Influence of the level of monovision on visual outcome with an extended range of vision intraocular lens

Purpose: The purpose of this study was to evaluate the influence of different levels of monovision on the clinical outcomes achieved with an extended range of vision (ERV) intraocular lens (IOL). Patients and methods: Subanalysis of 411 patients from the multicenter CONCERTO study aimed at evaluating the outcomes after bilateral implantation of the Tecnis Symfony IOL. Visual acuity, spectacle independence, photic phenomena incidence, and patient satisfaction outcomes were evaluated in six groups defined according to the level of monovision: 0.0 D (75 patients; group 1), 0 < x <= 0.25 D (148 patients; group 2), 0.25 < x <= 0.5 D (90 patients; group 3), 0.5 < x <= 0.75 D (52 patients; group 4), 0.75 < x < 1.0 D (27 patients; group 5), and > 1.0 D (19 patients; group 6). Results: Mean binocular uncorrected distance visual acuity (decimal) ranged from 0.90 +/- 0.17 in group 6 to 0.97 +/- 0.20 in group 2. Mean binocular uncorrected intermediate visual acuity (decimal) ranged from 0.77 +/- 0.25 in group 2 to 0.94 +/- 0.30 in group 4. Mean binocular uncorrected near visual acuity ranged from 0.64 +/- 0.23 in group 2 to 0.79 +/- 0.26 in group 6. The level of spectacle independence was high, with the highest value for near vision in group 6 (94.7%). Less patients reported halos (6.7%) in group 1, whereas only 3.8% of patients in group 4 reported disturbing glare symptoms. For near vision, the highest patient satisfaction was achieved in groups 4, 5, and 6. A total of 96.7% (group 3) and 96.2% (group 4) of patients would recommend the same procedure to their friends and family and would choose the same lens again. Conclusion: Mini-monovision of around 0.75 D after implantation of the Tecnis Symfony IOL provides a complete visual rehabilitation with minimal photic phenomena and high levels of patient satisfaction.