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Background. Modern laser vision correction for presbyopia treatment involves non-linear aspheric corneal ablation with the controlled induction of spherical aberration modulation to extend the depth of focus or corneal multifocality induction methods with or without micro-monovision in the non-dominant eye to provide continuous clear vision across distances. Anisometropia and the new higher-order aberrations pattern may be potential risk factors for postoperative stereopsis and contrast sensitivity (CS) deterioration. Purpose. The objective of this systematic review was to assess articles published until 2023 in which CS and/or stereopsis were reported following LASIK presbyopia treatment. Methods. We searched the PubMed, Scopus and Web of Science databases in accordance with the PRISMA 2020 flow diagram. The inclusion criteria specified original papers evaluating the outcomes of laser presbyopia correction as well as the pre- and postoperative assessment of stereopsis and/or CS. The Quality Assessment Tool was applied to assess the risk of bias. Results. We identified 13 studies, including 856 presbyopes (1712 eyes), with preoperative refractive errors from −11.13 D to +5.75 D, with the follow-up range between 3 and 30 months. Either contrast sensitivity improvement or no change following Presbyond® Laser Blended Vision and PresbyMAX® Hybrid was found in the reviewed articles. Some authors reported a significant CS reduction after symmetrical PresbyLASIK, wavefront-guided LASIK and aspheric monovision LASIK. Several studies assessing the effect of Presbyond® LBV on stereopsis showed conflicting results, with the near stereopsis being reduced, unchanged or increased. A significant decrease in stereopsis was reported after aspheric monovision LASIK. Conclusions. The Presbyond® Laser Blended Vision is a safe procedure in terms of the preservation of contrast sensitivity for presbyopia treatment. More studies are needed to elucidate the impact of aspheric corneal ablation methods or other methods inducing corneal multifocality with or without micro-monovision on stereopsis and contrast sensitivity. [ABSTRACT FROM AUTHOR]

Binocular diplopia limits quality of life by hampering visual function. There are several treatment options with individual advantages and drawbacks. Contact lenses have recently emerged as an attractive treatment delivery mechanism due to advances in lens manufacturing and imaging modalities. Contact lenses can offer better comfort, efficacy, and cosmetic appeal compared to alternative treatments such as spectacles. They also present unique challenges due to risks of inflammation, infection, and intolerability. This review will explore the management of binocular diplopia using several types of contact lenses including base down prism in contact lenses, scleral lenses, occlusive lenses, and monovision lenses. Increased awareness of differing contact lens will help providers and patients make better informed decisions about diplopia management. [ABSTRACT FROM AUTHOR]

An induced cylinder and spherical power after implantation with an extended depth of focus (EDOF) and enhanced monofocal intraocular lens (IOL) could improve distance, intermediate (60 cm) and near (40 cm) visual acuity (VA). In this prospective study, forty eyes with Eyhance EDOF IOL (Johnson and Johnson, USA) and 40 eyes with Vivity EDOF IOL (Alcon Laboratories Inc. USA) were included. Induced cylinder (applied to non-dominant eye) in steps of + 0.25D were used and then VA was measured monocularly (only non-dominant eye). Similarly, induced sphere (applied to non-dominant eye) in steps of + 0.25D were used and then VA was measured monocularly (only non-dominant eye). The above methods were repeated for the dominant eye as well. Then, binocular defocus curve for each patient was obtained by inducing optimal sphere and cylinder (one at a time in front of the non-dominant eye only). In both IOL groups, induced cylinder and sphere independently led to significant improvement in near and distance vision (p < 0.05). Induced sphere binocularly caused a greater decrease (~ 0.1 LogMAR) in distance VA compared to induced cylinder but this was not clinically significant. Most patients accepted an induced cylinder of +1.0 to +1.5D in both IOL groups. Induced cylinder and sphere caused a favourable improvement in near and intermediate VA after surgery in both IOL groups without a significant drop in distance VA. [ABSTRACT FROM AUTHOR]

This article summarizes the studies addressed in the doctoral thesis of the author carried out at the Institute of Optics of the Spanish National Research Council (IO-CSIC) under the supervision of Dr. Carlos Dorronsoro and awarded with the 9th Justiniano Casas Award. In summary, this thesis has covered different aspects of vision related to the perception of blur, from its theoretical description to its direct clinical application. First, we studied the spatiotemporal defocus perception of the human visual system. Second, we developed and validated a new subjective refraction method for fast and accurate measurement of the refractive error of an eye based on rapid changes in defocus. Third, a new metric for selecting the best eye for monovision correction was developed, that also provides a measure of the strength of ocular dominance. Finally, a new optical illusion caused by differences in defocus between the eyes was discovered, with important clinical implications. In fact, a new optical correction was developed to compensate for the previously discovered optical illusion, the anti- Pulfrich monovision correction. The results of this thesis have advanced the understanding of defocus perception and its application to the development of clinical instrumentation in optometry and ophthalmology. [ABSTRACT FROM AUTHOR]

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

Ocular dominance (OD), a commonly used concept in clinical practice, plays an important role in optometry and refractive surgery. With the development of refractive cataract surgery, the refractive function of the intraocular lens determines the achievement of the postoperative full range of vision based on the retinal defocus blur suppression and binocular monovision principle. Therefore, OD plays an important role in cataract surgery. OD is related to the visual formation of the cerebral cortex, and its plasticity suggests that visual experience can influence the visual system. Cataract surgery changes the visual experience and transforms the dominant eye, which confirms the plasticity of the visual system. Based on the concept and mechanism of OD, this review summarizes the application of OD in cataract surgery. [ABSTRACT FROM AUTHOR]

