Functional Intermediate Vision After Bilateral Cataract Surgery with a Monofocal Intraocular Lens: A Prospective Binocular Evaluation at 80 cm

Purpose To evaluate binocular uncorrected intermediate visual acuity at 80 cm and overall visual outcomes after bilateral cataract surgery with implantation of a monofocal intraocular lens under emmetropic targeting. The primary aim was to assess whether a standard monofocal lens can provide functionally relevant intermediate vision under natural binocular viewing conditions. Methods This prospective, single-center observational study included 13 patients (26 eyes) undergoing bilateral cataract surgery with bilateral implantation of a monofocal intraocular lens. Visual outcomes were evaluated three months after second-eye surgery. The primary outcome was binocular uncorrected intermediate visual acuity at 80 cm. Secondary outcomes included monocular uncorrected and best-corrected distance visual acuity, monocular defocus curves with distance correction, and refractive predictability assessed by comparison of planned and achieved spherical equivalent. Data were analyzed using non-parametric statistics and Bland–Altman agreement analysis. Results Median monocular uncorrected distance visual acuity improved from 0.60 [IQR 0.30–1.00] logMAR preoperatively to 0.05 [0.00–0.10] logMAR postoperatively. Median binocular uncorrected intermediate visual acuity at 80 cm was 0.10 [0.10–0.20] logMAR; all patients achieved 0.30 logMAR or better. The defocus curve demonstrated functional visual performance from distance to approximately 66 cm. Postoperative refractive outcomes showed high predictability, with 85% of eyes within ± 0.50 D of the intended target. No intraoperative complications occurred. Conclusion Bilateral implantation of a monofocal intraocular lens under emmetropic targeting provided excellent distance vision and clinically meaningful binocular intermediate visual acuity at 80 cm. These findings suggest that selected monofocal lenses may reduce dependence on intermediate spectacles without the optical trade-offs associated with multifocal or extended-depth designs.