Monovision versus multifocality for presbyopia during primary phacoemulsification: systematic review and network meta-analysis

This systematic review and network meta-analysis (NMA) focuses on comparing monovision and bilateral multifocal lenses (bMFIOL) implantation methods in treating presbyopia, a common age-related condition often seen in post-cataract surgery patients. This review focuses on evaluating the efficacy, user satisfaction and limitations of these two approaches through direct or indirect comparison. A comprehensive search was conducted in Medline, Embase, and Cochrane library, considering studies up to 15 July 2022, with direct or indirect comparisons between any monovision and bMFIOL implantation with bilateral cataract surgery. The study protocol has been published in the International Prospective Register of Systematic Reviews (PROSPERO, CRD42022340257). Thirty-two studies (3082 patients) were included in the NMA for the primary outcome, complete post-operative spectacle independence. NMA showed monovision to be inferior to bMFIOLs, as bMFIOL was more likely to provide complete spectacle independence (RR = 2.06, 95% CI = 1.34 to 3.15, p = 0.002) compared to monovision. Monovision resulted in less glare compared to bMFIOL (RR = 0.343, 95% CI = 0.181 to 0.651, p = 0.001). There was no statistically significant difference between monovision and bMFIOL for binocular unadjusted distance visual acuity (MD = 70.01, 95% CI = -19.88 to 4.60, p = 0.437) and binocular unadjusted near visual acuity (MD = 5.46, 95% CI = -5.24 to 10.94, p = 0.191). When compared to monovision, bMFIOL provided greater complete spectacle independence at the expense of greater glare. This study was limited by data heterogeneity, and further studies with standardized reporting would be useful.