Abstract Background Cataracts affect the optics of the eye in terms of absorption, blur, and scattering. When cataracts are unilateral, they cause differences between the eyes that can produce visual discomfort and harm binocular vision. These interocular differences can also induce differences in the processing speed of the eyes that may cause a spontaneous Pulfrich effect, a visual illusion provoking important depth misperceptions. Interocular differences in light level, like those present in unilateral cataracts, can cause the Classic Pulfrich effect, and interocular differences in blur, like those present in monovision, a common correction for presbyopia, can cause the Reverse Pulfrich effect. The visual system may be able to adapt, or not, to the new optical condition, depending on the degree of the cataract and the magnitude of the monovision correction. Case presentation Here, we report a unique case of a 45-year-old patient that underwent unilateral cataract surgery resulting in a monovision correction of 2.5 diopters (D): left eye emmetropic after the surgery compensated with a monofocal intraocular lens and right eye myopic with a spherical equivalent of -2.50 D. This patient suffered severe symptoms in binocular vision, which can be explained by a spontaneous Pulfrich effect (a delay measured of 4.82 ms, that could be eliminated with a 0.19 optical density filter). After removing the monovision with clear lens extraction in the second eye, symptoms disappeared. We demonstrate that, at least in this patient, both Classic and Reverse Pulfrich effects coexist after unilateral cataract surgery and that can be readapted by reverting the interocular differences. Besides, we report that the adaptation/readaptation process to the Reverse Pulfrich effect happens in a timeframe of weeks, as opposed to the Classic Pulfrich effect, known to have timeframes of days. Additionally, we used the illusion measured in the laboratory to quantify the relevance of the spontaneous Pulfrich effect in different visual scenarios and tasks, using geometrical models and optic flow algorithms. Conclusions Measuring the different versions of the Pulfrich effect might help to understand the visual discomfort reported by many patients after cataract surgery or with monovision and could guide compensation or intervention strategies.

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]

Background: Cataracts affect the optics of the eye in terms of absorption, blur, and scattering. When cataracts are unilateral, they cause differences between the eyes that can produce visual discomfort and harm binocular vision. These interocular differences can also induce differences in the processing speed of the eyes that may cause a spontaneous Pulfrich effect, a visual illusion provoking important depth misperceptions. Interocular differences in light level, like those present in unilateral cataracts, can cause the Classic Pulfrich effect, and interocular differences in blur, like those present in monovision, a common correction for presbyopia, can cause the Reverse Pulfrich effect. The visual system may be able to adapt, or not, to the new optical condition, depending on the degree of the cataract and the magnitude of the monovision correction. Case presentation: Here, we report a unique case of a 45-year-old patient that underwent unilateral cataract surgery resulting in a monovision correction of 2.5 diopters (D): left eye emmetropic after the surgery compensated with a monofocal intraocular lens and right eye myopic with a spherical equivalent of -2.50 D. This patient suffered severe symptoms in binocular vision, which can be explained by a spontaneous Pulfrich effect (a delay measured of 4.82 ms, that could be eliminated with a 0.19 optical density filter). After removing the monovision with clear lens extraction in the second eye, symptoms disappeared. We demonstrate that, at least in this patient, both Classic and Reverse Pulfrich effects coexist after unilateral cataract surgery and that can be readapted by reverting the interocular differences. Besides, we report that the adaptation/readaptation process to the Reverse Pulfrich effect happens in a timeframe of weeks, as opposed to the Classic Pulfrich effect, known to have timeframes of days. Additionally, we used the illusion measured in the laboratory to quantify the relevance of the spontaneous Pulfrich effect in different visual scenarios and tasks, using geometrical models and optic flow algorithms. Conclusions: Measuring the different versions of the Pulfrich effect might help to understand the visual discomfort reported by many patients after cataract surgery or with monovision and could guide compensation or intervention strategies. [ABSTRACT FROM AUTHOR]

Aim: To investigate the long-term safety, efficacy, and binocular balance of monovision surgery using Implantable Collamer Lens (ICL) V4c implantation and Femtosecond Laser-Assisted in situ Keratomileusis (FS-LASIK) for the treatment of myopic patients with presbyopia. Methods: This case series study involved 90 eyes of 45 patients (male/female= 19/26; average age:46.27± 5.54 years; average follow-up time:48.73± 14.65months) who underwent the aforementioned surgery to treat myopic presbyopes. Data on manifest refraction, corrected distance visual acuity, dominant eye, presbyopic addition, intraocular pressure, and anterior segment biometric parameters were collected. The visual outcomes and binocular balance at 0.4m, 0.8m, and 5m were documented. Results: The safety index for the ICL V4c and FS-LASIK groups were 1.24 ± 0.27 and 1.04 ± 0.20 (p = 0.125), respectively. Binocular visual acuity (logmar) for 0.4 m, 0.8 m, and 5 m were -0.03 ± 0.05, -0.03 ± 0.02, and 0.10 ± 0.03 for the ICL V4c group, and -0.02 ± 0.09, -0.01 ± 0.02, and 0.06 ± 0.04 for the FS-LASIK group, respectively. The proportions of all patients with imbalanced vision at 0.4 m, 0.8 m, and 5 m distances were 68.89, 71.11, and 82.22%, respectively (all p > 0.05 between the two groups). There were significant differences in refraction between the balanced and imbalanced vision for patients at 0.4 m distance (for non-dominant eye spherical equivalent [SE]: -1.14 ± 0.17D and -1.47 ± 0.13D, p < 0.001), 0.8 m distance (for preoperative ADD:0.90 ± 0.17D and 1.05 ± 0.11D, p = 0.041), and 5 m distance (for non-dominant SE: -1.13 ± 0.33D and -1.42 ± 0.11D, p < 0.001). Conclusion: ICL V4c implantation and FS-LASIK monovision treatment demonstrated good long-term safety and binocular visual acuity at various distances. After the procedure, the imbalanced patients' vision is primarily related to the age-related presbyopia and anisometropia progression caused by the monovision design. [ABSTRACT FROM AUTHOR]

