Enhanced Monofocal Intraocular Lenses Achieve Added Line of Intermediate Acuity

An enhanced aspheric monofocal IOL may improve intermediate vision without decreasing distance acuity, yielding low dysphotopsia.

An enhanced monofocal intraocular lens (IOL) can improve intermediate visual acuity (VA) and produce minimal postoperative dysphotopsia, leading to high patient satisfaction scores, according to a study published in the Journal of Cataract and Refractive Surgery. This lens features a modified aspheric design that produces uninterrupted power gradation from the outer edge inward, with 0.5 diopter (D) added to the middle 2 mm.

The prospective study reviewed responses from 60 adults between 45 and 85 years of age who were undergoing cataract surgery with presenting astigmatism that was less than 1.5 D, and who had axial lengths between 21 to 27 mm. Participants had no prior eye surgeries, or comorbidities affecting vision. Researchers randomly assigned patients to receive either bilateral enhanced monofocal ICB00 (Johnson & Johnson Vision Care, Inc.) or conventional monofocal ZCB00 (Johnson & Johnson Vision Care, Inc.). Procedures took place at an ophthalmology unit of an academic hospital in Chile, from March 2021 to April 2022.

This IOL adds more predictability of small postoperative refractive errors, which also contributes to surgeon satisfaction.

At 3 months, 29 participants who received enhanced monofocal IOLs attained mean binocular uncorrected intermediate VA of 0.37±0.12 logarithm of the minimum angle of resolution (logMAR). That acuity is significantly better than that of the 31 patients who received conventional monofocal lenses at 0.45±0.10 logMAR (P <.01).

The enhanced monofocal group showed corrected distance visual acuity (CDVA) similar to those with conventional monofocals (P >.05). Patient survey scores revealed 97% with enhanced IOL reported satisfaction regarding visual results vs 94% receiving conventional lenses. In the Quality of Vision Questionnaire (QoV), more than 90% of all participants in the trial indicated no worse than mild intermittent glare, stars, or halos.

All participants with enhanced monofocal IOLs achieved CDVA of 20/25 or better and 91% reached UDVA of 20/32 Snellen, in addition to displaying expected outcomes for uncorrected and corrected intermediate VA. “This IOL adds more predictability of small postoperative refractive errors, which also contributes to surgeon satisfaction,” according to the researchers.

Previous studies have also found significant improvements with the enhanced monofocal for binocular corrected intermediate VA and uncorrected near VA. However, this is the first clinical trial evaluating QoV and patient satisfaction using validated questionnaires.

A small sample limited this analysis, as did short follow-up time of 3 months. Also, researchers did not include assessments of contrast sensitivity. Conversely, patient- and assessor-masking strengthened the data, as well as directly comparing enhanced with conventional monofocal lenses.

Disclosure: This research was supported by Johnson & Johnson Vision Care, Inc. Please see the original reference for a full list of disclosures.


Donoso R, Torres A, Klagges J, et al. Enhanced versus conventional monofocal intraocular lens clinical results in cataract patients: a randomized clinical trial. J Cataract Refract Surg. Published online on May 22, 2023. doi:10.1097/j.jcrs.0000000000001224