EyeWorld India September 2020 Issue

CATARACT 28 EWAP SEPTEMBER 2020 targets in bilateral monofocal IOL implantation, compelling evidence is provided for a mild myopic aim to optimize uncorrected intermediate (66 cm; 80 cm) and near visual acuity (40 cm). While the emmetropic group did exhibit a mildly superior binocular UDVA at 0 D, it was not statistically significant. The mildly myopic group did not compromise UDVA as it remained very close to 20/20 at 0 D (logMAR 0.03±0.06). This is not surprising given the focal point of a Snellen chart located 4 meters away corresponds more closely to an eye with a refraction of –0.25 D. Furthermore, the preserved distance visual acuity is supported by the mildly myopic group having an average spherical equivalent of –0.63 D±0.31 and two-thirds of the remaining DOF being located distant to the targeted focal point. This study was limited by its retrospective nature, single surgeon/center design, and small sample size. There is lack of control for variables such as pupil size and axial length that can influence a patient’s DOF, with hyperopia and smaller pupil size favoring expanded DOF. 4 Thus, the generalizability of this study is limited. Future research could consider controlling for preoperative refractive expectations when addressing subjective satisfaction. However, with the increasing prevalence of near work in modern society, it is not surprising to see a non- statistically significant trend favoring the mildly myopic target group in overall patient satisfaction and spectacle independence. As alluded by the authors, future research into these areas in combination with multifocal lenses is needed to further customize these findings into patient-specific recommendations for effective preoperative counseling and improved postoperative satisfaction. Overall, the principles highlighted in this study provide evidence that aiming for mild myopia confers an improved spectrum of vision. Targeting mildly myopic refractive outcomes can provide statistically better vision at near and intermediate focal points without sacrificing meaningful distance vision. The practitioner can now more effectively counsel patients regarding goals Paolo Vinciguerra, MD, Jack Holladay, MD, Luca Pagano, MD, Marco Gramigna, MD, Alfredo Borgia, MD, Vittoria Lanni, MD, Emanuela Legrottaglie, MD, Riccardo Vinciguerra, MD. J Cataract Refract Surg. 2020;46(6);839–843. Purpose: To compare the binocular visual outcomes and satisfaction of patients with emmetropia or mild myopia (–0.50 diopters [D]) implanted with a bilateral spherical monofocal intraocular lens (IOL). Setting: Ophthalmology Department, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Design: Prospective nonrandomized study. Methods: This study comprised 2 groups of 30 patients each. Group 1 included patients implanted with bilateral monofocal IOLs with near emmetropic target (plano to –0.25 D). Group 2 included patients with a postoperative bilateral target of –0.50 D. Both Comparison of visual performance and satisfaction with a bilateral emmetropic vs. a bilateral mild myopic target using a spherical monofocal intraocular lens groups underwent uncorrected and corrected distance defocus curves postoperatively, and subjective questionnaires were used to investigate patient satisfaction after surgery. Results: The defocus curve showed a significant difference between Group 1 and Group 2 binocular vision (all p values <0.01 except at –3.00 D where p value=0.32) with Group 1 seeing significantly better than Group 2 at +1.00, +0.50 and 0 but significantly worse in all other points of the defocus. In addition, patients of Group 2 at 0 D of defocus curve (infinite) had a visual acuity close to 0 logarithm of the minimum angle of resolution (logMAR) (0.03±0.04). The main outcome of Group 2 defocus curves was that, at defocus point 0 D, even if the mean refraction was –0.67 0.15 x 160, mean unaided logMAR visual acuity was 0.0±0.06. Conclusions: Bilateral monofocal IOLs implanted with mild myopic target provided better intermediate visual acuity compared to emmetropia at a minimal cost in terms of unaided distance visual acuity. for refractive outcomes when utilizing solely monofocal lenses. The values and occupation of each patient should be considered when discussing targeted refractive outcomes. Patient satisfaction will heavily depend on an individualized preoperative discussion of visual goals with every cataract surgery candidate. EWAP References 1. Khandelwal SS, et al. Effectiveness of multifocal and monofocal intraocular lenses for cataract surgery and lens replacement: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2019;257:863–875. 2. Zvornicanin J, Zvornicanin E. Premium intraocular lenses: The past, present and future. J Curr Ophthalmol. 2018;30:287–296. 3. Labiris G, et al. A systematic review of pseudophakic monovision for presbyopia correction. Int J Ophthalmol. 2017;10:992–1000. 4. Wang B, Ciuffreda KJ. Depth-of- focus of the human eye: theory and clinical implications. Surv Ophthalmol. 2006;51:75–85.