Improvement of intermediate vision with new monofocal intraocular lenses: A systematic review and meta-analysis

Author: Redruello-Guerrero P, Rivera-Izquierdo M, Jiménez-Gutiérrez C, Láinez-Ramos-Bossini AJ, Yela R, López-Marín I.

Geographical coverage: Europe, Turkey and India

Sector: Cataract surgery

Sub-sector: Intraocular lens

Equity focus: Not reported

Study population: Patients with cataract

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background: Intraocular lenses (IOLs) have evolved to address various focal needs, with monofocal types traditionally used to enhance distance vision. A recent innovation is the Tecnis Eyhance (ICB00) IOL, which retains the standard platform of conventional monofocal lenses while introducing a central power gradient to improve intermediate vision. This enhancement is particularly valuable for daily tasks such as computer use, reading or playing sport. Unlike multifocal lenses, Eyhance extends the range of clear vision without compromising distance acuity or causing significant visual disturbances. Earlier studies have suggested that it enhances quality of life and reduces dependence on spectacles. However, despite its growing adoption in clinical practice, high‑quality comparative evidence against standard monofocal lenses remains limited, underscoring the need for further research to evaluate its functional advantages robustly.

Objective: To compare improvement in visual acuity (VA) with Tecnis Eyhance (ICB00) monofocal IOLs versus Tecnis ZCB00 standard lenses in patients undergoing cataract surgery.

Main findings: Five studies (604 eyes) were included in the meta‑analysis: two experimental and three observational. They were conducted in Europe (n=3), Turkey (n=1) and India (n=1). All studies exhibited some risk of bias or difficulties in assessment for certain items.

Pooled results showed statistically significant improvements in intermediate VA with the Eyhance lens, with a mean difference of –0.21 logMAR (95 % CI –0.24 to –0.18; p<0.001) at 2 weeks–1 month and –0.11 logMAR (95 % CI –0.12 to –0.10; p<0.001) at 6 months compared with standard monofocal IOLs. Near VA could not be assessed because too few studies reported it. Refractive outcomes revealed no clinically meaningful differences in spherical equivalent (–0.06 D; 95 % CI –0.12 to 0.00; p=0.03) or cylinder (–0.01 D; 95 % CI –0.05 to 0.03; p=0.69).

Methodology:  Searches of MEDLINE, Web of Science Core Collection and Scopus up to 1 April 2021 identified experimental and observational studies of patients who had cataract surgery with implantation of a monofocal IOL. Only English‑language papers were included. Reference lists of included studies were also screened. Two reviewers independently screened articles for inclusion, extracted data and assessed study quality using the Cochrane Risk of Bias Tool 2.0, with disagreements resolved by a senior ophthalmologist. Findings were synthesised using a random‑effects meta‑analysis. Heterogeneity was assessed with the Cochrane Q‑test and I² statistic.

Applicability/external validity: The review noted high heterogeneity, a paucity of studies, limited sample sizes and variable follow‑up periods. Nevertheless, the authors believe the preliminary pooled results are relevant and useful for guiding continued clinical use and further evaluation.

Geographic focus: No geographical limits were applied. Included studies were conducted in Europe, Turkey and India.

Summary of quality assessment: Overall confidence in the conclusions is medium. Searches were adequately reported; inclusion and exclusion criteria were clearly defined; and two reviewers independently screened studies, extracted data and assessed risk of bias using established tools, resolving disagreements through consultation with a senior ophthalmologist. Study characteristics were well documented and meta‑analyses appropriately performed, with heterogeneity addressed. However, the search was limited to English‑language articles, the review did not provide a list of excluded studies and the findings were not analysed by risk‑of‑bias status.