Impact of the "micro-monovision" approach with extended depth of focus intraocular lenses implantation on visual quality in elderly patients with senile cataracts

Objective To investigate the impact of the "micro-monovision" approach with extended depth of focus (EDOF) intraocular lens on visual quality in elderly patients with senile cataracts.

Methods A retrospective analysis was conducted on the clinical data of elderly patients with senile cataracts treated from January 2020 to December 2023. Forty-six patients who received trifocal intraocular lens were randomly selected and included in trifocal group, while 53 patients who underwent the "micro-monovision" approach with EDOF intraocular lens were included in EDOF group. Preoperative and 3-month postoperative uncorrected distance visual acuity (UCDVA), uncorrected intermediate visual acuity (UCIVA), uncorrected near visual acuity (UCNVA) and visual function index (VF-14) scores were recorded for both groups. Defocus, contrast sensitivity (CS) and spectacle independence were also evaluated at 3 months postoperatively.

Results At 3 months postoperatively, both groups showed significantly higher UCDVA, UCIVA, UCNVA and VF-14 scores compared to preoperative levels; the UCIVA, UCNVA and VF-14 scores in the EDOF group were significantly higher than those in the trifocal group (P < 0.05). At 3 months postoperatively, both groups achieved visual acuity greater than 0.35 at refractive errors from -4.0 D to +2.0 D. The EDOF group achieved visual acuity greater than 0.9 at refractive errors from -1.5 D to +1.5 D, and greater than 0.8 at refractive errors from -2.5 D to -1.5 D. Within the refractive range of 0.5 D to +2.0 D, the EDOF group had better visual acuity than the trifocal group, with more stable visual acuityin the range of -2.0 D to 1.0 D. Under photopic and mesopic conditions, the EDOF group demonstrated significantly higher CS values at different spatial frequencies (3, 6, 12, 18 degree per week) compared to the trifocal group (P < 0.05).

Conclusion In elderly patients with senile cataracts, the "micro-monovision" approach with EDOF intraocular lens implantation provides superior visual quality andintermediate and near vision compared to trifocal intraocular lens.