Eyeworld

44 | EYEWORLD | DECEMBER 2022 W hile the concept of monovision to en- hance distance vision in the dominant eye and provide functional near vision in the non-dominant eye—the goal being to reduce dependence on spectacles and con- tact lenses—is not new, advances in IOL technologies are providing a more coordinated visual experience compared to prior monovision options. In fact, Lance Kugler, MD, said there's a shift in how the field is talking about monovision produced with IOLs at the time of cataract surgery. "We're moving toward the term 'blended vision,' which seems to be a more inclusive term than monovision," he said. "With monovision, people think about wearing their contact lenses and a huge difference between the two eyes, and there is a negative connotation to that. Blended vision is more the eyes blending together. With some of these technologies that provide an extended depth of field, whether it's the IC-8 Apthera IOL [AcuFocus] or different IOLs, you get a completely different experience than what someone might have with monovision contacts." What does 'monovision' look like in your practice? Eric Donnenfeld, MD, said monovision is one of the most common treatments he uses for his cataract patients. "I don't do a full monovision; I do a micro-monovision of about 0.75–1 D, and that gives patients enough near that they are comfortable without having problems with distance. I like using the extended depth of focus [EDOF] lenses with monovision. I think that's been the biggest breakthrough that we've had in our practice over the last several years, and I think mini-monovision with the added value of an EDOF lens has been a terrific advancement for our patients," he said. "I like the Eyhance [Johnson & Johnson Vision], the RayOne EMV [Rayner], and Vivity [Alcon]." Dr. Donnenfeld said he'll usually use an EDOF in both eyes because the biggest risk of monovision is not hitting the distance target. "The significant change in my practice has been that I no longer aim for the first myopic lens because I don't want to leave anyone myopic in the dominant eye," he said, explaining that he aims for the first plus lens, know- ing that with the EDOF technology, even if the patient is +0.25–0.5, they'll still see 20/20 at distance. "The IC-8 Apthera IOL is a pinhole IOL that can provide as much as New IOLs offer option of 'blended vision' HOT TOPICS IN OPHTHALMOLOGY

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