Background Case Description Conclusion Cataract is the major cause of visual impairment in humans. Phacoemulsification with intraocular lens (IOL) implantation is the standard technique for cataract treatment with a high success rate. In a few cases, the surgical cataract procedure and lens implantation have been applied in non‐human primates.A +/− 40‐year‐old female chimpanzee (Pan troglodytes) in captivity was diagnosed with mature cataract optical density (OD) and posterior subcapsular cataract combined with cortical opacities OS after ophthalmic examination. To restore vision and facilitate far‐ and near sight, phacoemulsification OU with +22.5 diopter (D) IOL implantation OD and + 24 D OS were performed. Despite complicated surgery OD due to posterior capsular rupture, the outcome was successful during 1‐year follow‐up. The chimpanzee regained adequate vision, normal behavior, and was successfully re‐introduced to her group of chimpanzees.This is the first case report of a simultaneous bilateral cataract surgery with IOL implantations in both eyes, targeting emmetropia OS and near vision OD resulting in monovision, in a chimpanzee. Vision was restored without postoperative complications. [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

Purpose: Numerous multifocal soft contact lenses have been introduced into clinical practice over the past half century. The purpose of this work is to update earlier surveys by describing international trends in multifocal and monovision soft lens fitting for presbyopia between 2000-2023, inclusive., Method: An annual contact lens prescribing survey was sent to eye care practitioners in up to 71 countries between 2000-2023. Data relating to 52,580 soft daily wear lens fits to presbyopes (those ≥45 years of age) undertaken in 20 countries returning reliable longitudinal data were analysed in respect of multifocal and monovision soft daily wear lens fits., Results: Overall, multifocal and monovision soft daily wear lens prescribing to presbyopes has more than doubled over the course of this survey, from 26.4 % of standard soft daily wear lens fits in 2000 to 61.1 % in 2023 (p < 0.0001). There were significant differences between countries in presbyopia soft daily wear lens prescribing (p < 0.0001). Of all soft daily wear fits to males, 45.1 % were multifocal and monovision soft lenses, compared with 52.7 % for females (p < 0.0001). When considered as the proportion of lenses fitted by age, multifocal soft lens fitting peaked between 50-65 years, followed by a precipitous drop until 85-90 years of age, and then an increase beyond 90 years of age. Analysis of 13,014 recent soft lens fits to presbyopes (2019-2023) revealed the following fitting proportions: multifocal lenses - 51 %; monovision - 10 %; and non-presbyopia fitting - 39 %., Conclusion: There has been a substantial increase in soft contact lens correction of presbyopia using multifocal and monovision corrections throughout the 24 years of this survey. A significant number of soft contact lens-wearing presbyopes are not receiving a presbyopia contact lens correction., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Nathan Efron: Over the past three years Nathan Efron has received honoraria from CooperVision. Philip Morgan: Over the past three years Philip Morgan’s research group or he personally has received funding or honoraria from: Alcon, Bausch + Lomb, Clearlab, CooperVision, Daysoft, Johnson & Johnson Vision, Menicon, and Visco Vision. He is a director of M-Optometry Limited. Craig Woods: Over the past three years Craig Woods has acted as a consultant for the Brien Holden Vision Institute and Zeiss Vision Care. Deborah Jones: Over the past three years Debbie Jones has received honoraria from Hoya, Essilor, CooperVision, Alcon and SightGlass. Lyndon Jones: Over the past three years, Lyndon Jones’ research group (CORE) or he personally has received research support or lectureship honoraria from Alcon, Azura Ophthalmics, Bausch & Lomb, CooperVision, Essilor, Hoya, iMed Pharma, Integral Biosystems, Johnson & Johnson Vision, Menicon, Novartis, Ophtecs, Ote Pharma, Santen, SightGlass Vision, SightSage, Topcon and Visioneering. Dr Jones is also a consultant and/or serves on an advisory board for Alcon, CooperVision, Johnson & Johnson Vision, Novartis and Ophtecs. Jason Nichols: Jason Nichols has a consulting relationship with Topcon. Also, Kelly Nichols is the spouse of Jason Nichols, extending her declarations to him. In the past 12 months, Kelly Nichols has consulted for and received honoraria from: Abbvie, Alcon, Aldeyra, Azura, Bausch + Lomb, Bruder, Cavalry, Dompe, HanAll Bio, Harrow, Novartis, Novaliq, Oyster Point Pharma/Viatris, Sydnexis, Tarsus, TearSolutions, Thea, Topcon, and Trukera. She has received research funding from: Aramis, Kowa, Science Based Health, Sylentis, and TearScience., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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

BackgroundTo evaluate the efficacy and patient satisfaction of laser in situ keratomileusis (LASIK) monovision correction in presbyopic emmetropic patients.MethodsA 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.ResultsPatients 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).ConclusionsLASIK 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.

