FEATURE 8 EWAP MARCH 2023 by Liz Hillman Editorial Co-Director New IOLs offer option of ‘blended vision’ W hile the concept of monovision to enhance 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 contact 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, knowing 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 1.5 D of near vision without splitting light and maintaining 20/20 vision at distance. It’s ideal for post-refractive cornea patients who wish to be spectacle independent but are not good candidates for multifocal IOLs,” he said. Bryan Lee, MD, JD, said he achieves monovision in three ways: with a monofocal or monofocal toric, with the Vivity IOL, or with the Light Adjustable Lens (LAL, RxSight). “I explain to [patients] that with the monofocal, you have This article originally appeared in the December 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp. Contact information Donnenfeld: ericdonnenfeld@gmail.com Kugler: Ikugler@kuglervision.com Lee: bryan@bryanlee.pro Dr. Lee uses the LAL as one of his options for achieving monovision. Source: Bryan Lee, MD, JD
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