Ten-year outcomes of pseudophakic mini-monovision correction of hyperopic presbyopia

PURPOSE: Evaluating long-term efficacy, safety, and spectacle independence after the treatment of hyperopic presbyopia with pseudophakic mini-monovision using standard monofocal intraocular lenses (IOLs) following bilateral cataract surgery.

SETTING: Private practice in Barcelona, Spain.

DESIGN: Retrospective, non-comparative case series.

METHODS: Patients with hyperopic presbyopia underwent bilateral cataract surgery with pseudophakic mini-monovision using standard monofocal IOLs, between 2008-2018. Main outcomes analysed were uncorrected distance visual acuity (UCDVA), uncorrected near distance visual acuity (UCNVA), and rates of spectacle independence at postoperative day 1 (POD1), months 1, 6 and 12, and at 5- and 10 years (Y10) postoperatively.

RESULTS: The study enrolled 463 patients. Both UCDVA and UCNVA significantly improved postoperatively (p<0.05). Mean binocular UCDVA improved from 0.47±0.3 logMAR preoperatively to 0.096±0.14 at POD1 to 0.16±0.2 at Y10 (p=0.0033). The binocular UCNVA was 0.05 logMAR at Y10, whereas in preoperative visits all patients needed glasses. The mean UCDVA for the dominant eye (DE) ≤0.20 logMAR was achieved in 84.29% at the Y10.Self-reported and measured complete spectacle independence for near vision was achieved in 79.61% of patients at POD1 and 71.92% at Y10 postoperatively. For distance, respectively in 86.29% of patients at POD1 and 78.43% at Y10. The achieved results were stable. No serious events were reported, as well as no photic phenomena.

CONCLUSIONS: Pseudophakic mini-monovision in hyperopic presbyopes is a safe, effective, and low-cost approach for the long-term correction of presbyopia. It significantly reduces spectacle dependence and fulfils patients' expectations after bilateral cataract surgery.