Visual fields in patients with multifocal intraocular lens implants and monovision: an exploratory study

Area of Science:

• Ophthalmology
• Visual Science

Background:

• Cataract surgery commonly involves intraocular lens (IOL) implantation.
• Multifocal (MF) IOLs and monovision (MV) with monofocal IOLs are options to correct vision after cataract removal.
• Assessing binocular visual fields (VFs) is crucial for functional outcomes, especially for driving.

Purpose of the Study:

• To compare binocular visual field (VF) performance between patients receiving bilateral multifocal (MF) intraocular lenses (IOLs) and those receiving monofocal IOLs with monovision (MV).
• To evaluate the incidence of suboptimal VF results and compare testing durations between the two IOL groups.

Main Methods:

• A prospective exploratory study compared binocular Esterman VFs using the Humphrey Field Analyser II.
• The study included 10 participants with MV IOLs and 16 participants with MF IOLs.
• Visual acuity was 6/9 or better in all eyes; MV involved specific refractive targets for dominant and non-dominant eyes.

Main Results:

• No statistically significant difference was found in the overall incidence of suboptimal VF results or mean testing times between the MV and MF groups.
• However, 33% of MV plots showed markedly suboptimal right hemi-fields (distance-dominant eye) compared to 0% in the MF group.
• The MV group accounted for 79% of total 'Unseen Locations' (ULs), primarily in areas outside or bordering true binocular VFs.

Conclusions:

• While all participants met UK driving standards for visual fields, the MV group exhibited a pattern of VF defects of interest.
• The majority of ULs in the MV group (65%) were associated with the monocular visual field of the distance-dominant eye.
• These findings suggest potential limitations in binocular VF performance with monovision correction after cataract surgery.