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A pilot study of visual performance in hybrid monovision technique using an extended depth-of-focus implantable collamer lens (EDOF ICL) in phakic elderly patients

Kimiya Shimizu, Shuntaro Tsunehiro, Masahide Takahashi, Misae Ito

Purpose: To assess the clinical results in presbyopic eyes using a hybrid monovision technique in which an Implantable Collamer Lens (ICL) is implanted in the dominant eye and an Extended Depth-Of-Focus (EDOF) ICL is implanted in the nondominant eye.

Subjects and Methods: This prospective pilot study covered 26 eyes of 13 consecutive patients with presbyopia at the Eye Center of Sanno Hospital in Japan. We evaluated the following parameter at 3 months postoperatively: Corrected Distance Visual Acuity (CDVA), DistanceCorrected Intermediate Visual Acuity (DCIVA), Distance-Corrected Near Visual Acuity (DCNVA), Spherical Equivalent (SE), Higher-Order Aberrations (HOAs), Area Under The Log Contrast Sensitivity Function (AULCSF).

Results: A total of 92.3% (12/13 eyes) and 53.9% (7/13 eyes) were corrected to within ± 0.5 D of the target refraction in the dominant eye with an ICL and in the nondominant eye with an EDOF ICL, respectively. The safety index of dominant eye with an ICL was 1.31 ± 0.57 that of nondominant eye with an EDOF ICL was 0.46 ± 0.96. We found significant differences in CDVA (p=0.005), DCNVA (p=0.006), SE (p=0.005), ocular HOAs (p=0.004) and AULCSF (p=0.012) between fellow eyes. The AULCSF of binocular vision with hybrid monovision technique was higher than that of dominant eye implanted with an ICL (p=0.011).

Conclusion: We demonstrated that binocular performance was good in presbyopic patients underwent hybrid monovision technique of ICL surgery, however suggested a need for directly investigating the visual and refractive outcomes and adverse events including HOAs in the eyes with an EDOF ICL.