University of Florence Oto-Neuro-Ophthalmological Department Eye Institute

1. Alessandro Franchini MD Orsola Caporossi MD – Iacopo Franchini “ Pseudophakic monovision vs bilateral multifocal IOLs implantation : clinical results” Over the last few years the expectations of cataract patients have increased and 85% of them whis to be glasses free after surgery. Today to achieve this result we have three options : multifocal IOLs , accomodative IOLs and monovision. Even if multifocal and accomodative IOLs have represented a great step forward we seem to be far from representing the final solution for a number of reasons ( multifocal : influence of pupil diameter, reduction of contrast sensitivity (halo,glare), not suitable in ocular disease (glaucoma ,ARMD etc) – accommodative : low reliability, risk of posterior capsule opacification etc.) So the interest in monovision has increased. University of Florence Oto-Neuro-Ophthalmological Department Eye Institute I receive travel reimbursement from AMO None of the authors have a financial interest in the products or materials mentioned in this poster

2. In the monovision option , the dominant eye is focused for distance vision, and the non-dominant eye is focused for near to intermediate vision because correcting the dominant eye for the most commonly used viewing distance maximizes blur suppression. According to some authors the ocular dominance represents an important factor in the overall success of monovision but still more important seems to be the magnitude of ocular dominance. In fact for a successful monovision , interocular blur suppression should flexibly change in each eye at all distances. Material and Methods A group of 25 patients with pseudophakic monovision (target refraction : emmetropia in the dominant eye and -1.50 D in the non-dominant eye) have been compared with a group of 25 patients with a bilateral implantation of a multifocal IOL. In the monovision group an aspheric acrylic hydrophobic lens (Tecnis AMO etc) was implanted in both eyes and in the multifocal group an aspheric multifocal acrylic hydrophobic lens (Tecnis Multifocal AMO etc). Authors have evaluated : near and distant uncorrected visual acuity , contrast sensitivity in scotopic conditions, spectacle independence, patient satisfaction index.

3. Visual acuity Monovision Multifocal Binocular distant UCVA 100% 100% 83% 76% 100 80 60 % 40 20 20/40 20/30 20/20

4. Visual acuity Monovision Multifocal Binocular near UCVA 88% 75% 48% 36% 100 80 60 % 40 20 J2 J1

5. Contrast Sensitivity Monovision Multifocal Scotopic conditions 300 Functional Acuity Contrast Test (F.A.C.T.) 100 30 Contrast sensitivity 10 3 0.5 1.0 2.0 4.0 8.0 16.0 Spatial Frequency (cycles per degree)

6. Patients satisfaction 91% 79% 100 80 60 % 40 20 Monovision Multifocal

7. Spectacle independence 80% 62% 15% 100 80 60 % 40 20 Monovision Multifocal Monofocal

8. Key point for monovision option success Advantages of monovision vs multifocal • No sensitivity to decentration • Better contrast sensitivity • No glare ,halos etc. • Higher percentage of patient satisfaction • Higher postoperative spectacle independence • Easier correction with spectacles • Possible to perform even in patients with • ocular diseases • Questionnaire to identify appropriate candidates • Ocular dominance • Quantitative measurement of ocular dominance • depth Conclusion Today monovison represents a considerable option for presbyopic patients who need cataract removal. In our opinion the most important point is the right selection of patients to identify appropriate candidates for this form of correction. REFERENCES Greenbaum S. Monovision pseudophakia.J Cataract Refract Surg 2002;28:1439-1443 Handa T,Uozato H,Higa R,Nitta M et al. Quantitative measurement of ocular diinance using binocular rivarly induced by retinometers. J Cataract Refract Surg 2006;32:831-836 Handa T,Mukuno K,Uozato H,Niida T et al. Ocular dominance and patients satisfaction after monovision induced by intraocular lens implantation .J Cataract Refract Surg 2004;30: 769-774