MONOVISION VERSUS MULTIFOCAL INTRAOCULAR LENS IMPLANTATION IN CATARACT PATIENTS:A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective: With the aim to increase spectacle independence, recent approaches to repair cataracts include the implantation of premium intraocular lenses (IOLs), such as multifocals. Another approach is monovision techniques achieved by monofocal IOL implantation, which is more cost-effective, although it has the same good outcome as multifocal IOLs. This meta-analysis aimed to compare monovision versus multifocal IOL implantation in cataract patients. Method: Systematic search was performed in April 2023 on six databases (Medline, SCOPUS, Proquest, EBSCO, Embase, and PubMed). Studies were extracted for the following outcome of interest: monovision, multifocal intraocular lens, spectacles independence, visual acuity. All studies published up to April 2023 were reviewed. Cochrane risk of bias tool (RoB 2) and The Risk Of Bias In Non-randomized Studies – of Interventions (ROBINS-I) was used to screen studies for risk of bias where appropriate. A meta-analysis was done to quantify any reported quantitative data. Result: Ten studies satisfying the inclusion criteria were included. Pooling analysis for BCVA and BNVA showed no difference between monovision vs multifocal IOL (95% CI at -0,10 to 0,73; I2=79% (p=0,14) and 95% CI at -0,27 to 1,37; I2=94% (p=0,19), respectively). Spectacle independence showed monovision was inferior to multifocal IOL (RR 0,53; 95% CI at 0,34 to 0,82; I² 83% (p=0,004)). Conclusion: Current evidence showed monovision was comparable to multifocal IOL in terms of visual acuity. While multifocal IOL achieved more spectacle-free patients than monovision, many patients in the monovision group also achieved spectacle-free condition. Keywords: cataract, monovision, multifocal intraocular lens, visual acuity, spectacle independence.