Adaptive Optics Simulation of Mini-monovision with Enhanced-monofocal Intraocular Lens Technology

BACKGROUND: Enhanced monofocal intraocular lenses aim to improve intermediate vision while maintaining good distance visual acuity (VA), offering an alternative to multifocal IOLs. Mini-monovision can expand the range of vision without significantly compromising binocular quality. This study evaluated the visual performance of the RayOne EMV (RAO200E) and Acunex Quantum (AN6Q) IOLs under mini-monovision conditions using the SimVis Gekko simulator.

PATIENTS/METHODS AND MATERIAL: Six healthy volunteers underwent a simulation with the SimVis Gekko. Ocular dominance was determined using the "hole-in-the-hand" test. Mini-monovision was induced by applying -0.5 and -1.0 D of myopia to the nondominant eye. Monocular and binocular defocus curves were measured from +0.5 to -2.5 D in 0.5 D increments under photopic conditions and cycloplegia. VA was assessed using standard logMAR charts at 4 m.

RESULTS: Both IOLs provided excellent distance VA under emmetropic conditions. The Acunex Quantum IOL performed slightly better at intermediate distances. With -0.5 D of mini-monovision, the useful visual range (VA equal or better than 0.2 logMAR) reached -1.75 D for both IOL groups. When -1.0 D was induced, the useful visual range extended to -2.25 D, with binocular acuity at far distances. Both lenses benefited from mini-monovision without significantly compromising distance visual quality.

CONCLUSION: Simulated mini-monovision with enhanced monofocal IOLs effectively expands the functional range of vision, improving intermediate and near acuity while maintaining good distance vision. A -1.0 D compensation in the nondominant eye can provide good visual quality at all distances to improve spectacle independence in pseudophakic patients, with a small but noticeable difference between the two eyes.