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EW RESIDENTS 62 January 2015 by Abdallah Jeroudi, MD, Jennifer Kim, MD, Jessica Shantha, MD, Michael Shumski, MD, Heather Weissman, MD, Monica Zhang, MD, Maria Aaron, MD, and Jeremy Jones, MD According to the 2014 ASCRS Clinical Survey, pseudophakic monovision is used more often than presbyopia-correcting IOLs. This month, I asked the Emory residents to review this study comparing mini-monovision to multifocal IOLs, which appears in the current issue of JCRS. –David F. Chang, MD, chief medical editor P seudophakic presbyopic correction continues to be a challenge for patients and ophthalmologists. The current treatments include multifocal intraocular lenses (MFIOLs), accommodating IOLs, monovision, and hybrid mono- vision. As technology advances and more options exist to correct pseudophakic presbyopia, there are still many barriers to meeting the demands of heightened patient expectations. Each patient must be evaluated individually and the correction of choice be aimed at the patient's final refractive goal. 1 Monovision has been an option that continues to change due to new technological advances. Monovision is induced anisometropia with the dominant eye set for distance vision and the nondominant eye set for near vision. This can be achieved with contact lenses, monofocal IOLs, or surface ablation procedures. Disadvantages of monovision in- clude diminished contrast sensitivi- ty, binocular acuity, and stereopsis. Controversy exists for the refractive outcome of the near vision eye with a shift toward mini-monovision. 1 MFIOLs are another popular option for the motivated patient. Three types of lenses exist including refractive IOLs, diffractive IOLs, and a hybrid refractive/diffractive IOL. The power of refractive IOLs varies from the center to the periphery resulting in many focal points, while diffractive IOLs have 2 focal points. Shortcomings of these lenses are decreased contrast sensitivity and increased glare symptoms. 2 Summary In the January issue of the Journal of Cataract & Refractive Surgery (JCRS), Labiris et al report on a random- ized controlled trial comparing clinical outcomes and satisfaction of patients receiving pseudopha- kic mini-monovision to bilateral implantation of refractive multifocal IOLs. Labiris and colleagues assessed preoperative and postoperative dysphotopsia, glare, spectacle independence, functional im- pairment, binocular uncorrected distance and near visual acuity, con- trast sensitivity, and stereo acuity. This randomized controlled trial was conducted at the Univer- sity Hospital of Alexandroupolis in Greece between January and July 2013. Patients were eligible for the study if they had a diagnosis of senile cataract with grade 2 opalescence according to the Lens Opacification System III grading scale. Exclusion criteria included manifest refraction cylinder of great- er than 1 D, complaint of headaches or eyestrain associated with visual activities, a positive test for ocular misalignment, endothelial cell count less than 1,900 cells/ mm 2 , glauco- ma, intraocular pressure lowering medications, previous incisional surgery, or previous diagnosis of corneal disease, retinal disease, diabetes or mental illness. Patients were recruited on a consecutive if-able basis and randomized to 2 study groups: mini-monovision and multifocal IOL. In the mini-monovision group, the dominant eye was targeted for –0.50 D and the nondominant eye was targeted for –1.25 D. Ocular dominance was determined with the hole-in-the-card test. An SN60WF lens (Alcon, Fort Worth, Texas), a foldable, hydrophilic, acrylic intraocular lens, was used in the mini-monovision group. The iSert PY60MV lens (Hoya Surgical Optics, Chino Hills, Calif.) was used in the multifocal group, which is a 3-piece, 3-zone aspheric refractive multifocal intraocular lens with +3.00 D of near addition. All surgery was performed by the same surgeon using the Infiniti Vision System (Alcon). The postoperative antibiotic and anti- inflammatory regimen was the same in all patients. Seventy-five patients partici- pated in the study, with 38 in the mini-monovision group and 37 in the multifocal group. There were no significant differences in the pre- operative characteristics of the two groups. Postoperatively, each group showed significant improvement in binocular UDVA. There were, however, no statistically significant differences in binocular UDVA, binocular UNVA, contrast sensitiv- ity, or stereopsis between the two groups. Multifocal patients perceived significantly more dysphotopsias (p=0.02) and insignificantly more glare (p=0.08). No significant difference be- tween the groups was found with respect to functional impairment, which was assessed using the Visual Function Index-14 (VF-14) question- naire. Multifocal patients displayed significantly greater spectacle inde- pendence versus the mini-monovi- sion group. In both groups, more than 90% of patients achieved spectacle independence at distance. However, at near, 72.1% of multifo- cal patients were spectacle free, com- pared to 31.4% of mini-monovision patients. Overall, 65.7% of patients from the multifocal group reported Review of "Mini-monovision versus multifocal intraocular lens implantation" Mini-monovision versus multifocal intraocular lens implantation Georgios Labiris, MD, PhD, Athanassios Giarmoukakis, MD, Maria Patsiamanidi, MD, Zois Papadopoulos, MD, Vassilios P. Kozobolis, MD, PhD J Cataract Refract Surg (Jan.) 2015;41:54–58 Purpose: To compare the effect of monovision correction and multifocal intraocular lens (IOL) implantation on patient satisfaction, spectacle dependence, visual acuity, and dysphotopsia in cataract patients. Setting: University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece. Design: Prospective randomized trial. Methods: Patients with a diagnosis of senile cataract with stage 2 nuclear opalescence were randomly assigned to 2 groups: monovision and multifocal IOL implantation. Uncorrected (UDVA) and corrected (CDVA) distance visual acuity, Visual Function Index-14 (VF-14) scores, and spectacle dependence were assessed prior to surgery and 6 months postoperatively. Results: The monovision group comprised 38 patients and the multifocal IOL implantation group, 37 patients. Both techniques provided excellent refractive outcomes in UDVA and VF-14 scores (all P<.01). No significant intergroup differences were detected in VF-14 scores at the final postoperative examination. The monovision group patients presented significantly more spectacle dependence for near vision but less glare. Conclusions: Monovision and multifocal IOL implantation provided excellent refractive outcomes for distance vision. Multifocal IOL insertion was associated with less dependence on glasses overall but significantly more dysphotopsia. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned. Jeremy K. Jones, MD, associate residency program director, Emory University School of Medicine Maria M. Aaron, MD, residency program director, Emory University School of Medicine EyeWorld journal club

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