1. Kaori Morii, M.D. Shinji Miura, M.D, Ph.D. Dept. of Ophthalmology, Asagiri Hospital, Hyogo, JPN We have no financial interest. This retrospective study was performed in conformity with the Declaration of Helsinki and was approved by our ethical committee.

2. Introduction Currently, much attention is being paid to treating presbyopia with intraocular lenses (IOLs). Implanting multifocal IOLs is an available option. However, this alternative is not available to all patients because of its high cost. In addition, some of patients who have undergone bilateral implantation of multifocal IOLs have complained of postoperative halo, glare, or waxy vision. Another option is a monovision approach. There have been several reports of presbyopia treatment with a pseudophakic monovision technique, implanting an IOL optimized for distance vision in one eye and an IOL for near vision in the other.

3. Purpose The purpose of this presentation is to evaluate visual performance and general satisfaction in patients who underwent bilateral cataract surgery on both eyes with a pseudophakic monovision technique. We adopted a “hybrid“ pseudophakic monovision technique according to the reports by Shimizu et al(1); a monofocal IOL adjusted for distance vision was implanted in the dominant eye and a multifocal IOL was placed in the other. “Conventional” pseudophakic monovision technique Dominant eye monofocal IOL for distance vision (+/-0D) Non-dominant eye monofocal IOL for near vision (-2D) “Hybrid” pseudophakic monovision technique Dominant eye monofocal IOL for distance vision (+/-0D) Non-dominant eye multifocal IOL “Conventional” vs. “hybrid” pseudophakic monovision technique (1)Shimizu spoked at the 34th meeting of the Japanese Society of Ophthalmic Surgeons in 2010.

4. Patients’ data (Mean±SD) Group Z (n=5)Group S (n=10) Age (y.o.) 67.2±6.867.8±5.97 Axial length (mm) 23.72±1.6024.14±1.60 Pre-op sphere (D) 0.25±2.50-0.2±1.66 Pre-op cylinder (D) 0.43±0.40-0.74±0.44 IOL model* for dominant eye ZA9003SN60WF IOL model** for non-dominant eye ZMA00SN6AD3 Determining the dominant eye: Hole in card method. IOL power calculation: IOL Master® and SRK/T formula *ZA9003, SN60WF: monofocal IOL. **ZMA00, SN6AD3: diffractive multifocal IOL Operation schedule and surgical technique Operation schedule Day 0 Dominant eye: monofocal IOL adjusted for distance vision Day 6 Non-dominant eye: multifocal IOL Surgical technique IOL implanted in the capsular bag via 2.3mm temporal corneal incision using an injector

5. Postoperative parameters evaluated at three months Binocular uncorrected distance visual acuity Binocular uncorrected near visual acuity Contrast sensitivity OGT1000® Stereopsis Near: Titmus stereo test (T.S.T) Distance: Synoptophore

6. Result Binocular uncorrected visual acuity (log MAR) GroupSGroupZGroupSGroupZ Binocular uncorrected distance and near VA showed no significant difference between GroupZ and Group S.

7. Contrast sensitivity 6.3deg4deg2.5deg1.6deg1deg0.7deg ZMA00 38.33±11.1823.33±6.9716.66±5.108.63±2.586.05±1.943.01±0.87 ZA9003 36.66±12.6330±4.5619.16±8.1210.18±8.453.85±0.662.40±0.40 SN6AD3 37.61±22.6518.33±3.7311.40±3.936.35±3.534.13±2.793.02±1.80 SN60WF 33.33±0.128.33±12.6311.40±3.937.68±3.173.36±0.542.22±0.1 Group ZGroup SAll Near: T.S.T. (s) 118.0±144.5160±137.9146±144.6 Distance: Synoptophore St(+) (%) 80.070.073.3 Mean ± SD Stereopsis Mean ± SD Patients achieved good stereopsis in both near and far distance. Contrast sensitivity showed no significant difference between monofocal and multifocal IOL.

8. Results: Questionnaire on visual satisfaction QuestionGroup Z(%)Group S(%)All(%) Degree of satisfaction Distance Satisfied 100.090.093.3 Acceptable010.06.7 Dissatisfied000 Near Satisfied60.0 Acceptable40.0 Dissatisfied000 Postoperative halo010.06.6 Postoperative glare010.06.6 Spectacle independence100.0 The questionnaire revealed that 93.3% patients were satisfied or very satisfied With this technique and all patients were independent of spectacles.

9. Summary The “hybrid” pseudophakic monovision technique achieved; 1) Good visual performance Good uncorrected VA for both distance and near vision. Minimized loss of stereopsis. 2) Satisfying postoperative visual life Spectacle independence. Less complaint of halo or glare. Thank you for your attention. If you have any questions, please contact us at k-morii@asagiri-hp.or.jp.k-morii@asagiri-hp.or.jp