Enhanced Monofocal Versus Conventional Monofocal Intraocular Lens in Cataract Surgery: A Meta-analysis

Purpose: To compare different outcomes of an enhanced monofocal intraocular lens (IOL) versus a conventional monofocal IOL implantation after cataract surgery.

Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was used for abstracting data and assessing quality. Comparative studies between enhanced monofocal versus conventional monofocal IOL implantations reporting outcomes in monocular and binocular visual acuities at various distances, spectacle independence, contrast sensitivity, optical quality, and adverse effects were identified from three databases. Meta-analysis, sensitivity analysis, and subgroup analysis were performed.

Results: A total of 680 eyes implanted with an enhanced monofocal IOL (Tecnis Eyhance ICB00; Johnson & Johnson) and 647 eyes with a conventional monofocal IOL from 3 randomized controlled trials and 9 comparative studies were included. The enhanced monofocal IOL showed better monocular uncorrected intermediate visual acuity (UIVA) (mean difference [MD]: -0.11 logMAR; 95% CI: -0.12 to -0.09), binocular UIVA (MD: -0.17 logMAR; 95% CI: -0.23 to -0.11), and binocular uncorrected near visual acuity performance (MD: -0.17 logMAR; 95% CI: -0.29 to -0.04) than the conventional monofocal IOL. More patients were spectacle free at intermediate distance with the enhanced monofocal IOL (odds ratio: 12.9; 95% CI: 6.2 to 27.0). Both monocular (MD: -0.002 logMAR; 95% CI: -0.01 to 0.01) and binocular (MD: 0.01 logMAR; 95% CI: -0.02 to 0.03) uncorrected distance visual acuity revealed non-significant differences between the IOL designs. Contrast sensitivity, photic phenomenon, and adverse effects were comparable.

Conclusions: Enhanced monofocal IOLs effectively improved unaided intermediate vision with similar distance performance relative to conventional monofocal IOLs. This was achieved without compromising the contrast sensitivity or inducing photic phenomena. .