AIM: To observe the clinical efficacy between SMILE and FS-LASIK with monovision design to treat the presbyopia.METHODS: According to the methods of operation, the presbyope with myopia were divided into two groups, who received the treatment with monovision design. SMILE group had 10 patients(20 eyes),the average age were 45±2.83 years old and myopia degree was -5.42±1.74D. FS-LASIK group had 9 patients(18 eyes), the average age were 45±1.97 years old and myopia degree was -5.60±1.84D. The far vision and the near vision of monocular and binocular of preoperative and postoperative between two groups were observed.RESULTS: SMILE group in preoperative: the preoperative subjective eye's far visual acuity was 0.05±0.04, the subjective eye's near vision was 0.36±0.15; the objective eye's far visual acuity was 0.35±0.11, the objective eye's near visual acuity was 0.16±0.11; the binocular far visual acuity was 0.05±0.05 and the binocular near visual acuity was 0.18±0.09. Preoperative FS-LASIK group: preoperative subjective eye's far visual acuity was 0.09±0.09, subjective eye's near vision was 0.42±0.17; the objective eye's far visual acuity was 0.44±0.11, the objective eye's near visual acuity was 0.19±0.10; the binocular far visual acuity was 0.03±0.04 and the binocular near visual acuity was 0.19±0.11. The result of before surgery between the two groups had no statistical difference(P﹥0.05). Postoperative SMILE group: the far visual acuity of subjective eye was -0.01±0.06, the near vision of subjective eye was 0.32±0.14; the far visual acuity of objective eye was 0.16±0.18, the near visual acuity of objective eye was 0.12±0.12; the binocular far visual acuity was -0.04±0.07, the binocular near visual acuity was 0.10±0.11. Postoperative FS-LASIK group: the far visual acuity of subjective eye was 0.03±0.03, the near vision of subjective eye was 0.45±0.13; the far visual acuity of objective eye was 0.20±0.15, the near visual acuity of objective eye was 0.24±0.12; the binocular far visual acuity was 0.01±0.03 and the binocular near visual acuity was 0.22±0.09. The comparisons of after surgery between the two groups were statistical differences in the binocular far vision(t= -2.383, P=0.034), and the binocular near vision(t= -2.424, P=0.027). The vision comparisons between preoperative and postoperative in SMILE group, there were all statistically significant in the far visual acuity of subjective eye(t=3.914, P=0.004), the far visual acuity of objective eye(t=4.894, P=0.001), the binocular far visual acuity(t=4.870, P=0.001)and the binocular near visual acuity(t=2.388, P=0.041). That means the vision of postoperative was better than the expected vision before operation. The far visual acuity of objective eye were compared between preoperative and postoperative in FS-LASIK group, the differences was statistically significant(t=4.068, P=0.004).CONCLUSION: To presbyope with myopia, the treatment of SMILE and FS-LASIK all can get expected results with monovision design. But the patients after SMILE would have better binocular far vision and binocular near vision than after FS-LASIK.

Purpose: To investigate the long-term safety and efficacy of monovision surgery using implantable collamer lens V4c (ICL V4c) implantation in myopic patients with early presbyopia. Setting: Eye and ENT Hospital of Fudan University, Shanghai, China. Design: Prospective case series study. Methods: This study included 64 eyes of 32 patients with early presbyopia, who underwent bilateral ICL V4c implantation for myopia correction. Parameters, including mean spherical equivalent (SE), uncorrected distance visual acuity, corrected distance visual acuity, intraocular pressure, endothelial cell density, presbyopic add power, visual acuity (logMAR) of dominant eyes (D-eye), nondominant (nD-eye) eyes, and both eyes (Bi) at 0.4 m, 0.8 m, and 5 m were recorded at the last follow-up. Results: All surgeries were uneventful. At the last follow-up, the safety indices were 1.23 ± 0.18 (D-eyes) and 1.21 ± 0.18 (nD-eyes) (p > 0.05); the efficacy indices were 0.95 ± 0.27 (D-eyes) and 0.92 ± 0.28 (nD-eyes) (p < 0.05), the SE was -0.62 ± 0.47 D (D-eyes); and − 1.21 ± 0.78D (nD-eyes) (p < 0.05), presbyopic add power was 1.31 ± 0.58 D. The visual acuity (logMAR) of D-eyes, nD-eyes, and binocular (Bi) at 5.0 m were: 0.06 ± 0.15 (D-eye), 0.21 ± 0.18 (nD-eye), (p < 0.01), and 0.04 ± 0.13 (Bi); 0.8 m: 0.03 ± 0.18 (D-eye), 0.08 ± 0.16 (nD-eye), (p > 0.05), and − 0.02 ± 0.11 (Bi); 0.4 m: 0.08 ± 0.09 (D-eye), − 0.02 ± 0.08 (nD-eye), (p < 0.001), and − 0.03 ± 0.09 (Bi). Subjects were very satisfied or felt excellent with their visual acuity at near (81.25%) and far distances (87.50%), respectively (versus preoperative, p < 0.001). Conclusion: Monovision surgery using ICL V4c implantation is safe and practicable for correction of myopes with presbyopia, with long-term efficacy at near and far distances and patient satisfaction. [ABSTRACT FROM AUTHOR]

