursts slightly more common in the mini monovision group.Conclusions: A slightly myopic correction in the non-dominant eye improved binocular near vision by 0.5 to 1.0 lines based on defocus curve data. Patients reported better functional vision, but with a slight increase in reported starbursts in the mini monovision group.Keywords: symfony, extended depth of focus, intraocular lens, cataract surgery, monovision

Michelle Y Peng,1 Stephen Hannan,2 David Teenan,2 Steven J Schallhorn,1,3 Julie M Schallhorn1,4 1Department of Ophthalmology, University of California, San Francisco, CA, USA; 2Optical Express, Glasgow, UK; 3Carl Zeiss Meditec, CA, USA; 4F.I. Proctor Foundation, University of California, San Francisco, CA, USA Background: To evaluate the efficacy and patient satisfaction of laser in situ keratomileusis (LASIK) monovision correction in presbyopic emmetropic patients.Methods: A retrospective review of 294 patients who underwent LASIK for monovision was conducted. All patients had preoperative uncorrected distance visual acuity in each eye of 20/25 or better in both eyes and underwent primary LASIK treatment in one eye with a near target; 82 patients underwent surgery in the distant eye for hypermetropia. Patients completed a patient-reported-outcome questionnaire at their one-month postoperative visit. Analysis was performed on a per patient basis with a logistic regression model.Results: Patients achieved a postoperative mean spherical equivalent of -0.05 diopters (D) in the distant eye and -1.92 D in the near eye. Prior to surgery, 64.7% (n=178) of patients reported they were satisfied or very satisfied with their vision; postoperatively, this increased to 85.4% (n=251). The greatest predictor of dissatisfaction after surgery was severe patient-reported visual phenomena (glare, halos, starbursts, ghosting) (odds ratio 1.18, P=0.001).Conclusions: LASIK monovision for presbyopic patients with low refractive error and good preoperative uncorrected distance visual acuity is both safe and effective with high patient satisfaction. Patients who were dissatisfied in the postoperative period tended to be those with postoperative visual symptoms. Keywords: monovision, LASIK, presbyopia, refractive surgery

Cornelis Verdoorn Lasik Centrum Eye Clinic, Boxtel, the Netherlands Purpose: To compare the visual performance and optical quality after Raindrop Near Vision Inlay implantation or monovision LASIK for the correction of presbyopia. Materials and methods: In this retrospective case-series study, patients previously treated in the nondominant eye with monovision LASIK were compared with patients previously implanted with Raindrop Near Vision Inlay. The study enrolled 16 inlay and 15 monovision LASIK patients. Uncorrected near visual acuity, uncorrected distance visual acuity, binocular stereopsis, patient satisfaction, and patient task performance were assessed. Results: Postoperatively, the mean spherical equivalent was -0.66 D (0.78 SD) for the inlay group and -1.03 D (0.56 SD) for the monovision LASIK group. Monocularly, at uncorrected near distances, 60% of inlay patients and 47% of monovision LASIK patients achieved ≥20/20. Monocularly, at uncorrected far distances, 75% of inlay patients and 40% of monovision LASIK patients achieved ≥20/32 vision. Binocularly, at near distances, 79% of inlay patients and 53% of monovision LASIK patients obtained ≥20/20 vision. All patients achieved ≥20/20 binocularly for distance. On average, inlay patients obtained 98 seconds of arc and monovision LASIK patients obtained 286 seconds of arc for stereopsis. Most (79%) of the inlay patients and 66% of monovision LASIK patients were satisfied with their near vision, while 86% of inlay patients and 67% of monovision LASIK patients were satisfied with their distance vision. Conclusion: Patients receiving corneal inlays demonstrated better near and distance visual acuities, binocular stereopsis, task performance, and satisfaction, when compared to patients treated with monovision LASIK. Keywords: presbyopia, corneal inlays, monovision, laser in situ keratomileusis, LASIK, Raindrop Near Vision Inlay

Roy Schwartz, Yossi Yatziv Ophthalmology Department, Tel Aviv Sourasky Medical Center and The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Purpose: The aim of this study is to assess whether eye dominance may change after cataract surgery. Methods: This is a prospective case series. Cataract surgery candidates were examined prior to surgery for best-corrected visual acuity, eye dominance, and handedness. Patients with ocular conditions that may affect visual acuity were excluded from the study. A month following surgery, best-corrected visual acuity and eye dominance examinations were repeated. Results: The study included 33 patients with a mean age of 70.5±9.4 years. Eighteen patients (54.5%) had right eye dominance. Following surgery, seven patients (21.2%) had a change in eye dominance. The change in dominance was linked to improved visual acuity in the operated eye and to a younger age, although with no statistical significance. Conclusion: This is the first study reported in the literature to show that ocular dominance is a plastic characteristic following cataract surgeries. The results may change the importance given to eye dominance measurement prior to surgeries that rely on this examination, such as monovision surgeries. Keywords: monovision, cataract, dominance, refractive, surgery

Steven H Linn,1 David F Skanchy,2 Tyler S Quist,3 Jordan D Desautels,4 Majid Moshirfar1,5 1Department of Clinical Research, HDR Research Center, Hoopes Vision, Draper, UT, 2McGovern Medical School, The University of Texas Health Science Center at Houston, TX, 3University of Utah School of Medicine, Salt Lake City, UT, 4Tufts University School of Medicine, Boston, MA, 5John A Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA Purpose: The aim of this study was to compare stereoacuity before and after KAMRA corneal inlay implantation for the correction of presbyopia.Patients and methods: This is a prospective study of 60 patients who underwent KAMRA inlay implantation. Patients were examined before and 6 months after surgery for stereoacuity, uncorrected distance visual acuity (UDVA), and uncorrected near visual acuity (UNVA).Results: The mean stereoacuity before surgery was 29.5±28.1 arcsec (range: 20–200) and at 6 months was 29.8±26.4 arcsec (range: 20–200). The decline in stereoacuity was not statistically significant. At 6 months follow-up, UDVA was 20/25 or better in all 60 patients and UNVA was J2 (20/25) or better in 51 (85%) patients.Conclusion: There is no significant change in stereoacuity following KAMRA inlay implantation. The KAMRA inlay is a good treatment option for improving near vision in presbyopic patients while preserving stereoacuity and distance vision. Keywords: KAMRA, corneal inlay, AcuFocus, stereoacuity, presbyopia