Patient-Reported Outcomes After Bilateral Implantation of Monofocal versus Monofocal-Plus Toric Intraocular Lenses

To compare patient-reported outcomes and visual performance after implantation of a conventional monofocal toric intraocular lens (Clareon, Alcon) versus a monofocal-plus toric intraocular lens (Eyehance, Johnson & Johnson Vision).

Single-center retrospective observational study with cross-sectional postoperative survey.

Vance Thompson Vision, West Fargo, North Dakota.

Patients who underwent bilateral cataract surgery between 2020 and 2025 with monofocal (Clareon) or monofocal-plus (Eyehance) toric IOLs were included. Chart data included uncorrected and best-corrected visual acuities, lens power, prior LASIK, and postoperative YAG capsulotomy or laser fine-tune. Eligible patients completed an 11-question telephone survey assessing satisfaction, glare/haloes, spectacle use across visual tasks, and willingness to choose the same lens again. Differences between groups were analyzed using Fisher's exact, Chi-square, and Wilcoxon rank-sum tests. Multivariable ordinal logistic regression evaluated independent predictors of satisfaction.

In total, 92 patients completed the survey (response rate 83.6%). Distance UCVA and BCVA were excellent and not significantly different between groups. Eyehance patients demonstrated better near UCVA (p < 0.001), consistent with its optical design. Spectacle independence across intermediate and near tasks was broadly similar, showing only a non-significant trend toward greater independence for computer use in the Eyehance group. Eyehance patients reported glare more frequently (p = 0.034), but glare-related bother remained low and did not differ significantly between groups. Clareon patients reported being "very satisfied" more frequently (p < 0.001), but adjusted ordinal regression showed higher overall satisfaction odds in the Eyehance group (adjusted OR 2.11, 95% CI 1.08-4.18, p = 0.031).

Both toric IOL platforms provided excellent distance vision and favorable patient-reported outcomes. The monofocal-plus Eyehance design offered superior uncorrected near vision with increased glare frequency, without significant differences in glare bother between groups. These findings support individualized counseling and shared decision-making when choosing between conventional monofocal and monofocal-plus toric IOLs.