Abstract Background Aiming at spectacle independence, conventional pseudophakic monovision has been widely used in myopia patients with bilateral monofocal intraocular lens implantation. However, the crossed monovision, which is to correct the dominant eye for near vision and the non-dominant eye for distant vision, has been mentioned preferable for high myopic cataract patients by some studies. We have conducted this study to compare clinical results to assess the feasibility of conventional and crossed monovision for high myopic pseudophakic patients by comparing patient satisfaction, visual function and spectacle independence. Method Forty-sixth high myopia patients were divided into two groups: 22 in crossed monovision group with patients whose refraction targeted to − 2.00 diopters (D) in the dominant eye and − 0.50D in the non-dominant eye; 24 in conventional monovision group with patients whose refraction targeted to − 0.50D in the dominant eye and − 2.00D in the non-dominant eye. Binocular uncorrected distance visual acuity (BUDVA), binocular uncorrected near visual acuity (BUNVA), binocular corrected distant visual acuity (BCDVA), binocular corrected near visual acuity (BCNVA), contrast visual acuity and stereoacuity were examined at postoperative 2 weeks, 1 month and 3 months. Questionnaires were completed by patients 3 months after binocular surgery to evaluate patients’ satisfaction and spectacle independence. Results The conventional monovision and the crossed monovision group showed no significant differences of mean BUDVA, BUNVA, BCDVA, BCNVA 2 weeks, 1 month or 3 months postoperatively (P > 0.05). There was no difference in the bilateral contrast sensitivity or stereoscopic function between the convention conventional and crossed monovision groups (P > 0.05). Patient satisfaction with near and distant vision, as well as spectacle dependence did not differ significantly between the two groups (P > 0.05). Conclusion Crossed pseudophakic monovision exhibited similar visual function when compared with conventional monovision technique, which indicates that it is an effective option to improve the visual functionality and quality of life for high myopic patients who considering bilateral cataract surgery. Trial registration The Institutional Review Board and Ethics committee of the First Affiliated Hospital of Chongqing Medical University, Chongqing, China. The trial registration was submitted in September 2018 and passed on March 18, 2020, and the registration number is: ChiCTR2000030935 .

AIM: To assess objective visual quality after presbyopia correction using the PresbyMAX monocular mode. METHODS: This prospective, nonrandomized study included 28 eyes from 18 patients (mean age 50.4±5.6y) who underwent presbyopia correction with the PresbyMAX monocular mode. Monocular and binocular visual acuities were evaluated preoperatively, 1d, 1wk, 1, 3mo, and 1y after surgery. Optical quality was analyzed by Hartmann-Shack wavefront aberration supported cornea ablation. Modulation transfer function (MTF) cutoff frequency, Strehl ratio, and objective scattering index (OSI) were analyzed using an optical quality analysis system. RESULTS: One year after surgery, 100% and 94.4% of patients achieved binocular uncorrected distance and near visual acuity of 20/25, respectively. At the last visit Spherical aberration and total higher aberration were higher than the corresponding preoperative levels (P

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

Cataract surgery including intraocular lens (IOL) insertion, has been refined extensively since the first such procedure by Sir Harold Ridley in 1949. The intentional creation of monovision with IOLs using monofocal IOL designs has been reported since 1984. The first reported implantation of multifocal IOLs was published in 1987. Since then, various refractive and or diffractive multifocal IOLs have been commercialised. Most are concentric, but segmented IOLs are also available. The most popular are trifocal designs (overlaying two diffractive patterns to achieve additional focal planes at intermediate and near distances) and extended depth of focus designs which leave the patient largely spectacle independent with the reduced risk of bothersome contrast reduction and glare. As well as mini-monovision, surgical strategies to minimise the impact of presbyopia with IOLs includes mixing and matching lenses between the eyes and using IOLs whose power can be adjusted post-implantation. Various IOL designs to mimic the accommodative process have been tried including hinge optics, dual optics, lateral shifts lenses with cubic-type surfaces, lens refilling and curvature changing approaches, but issues in maintaining the active mechanism with post-surgical fibrosis, without causing ocular inflammation, remain a challenge. With careful patient selection, satisfaction rates with IOLs to manage presbyopia are high and anatomical or physiological complications rates are no higher than with monofocal IOLs. [ABSTRACT FROM AUTHOR]

This paper seeks to outline the history, market situation, clinical management and product performance related to the correction of presbyopia with both contact lenses and spectacles. The history of the development of various optical forms of presbyopic correction are reviewed, and an overview is presented of the current market status of contact lenses and spectacles. Clinical considerations in the fitting and aftercare of presbyopic contact lens and spectacle lens wearers are presented, with general recommendations for best practice. Current options for contact lens correction of presbyopia include soft simultaneous, rigid translating and rigid simultaneous designs, in addition to monovision. Spectacle options include single vision lenses, bifocal lenses and a range of progressive addition lenses. The comparative performance of both contact lens and spectacle lens options is presented. With a significant proportion of the global population now being presbyopic, this overview is particularly timely and is designed to act as a guide for researchers, industry and eyecare practitioners alike. [ABSTRACT FROM AUTHOR]

