Corneal lenticular surgery using the monovision technique: First experience

Background. Monovision is a well-established method for presbyopia correction in which the dominant eye is corrected for distance vision, while the non-dominant eye is adjusted for near vision. Initially developed for contact lens correction, this approach has subsequently been adapted for use in refractive surgery. To date, no reports have been found describing the application of the monovision concept in myopic presbyopic patients undergoing laser vision correction using the Corneal Lenticule Extraction for Advanced Refractive Correction (CLEAR) technique, which underscores the relevance of the present study.

Purpose: to evaluate the functional outcomes of the monovision technique following lenticule extraction in myopic patients of presbyopic age.

Materials and methods. The study included 20 patients (40 eyes), divided into two groups of 20 eyes each. The mean patient age was 40.6 ± 2.7 years. The study was conducted at the Department of Laser Refractive Surgery, S. Fedorov Eye Microsurgery Federal State Institution, from July to December 2024. In Group 1, surgery was performed using the CLEAR technique with the monovision approach, leaving a residual myopia of 1.25–1.75 D in the non-dominant eye. Group 2 underwent standard CLEAR surgery. All patients had mild to moderate myopia and a preoperative best-corrected visual acuity (BCVA) of at least 1.0. Before surgery, postoperative visual acuity was simulated with soft contact lenses, and a comprehensive ophthalmological examination, including binocular vision assessment, was performed. In both groups, the femtosecond laser FEMTO LDV Z8 (Ziemer, Switzerland) was used. Distance and near visual acuity, type of vision, and visual fields were evaluated before and after surgery. The follow-up period was three months.

Results. Postoperatively, uncorrected distance visual acuity (UDVA) improved in both eyes in Group 1, though it was slightly lower in the non-dominant eye (0.98 and 0.76, respectively). In Group 2, UDVA improved to 0.99 and 0.96, respectively. The target refraction was achieved in all cases without loss of BCVA and remained stable throughout the follow-up. The postoperative values of UDVA, BCVA, and spherical equivalent showed no significant change over time. Near visual acuity was evaluated binocularly—preoperatively with maximum distance correction and postoperatively without correction. In Group 1 (monovision), postoperative uncorrected near visual acuity (UNVA) increased to 0.99 – 1.0, whereas in Group 2 it reached only 0.37. Binocular vision was preserved in all patients, and visual field parameters remained within normal limits before and after surgery in all cases.

Conclusion. Corneal lenticule extraction using the CLEAR technique with the monovision approach provides high postoperative visual acuity at both distance and near in presbyopic myopic patients while maintaining binocular and peripheral vision.

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