1. Controversies about binocular function and patient satisfaction after induced conventional monovision in case of bilateral intraocular lens implantation The authors have no financial interest in the subject matter of this poster. Dr Rajendra Prasad Centre For Ophthalmic Sciences, AIIMS,. New Delhi, India  Vikas Jain, MD  Sourabh D Patwardhan, MD, DNB, FRCS  Rajvardhan Azad, MD FRCS  Vikas Jain, MD  Sourabh D Patwardhan, MD, DNB, FRCS  Rajvardhan Azad, MD FRCS Level of evidence : II Confirmatory Level of evidence : II Confirmatory

2. Aim  To evaluate the success of induced conventional monovision in patients with bilateral cataract extraction with IOL implantation on the basis of ability to achieve spectacle free life, stereopsis and patients satisfaction

3. Methods  Fifteen patients with bilateral cataract were enrolled in the study. We tested ocular dominance in all.  Non dominant eye was operated first with 1.5D overcorrection. After 4 weeks dominant fellow eye was operated to achieve emmetropia. A questionnaire was asked to all patients to assess satisfaction level at 2nd and 4th month follow-up. According to response patients were divided into 4 categories. QUESTIONNAIRE Do you have any difficulty in- 1.reading (near vision) 2.watching television (intermediate vision) 3. driving (distance vision) without spectacles Each point had 5 responses- - No difficulty at all1 - A little difficulty2 - Moderate difficulty3 - Extreme difficulty4 - Stopped doing this because of extreme difficulty5

4. Method ….. CategoryScoreImpression 13-6No need of spectacles 27-9Most of the time manage without glasses 310-12Sometimes manage without glasses 413-15Always need glasses Categories According of response to questionnaire patients divide in 4 categories

5. The mean anisometropia between near and distant eye was 1.17D (range 0.75-1.5). Uncorrected distance acuity was 20/30 or better in all eyes and 20/20 or better in 9 (60 %) eyes. All patients achieved N8 or better uncorrected near acuity and it was better than N6 in 11(73%) of patients. The mean near stereopsis on TNO was 173.33 ±65.31 seconds of arc. The mean distance stereoacuity on FD-2 was 51±11.20 sec of arc. Our study showed that patients' satisfaction improved with time. At the end of 2nd month average satisfaction score was 4.85(range 3-7) which improved to 4.14(range 3-5) at 4th month follow -up. All patients in our study are satisfied with result and no one uses glasses for reading, television watching or driving. Results

6. ParameterDominant eye (n=15)Near eye (n=15) MeanSDMeanSD Preop BCVA for distance(log MAR) 0.5140.1060.600.057 Postop UCVA for distance(log MAR) 0.1140.1060.3140.089 Post op Spherical equivalent-0.2850.172-1.460.365 Table 1. Preoperative BCVA and Postoperative UCVA, refractive status of dominant and non dominant eyes Category I (3-6) Category II (7-9) Category III (10-12) Category IV (>13) Patients at 2 nd month follow-up 13 (86.6%)2 (13.3%)00 Patients at 4 th month follow-up 15 (100%)000 Table 2: Distribution of patients in different categories

7. CharacteristicResult Distance UCVA (Snellen)N(%) <20/209(60%) >20/20-20/306(40%) >20/300 Near UCVAN(%) < N611(73%) >N6-N84(26%) >N80 Distance stereopsis(seconds of arc) Mean51±11.21 Range35-80 Near stereopsis(seconds of arc) Mean173.33±65.31 Range80-240 Mean contrast sensitivity Distance eye1.45±0.09 Near dominant eye1.41±10 Both eyes1.59±0.09 Table 3: Postoperative visual function

8.  In conclusion we recommend conventional monovision with moderate anisometropia in bilateral IOL implantation to improve success of monovision and patients satisfaction level.  With time patients satisfaction level and stereopsis may improve because of visual adaptation.  Preoperative counseling and patients motivation improve the success of monovision. Conclusions and Recommendations

9.  1. Steinert RF, Aker BL, Trentacost DJ et al. A prospective comparative study of the AMO  ARRAY zonal progressive multifocal intra ocular lens and a monofocal intraocular lens.  Ophthalmology 1999; 106: 1243-1255.  2. Haring G, Dick HB, Krummenauer F, et al. Subjective photic phenomena with refractive  multifocal and monofocal intraocular lenses; results of multicenter questionnaire. J Cataract  Refract Surg 2001; 27:245-249.  3. Ravalico G, Parentin F, Baccara F. effect of astigmatism on multifocal intra ocular lenses. J  Cataract Refract Surg 1999; 25: 804-807.  4. Hayashi k, Hayashi H, Nakao F,Hayashi F. influence of astigmatism on multifocal and  monofocal intraocular lenses. Am J Ophthalmol 2000; 130:477-482.  5. Hayashi k, Hayashi H, Nakao F, Hayashi F. Correlation between papillary size and  intraocular lens decentration and visual acuity of a zonal progressive multifocal lens and  monofocal lens. Ophthalmology 2001; 108: 2011-2017.  6. Yaron M. Finkelman, Jonathan Q, Graham D. Barrett. Patients satisfaction and visual  function after pseudophakic monovision. J Cataract Refract Surg 2009; 35: 998-1002  7. Jain S, Ou R, Azar DT. Monovision outcomes in presbyopic individuals after refractive  surgery.Ophthalmology 2001; 108: 1430-1433. References For any correspondence please contact to: Vikas Jain. Email: jainvikas2000@gmail.com