Presbyopia is often the first sign of ageing experienced by humans. Standardising terminology and adopting it across the BCLA CLEAR Presbyopia reports, improves consistency in the communication of the evidence-based understanding of this universal physiological process. Presbyopia can be functionally and psychologically debilitating, especially for those with poor access to eyecare. Presbyopia was defined as occurring when the physiologically normal age-related reduction in the eye's focusing range reaches a point that, when optimally corrected for far vision, the clarity of vision at near is insufficient to satisfy an individual's requirements. Accommodation is the change in optical power of the eye due to a change in crystalline lens shape and position, whereas pseudo-accommodation is the attainment of functional near vision in an emmetropic or far-corrected eye without changing the refractive power of the eye. Other definitions specific to vision and lenses for presbyopia were also defined. It is recommended that these definitions be consistently adopted in order to standardise future research, clinical evaluations and education. [ABSTRACT FROM AUTHOR]

RESUMEN Objetivo: Evaluar la calidad de vida relacionada con la visión, en pacientes con catarata tratados con monovisión inducida con lente intraocular monofocal. Métodos: Se realizó un estudio experimental antes y después con un solo grupo. Para esto fueron reclutados 50 pacientes tributarios de cirugía de catarata, que presentaban presbiopía. Se evaluó la visión funcional (agudeza visual de cerca y de lejos), sin corrección, mejor corregida y la calidad de vida relacionada con la visión (cuestionario VF-14) antes y después de la cirugía. Resultados: El promedio de edad fue de 59,6 años y predominó el sexo femenino (60,0 %). La mediana de la agudeza visual sin corrección en el ojo dominante poscirugía fue de 0,80 y la del equivalente esférico de -0,16 dioptrías, mientras que en el no dominante fue de 0,50 y de -1,68 dioptrías, respectivamente. La mediana de la agudeza visual sin corrección de cerca fue de 0,80. El 86,0 % de los pacientes no requirió espejuelos después de la cirugía. La puntuación promedio del VF-14 precirugía ubicaba el 50 % de los pacientes con una incapacidad parcial para desarrollar una actividad por causa visual. Después de la cirugía la totalidad de los pacientes no presentaba esta limitación visual. Conclusiones: La cirugía de catarata mejora la calidad de vida relacionada con la visión.

Purpose: To explore the safety, efficacy, and satisfaction of the PresbyMAX monocular mode for the correction of presbyopia.Methods: Prospective study. Twenty-two patients (mean age 50.6 ± 6.2 years, 11 myopia patients and 11 hyperopia patients) were enrolled. The dominant eye was fully corrected for distance vision; the non-dominant eye was corrected using central PresbyMAX monocular mode. Binocular uncorrected distance visual acuity (BUDVA), near visual acuity (BUNVA), intermediate visual acuity (BUIVA), corrected distance visual acuity (CDVA), and mean spherical equivalent (SE) were tested at 1 day, 1 week, 1 month, 3 months, and 1 year postoperatively. Questionnaire was performed preoperatively, 1 month, 3 months, and 1 year after surgery.Results: At the final visit, the mean safety index was 1.03 ± 0.14. There were 85.7% eyes with the same or better CDVA than the preoperative value, and 17.1% and 2.9% eyes gained 1 line and 2 lines of CDVA, respectively. All treated eyes achieved 20/25 or better BUDVA, and 95.5% achieved 20/32 or better BUNVA, which improved significantly compared with preoperative values (P < 0.001). BUDVA maintained stability from 1 month postoperatively, BUNVA and BUIVA kept stable since 1 week after surgery. Overall satisfaction was 95.5% (21/22) at 3 months visit, and 100% at the last visit. No differences in terms of visual acuity and satisfaction were found between the myopia and hyperopia groups.Conclusion: The PresbyMAX monocular ablation profile was safe and effective in treating presbyopia, with great satisfaction achieved at postoperative 1 year.

Purpose: To assess the effect of experimental anisometropia and monovision on stereopsis using the Titmus, Randot, and TNO stereoacuity tests. Methods: Sixty adult volunteers were enrolled in the present study. Four different types of anisometropia—myopia, hyperopia, and astigmatism (both 90° and 45°)—were induced by placing trial lenses over the dominant eye (from 3 to 1 D). Stereoacuity was measured using the Titmus, Randot, and TNO tests. Results: In all the anisometropia types, stereopsis deteriorated with increase in anisometropia in the three stereoacuity tests performed (P < 0.001). The largest decrease in stereopsis was attributed to 3 D myopic anisometropia—6.51 ± 2.10, 6.59 ± 2.35, and 7.36 ± 1.89 arc seconds in Titmus circles, Randot circles, and TNO, respectively. Minimal change in stereopsis was observed in 1 D astigmatism of 45°. Conclusion: Any type of anisometropia may reduce stereoacuity; this reduction is most noticeable with myopic anisometropia, especially in the TNO test, probably due to the lack of monocular cues.

