Blended vision after bilateral monofocal cataract surgery an

Blended vision after bilateral monofocal cataract surgery: an evaluation of spectacle independence and vision related quality of life Allison Landes, MD Department of Ophthalmology, Loyola University Health System, Maywood, IL Introduction The primary goal of cataract surgery has been cataractous lens extraction with implantation of an intraocular lens for improvement of best corrected visual acuity. Standard bilateral monofocal implants are typically corrected for distance vision, and do not correct for near or intermediate vision such as required for reading a book or computer screen. In other words, they do not correct for preexisting presbyopia or allow the patient to accommodate for near vision. Therefore, patients who have had bilateral monofocal implants corrected for distance will still require spectacles for near visual tasks. Results We identified 5 blended vision candidates thus far who completeld the NEI RQL-42 survey. The surveys were analyzed and each patient received a score in 13 subcategories. Their scores were compared to the normative data provided by the survey’s manual for use and scoring consisting of 665 myopes, 375 hyperopes, and 114 emmetropes. A Student’s t-test (p <0. 05) was performed, and no statistical significance was found between the groups at this time. With an increasing demand for spectacle independence, modern day cataract surgery has evolved into an essentially refractive procedure. Multifocal and accommodating intraocular lenses can be utilized to try to correct for prebyopia and meet the high expectations of today’s patients, however they have their own limitations including cost. Lenses can be implanted for a monovision outcome where one eye is corrected for distance and the other for near, however this also has its own limitations and is not tolerated in all patients. Blended vision is a modification of monovision where one eye is corrected for distance and the other for an intermediate distance rather than near. It reduces the refractive difference between the eyes and therefore may increase tolerability and decrease the unwanted outcomes of monovision. It avoids the cost and potential side effects of multifocal and accomodating lenses. Blended vision may be an alternative for those patients wishing to achieve spectacle independence after cataract surgery. Objectives To evaluate spectacle independence and vision related quality of life in patients after bilateral cataract extraction and monofocal intraocular lens implantation corrected for blended vision. Methods This current study will compare two groups: 1) patients after uncomplicated bilateral cataract extraction and implantation of monofocal intraocular lenses (Acrysof), both eyes corrected for distance, with less than or equal to 0. 5 diopters (D) difference between the eyes, and with spherical equivalents (SE) between -0. 5 and +0. 5 D, and 2) patients after uncomplicated bilateral cataract extraction and implantation of monofocal intraocular lenses (Acrysof) with unintentional refractive differences consistent with “blended vision. ” Blended vision will be defined as the distance corrected eye with SE between -0. 5 and +0. 5 D, and the intermediate corrected eye with SE between -0. 75 and -1. 25 D. This is less refractive difference than typical monovision in which the eye corrected for near is left with 1. 5 -2 D residual myopia. All patients with other known causes of vision loss will be excluded as well as patients with an uncorrected distance visual acuity of less than 20/25 in the distance corrected eye and less than 20/50 in the intermediate corrected eye. These spherical equivalents and visual acuities will be based on manifest refractions taken at or greater than 2 weeks postoperative. All patients will then complete the National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI RQL-42) to evaluate vision related quality of life, including dependence on spectacles. Conclusion With our very limited data set, no statistical significance was found between our blended vision group and the normative data in terms of the 13 subcategories of vision related quality of life and spectacle independecne. As we identify more blended vision candidates, we will continue to investigate if blended vision results in statistically higher socres on the NEI RQL-42 survey. We also plan to compare our blended vision scores to the existing data in the lterature where patients with multifocal intraocular lenses completed the NEI RQL-42 survey, thus further investigateing if blended vision is indeed a good alterative to multifocal lenses as other studies have suggested. References 1. Hoffman RS, Fine IH, Packer M. Refractive lens exchange with a multifocal intraocular lens. Current Opinion in Ophthalmology 2003; 14(1): 24 -30. 2. Sippel KC, Jain S, Azar DT. Monovision achieved with excimer laser refractive surgery. Int Ophthalmol Clin 2001; 41(2): 91 -101. 3. Jain S, Arora I, Azar DT. Success of monovision in presbyopes: Review of the literature and potential applications to refractive surgery. Surv Ophthalmol 1996; 40: 491 -499. 4. Johannsdottir KR, Stelmach LB. Monovision: A review of the scientific literature. Optom Vis Sci 2001; 78(9): 646 -651. 5. Chen M, Atebara NH, Chen TT. A comparison of a monofocal Acrysoft IOL using the "blended monovision" formula with the multifocal array IOL for glasses independence after cataract surgery. Annals Of Ophthalmology 2007; 39(3): 237 -40. 6. Hays RD, Spritzer KL. (2001, August). National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42), Version 1. 0: Selfadministered Format. Los Angeles, CA. 7. Hays RD, Spritzer KL. (2002, February). National Eye Institute Refractive Error Quality of Life Instrument (NEI RQL-42), Version 1. 0: A Manual for Use and Scoring. Los Angeles, CA. Acknowledgments: This work was supported by the Richard A. Perritt Charitable Foundation