Abstract Monovision can be used as a method to correct presbyopia with contact lenses (CL) but its effect on reading behavior is still poorly understood. In this study eye movements (EM) were recorded in fifteen presbyopic participants, naïve to monovision, whilst they read arrays of words, non-words, and text passages to assess whether monovision affected their reading. Three conditions were compared, using daily disposable CLs: baseline (near correction in both eyes), conventional monovision (distance correction in the dominant eye, near correction in the non-dominant eye), and crossed monovision (the reversal of conventional monovision). Behavioral measures (reading speed and accuracy) and EM parameters (single fixation duration, number of fixations, dwell time per item, percentage of regressions, and percentage of skipped items) were analyzed. When reading passages, no differences in behavioral and EM measures were seen in any comparison of the three conditions. The number of fixations and dwell time significantly increased for both monovision and crossed monovision with respect to baseline only with word and non-word arrays. It appears that monovision did not appreciably alter visual processing when reading meaningful texts but some limited stress of the EM pattern was observed only with arrays of unrelated or meaningless items under monovision, which require the reader to have more in-depth controlled visual processing.

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

AIM:To investigate the influence of monovision design of cataract surgery on the prognosis visual quality in cataract patients. METHODS: Totally 84 cases cataract patients(168 eyes)who receiving cataract surgery were enrolled from February 2016 to February 2017 in our hospital to conduct a prospective study. According to the different near addition in the monovision design, patients were divided into low near addition group(1.25D-1.75D)and high near addition group(2.25D-2.75D), each group was 42 cases. At postoperative 6mo, the binocular uncorrected near visual acuity, uncorrected intermediate visual acuity, uncorrected distance visual acuity and stereoscopic vision were compared between two groups. The visual function survival quality score before and after treatment were compared. RESULTS: The binocular uncorrected intermediate and distance visual acuity in the low near addition group respectively was 0.27±0.20, 0.09±0.08, and that in the high near addition group respectively was 0.29±0.25, 0.10±0.07, which had no statistically significant difference between two groups(P>0.05). The binocular uncorrected near visual acuity in the high near addition group was 0.03±0.06, which was significantly better than the low near addition group 0.07±0.04, the difference was statistically significant(PP>0.05). After treatment, the VF-14 score both significantly increased in the two groups(PP>0.05). CONCLUSION: Two kinds of near addition have similar advantages to cataract patients after cataract surgery on uncorrected visual acuity, the quality of visual function and stereopsis.

Abstract Background To investigate the safety and optical quality of small-incision lenticule extraction (SMILE) combined with monovision, and patient satisfaction with the procedure. Methods The present study assessed a non-random case series involving 60 eyes of 30 patients (mean age 45.53 ± 3.20 years [range 41 to 52 years]) treated bilaterally using the VisuMax 500 system (Carl Zeiss Meditec, Jena, Germany) between January and July 2016. The target refraction was plano for the distance eye, and between − 0.5 and − 1.75 diopters (D) for the near eye. Visual acuity, refraction errors, ocular aberrations, and satisfaction questionnaire scores were calculated 1 year after surgery. Results All surgeries were uneventful, with a mean safety index of 1.03 and 1.04 in dominant and nondominant eyes, respectively. Binocular uncorrected distance visual acuity of all patients was ≥20/32, while binocular uncorrected near visual acuity was ≥20/40 1 year postoperatively. Higher-order aberration (0.45 ± 0.14, 0.51 ± 0.15 μm), spherical (0.18 ± 0.15, 0.21 ± 0.14 μm) and coma aberration (0.31 ± 0.16, 0.27 ± 0.17 μm) were identical between dominant and nondominant eyes after surgery. The overall satisfaction rate was 86.7% (26/30), with large contributions from age (OR = 1.76 95% CI: 1.03–2.53; P = 0.036). Binocular uncorrected distance visual acuity was related to preoperative spherical diopter (r = − 0.500; P = 0.005). Conclusions Monovision appears to be a safe and effective option for myopia patients with presbyopia who are considering the SMILE procedure. Patients with younger age were more satisfied with the procedure.

This publication represents the summary of results of the doctoral thesis Presbyopia Corrections: Optical, Perceptual and Adaptational Implications presented at the Universidad Complutense de Madrid, Spain. Presbyopia, the physiological inability of the aging crystalline lens to accommodate for objects at near distance, can be treated using a multitude of optical corrections. Systematic evaluation of the visual system's ability to interact with these corrections will help in optimization of their performance. In this thesis we studied optical and perceptual performance of different presbyopic corrections such as alternating vision, monovision and simultaneous vision and the effect of adaptation on perceptual performances. We used custom-developed adaptive optics setup to measure and correct ocular aberrations and projected manipulated images simulating pure simultaneous vision corrections of different far/near energy profiles and near additions. We also developed and validated an on-bench and a hand-held simultaneous vision simulator to optically simulate pure or segmented simultaneous vision corrections. Psychophysical methods were employed to study the changes in perceptual quality and after-effects of adaptation. We performed numerical simulations to predict perceptual performance from the ocular aberrations of the subjects. We demonstrated that mechanism of adaptation to simultaneous vision is similar to that of blur adaptation, influenced mostly by retinal image contrast and that systematic changes in visual and perceptual performance influenced by multifocal design and testing distance. The ocular optics of the subject's eye correlated significantly with visual performance and was associated with the intersubject variability in performance. We found that a cyclopean locus for perception and adaptation, in subjects with different blur magnitude between eyes, influenced by the eyes with better optical quality. The internal code for blur was also influenced by the eye with better optical quality, both in orientation and magnitude. Our results confirm that the existing optical solutions should be chosen based on the subjective needs and the ocular optics would be an ideal starting point to customize optical solutions of presbyopia for optimal performance. We also demonstrated the usefulness of rapid assessment of perception to multifocal designs using the handheld, seethrough simultaneous vision simulator. [ABSTRACT FROM AUTHOR]

Presbyopia results from loss or insufficiency of the eye's accommodative ability, and clinically manifests as the inability to focus near objects on the retina. It is one of the most common causes of visual impairment worldwide especially in adults of productive or working age. Various means of compensating for the loss of accommodative ability have been devised from optical tools such as spectacles and contact lenses, to topical medications and to surgical procedures. A comprehensive search on journal articles about topical and surgical correction of presbyopia was undertaken. The various techniques for presbyopia correction, as enumerated in these articles, are discussed in this paper with the addition of our personal experience and perspective on the future of these techniques.

Purpose: To evaluate the results of intraocular correction of presbyopia by monovision in patients with cataract and primary corneal astigmatism and conduct a comparative analysis of these outcomes with the results of binocular multifocal IOLs implantation. Patients and methods. There were 21 patients with bilateral cataract surgery performed using toric monofocal intraocular lenses (monovision group) in the study. The indications for the operation were: 1) primary corneal astigmatism ≥ 1.0D in patients with cataract, 2) inability to conduct excimer laser correction. Reduction of spectacle dependence by monovision was discussed during preoperative conversation. The age of patients range from 32 to 65 years. Target refraction: Emetronopia on the dominant eye (DG) and myopia at 1.0–2.0 D in the non-dominant eye (NDG). Evaluation included measurement of uncorrected visual acuity, refraction, stereopsis, contrast sensitivity and patient satisfaction. The results were compared with the outcomes of binocular multifocal Iols implantation in 22 patients (44 eyes). Results. The spherical component decreased from 3.39±2.63D to 0.34±0.24D, cylinder decreased from 3.05±1.47D to 0.44±0,35D (P

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

Purpose: To examine the impact of monovision on dynamic changes in accommodation, pupil responses, spherical aberration and resultant image quality in early presbyopes. Methods: Refractive state, pupil size and spherical aberration levels were monitored in nine early presbyopes who exhibited some accommodation (40–50 years, mean = 42 ± 2.37 years) using a Shack‐Hartmann aberrometer as a binocularly viewed stimulus stepped closer (from 2 m to 40 cm), or farther (from 40 cm to 2 m). Comparison data from two fully presbyopic (i.e. non‐accommodating) subjects (ages 46 and 61 years) and two young adults (ages 26 and 29 years) were also collected. Each subject was fit with four different refractive strategies: (1) both eyes corrected for 2 m, (2) both eyes corrected for 40 cm, (3) monovision with the measured right eye corrected for 2 m and, (4) monovision with the right eye corrected for 40 cm. Monochromatic image quality was quantified using the AreaMTF metric. Results: When fit with monovision, the largest number of early presbyopes produce an accommodative response dominated by the right eye correction (distance or near) as the stimulus is abruptly changed from the retinal conjugate plane of one eye to that of the other eye. However, the accommodative responses in some early presbyopes were always dominated by the distance corrected eye, the near corrected eye, or by convergence. When the stimulus approached, the near corrected eye experienced high image quality only if there was no accommodative response. However, reduced image quality was observed if an accommodative response was initiated. Neither accommodation nor pupil response latencies were longer with monovision corrections compared with bilateral distance corrections (p > 0.05). In the early presbyopes, spherical aberration was reduced during near viewing, but primarily due to pupil miosis and not lens shape changes. Conclusion: As the stimulus was abruptly changed from the retinal conjugate plane of the distance corrected eye to that of the near corrected eye, most early presbyopes fit with monovision accommodated, which resulted in a decline, not an increase in image quality in the near corrected eye. These results reveal a non‐optimal accommodative strategy in early presbyopes fit with monovision. [ABSTRACT FROM AUTHOR]

Recent studies have confirmed that monovision treatment degrades stereopsis but it is not clear if these effects are limited to fine disparity processing, or how they are affected by viewing distance or age. Given the link between stereopsis and postural stability, it is important that we have full understanding of the impact of monovision on binocular function. In this study we assessed the short-term effects of optically induced monovision on a depth-discrimination task for young and older (presbyopic) adults. In separate sessions, the upper limits of stereopsis were assessed with participants' best optical correction and with monovision (-1D and +1D lenses in front of the dominant and non-dominant eyes respectively), at both near (62 cm) and far (300 cm) viewing distances. Monovision viewing resulted in significant reductions in the upper limit of stereopsis or more generally in discrimination performance at large disparities, in both age groups at a viewing distance of 300 cm. Dynamic photorefraction performed on a sample of four young observers revealed that they tended to accommodate to minimize blur in one eye at the expense of blur in the other. Older participants would have experienced roughly equivalent blur in the two eyes. Despite this difference, both groups displayed similar detrimental effects of monovision. In addition, we find that discrimination accuracy was worse with monovision at the 3 m viewing distance which involves fixation distances that are typical during walking. These data suggest that stability during locomotion may be compromised, a factor that is of concern for our older participants. • Assessed effects of monovision on stereopsis over the range of useable disparities. • Monovision degrades stereoacuity but had less effect at large disparity. • Stereopsis from large disparities may be more resistant to interocular blur. • Disruption of stereopsis was more severe at fixation distances typical of walking. [ABSTRACT FROM AUTHOR]