Enhanced monofocal implant: seeing the screen without glasses after cataract surgery, without the halos of a multifocal?
Between the conventional monofocal implant, which gives sharp distance vision but requires glasses as soon as you look at a screen, and the multifocal, which frees you from glasses at the price of night-time halos in some people, a third family has established itself: the enhanced monofocal. It gains about one line of intermediate vision without losing anything at distance or adding halos, according to three meta-analyses. At the ESCRS congress in London in September 2026, a debate asked whether it should become the default implant in cataract surgery. Here is what the studies say, and what it means for you.
UNDERSTANDING
A monofocal that is no longer quite monofocal
For twenty years, the question asked before a cataract operation came down to a choice: a monofocal implant, sharp at a single distance, or a multifocal implant, which shares the light between several focal points so that you can do without glasses. The enhanced monofocal blurs that boundary. Its lens remains monofocal in the optical sense, but its front surface has been redesigned so that focus does not collapse as soon as you look away from infinity.
The principle rests on a higher-order asphericity: the curvature varies from the centre to the edge in a controlled way, which stretches the focus slightly along the axis of the eye. The result is an extended depth of focus of about half a dioptre, enough for a computer screen, placed at sixty or seventy centimetres, to become legible again without glasses in many patients.
One focus: sharp, stretched or shared
What sets the three families of implant apart is how they gather light onto the retina.
Monofocal
A single focus, sharp at distance.
Enhanced monofocal
A slightly stretched focus: distance and screen.
Multifocal
Light shared between several foci: near as well, with possible halos.
Simplified teaching diagram, not to scale. The dotted circle represents the halo.
What sets it apart from a multifocal implant
A multifocal implant has concentric diffractive rings that divide the light between distance, intermediate and near vision. This division has a cost: part of the light is lost, and the rings create halos around car headlights at night in some of the people operated on. The enhanced monofocal has no rings. It does not divide the light, it spreads it out a little. That is why it cannot offer the near vision of a multifocal, but also why it does not have its halos.
Several models exist today in the published studies: the Tecnis Eyhance, the most studied, the Vivinex Impress, the RayOne EMV or the Isopure. Their optical designs differ, but they share the same measured benefit: one more line at intermediate distance, and unchanged distance vision.
Where each implant sees sharply
Three distances matter in daily life: the road, the screen, the book. Each family of implant covers a different part of this range.
Monofocal
Enhanced monofocal
Multifocal
Teaching diagram: the exact range depends on each eye, the pupil and any residual astigmatism. The dotted circle indicates halos.
THE EVIDENCE
What the studies show: one more line at the screen, nothing lost at distance
The level of evidence is now solid, because three independent meta-analyses converge. The first, published in 2022, pooled 680 eyes operated on with an enhanced monofocal and 647 eyes with a conventional monofocal, drawn from three randomised trials and nine comparative studies. Uncorrected intermediate vision was better by about one line with one eye tested, and by nearly two lines with both eyes open (PMID 35947003).
The same analysis measured what matters to the patient: the probability of not needing glasses at intermediate distance was clearly higher with the enhanced monofocal, with an odds ratio of 12.9. Distance vision, for its part, did not differ between the two groups. Contrast sensitivity, light-related phenomena and adverse effects were comparable (PMID 35947003).
Two more recent meta-analyses confirm this
In 2025, a systematic review registered on PROSPERO pooled 31 studies, eight of them randomised trials. With a high level of certainty, it finds no difference in corrected distance vision between the two families of implants. Intermediate and near vision, corrected for distance, were better with the enhanced monofocal, by a little more than one line, and spectacle independence at intermediate distance was favoured, with an odds ratio of 7.85. Neither contrast sensitivity nor halos differed (PMID 39893265).
In 2026, a meta-analysis limited to randomised trials alone, that is six trials and 429 patients, found an intermediate vision gain of about one line, with one eye tested as well as with both, and a safety profile comparable to the conventional monofocal. Its authors describe the benefit as “modest but significant”, a phrase that sums up the reality of this implant well (PMID 40840532).
Three meta-analyses, one conclusion
Each pools independent studies, carried out with several models of implant.
One line of acuity corresponds to one row of letters on the ophthalmologist’s eye chart.
What individual trials add
A Chilean double-blind randomised trial, published in 2023, compared the two implants in 66 patients operated on in both eyes. The enhanced monofocal gave one additional line of binocular intermediate vision, with no difference at all on the quality-of-vision questionnaires (PMID 37232418). A multicentre trial published in 2025 with another model, the Vivinex Impress, found a gain of 1.2 lines in intermediate vision, independent of pupil diameter and of the length of the eye (PMID 40197064).
A Japanese study compared three different enhanced monofocals with a standard monofocal in 172 patients assigned at random: intermediate vision at 50 centimetres, 70 centimetres and one metre was better with all three, distance and near vision were identical, and contrast sensitivity and halos did not differ (PMID 40623059). A randomised Spanish study reports slightly more optical aberrations measured with the instrument, with no effect on perceived halos or on contrast (PMID 35622140). A recent series of 100 eyes confirms the intermediate gain at one month (PMID 40488482).
THE LIMITS
What it does not do: let you read a book without glasses
The most important point to understand before choosing comes down to one sentence: one more line of intermediate vision is not near vision. Reading a novel, a phone held at thirty centimetres or a medicine leaflet will most often require reading glasses, exactly as with a conventional monofocal. Patients who expect complete independence from glasses are likely to be disappointed.
The gain is also an average. In the trials, some patients read their screen effortlessly, others notice only a subtle difference. Pupil size, residual astigmatism and the quality of the surface of the eye all modulate the result. An untreated dry eye, for example, degrades intermediate vision whatever the implant.
One must also accept a degree of uncertainty inherent in any cataract surgery: the power of the implant is calculated, not measured afterwards, and a gap of half a dioptre between the target and the result remains possible. With an enhanced monofocal, this gap is tolerated a little better than with a multifocal, because the depth of focus absorbs part of the error. But it does not make it disappear.
Astigmatism must be corrected at the same time
The additional depth of focus does not compensate for corneal astigmatism. Beyond about one dioptre, the implant exists in a toric version, which corrects the astigmatism in the same procedure. The choice is made on the biometry and the corneal topography carried out at the preoperative assessment, at the Cachan practice. The principle is the same as for the conventional toric implant.
Finally, this implant is no better suited than any other to eyes with a retinal disease or advanced glaucoma. In these situations, it is the condition that dictates the choice, and the discussion takes place in consultation, based on the OCT and the fundus examination, as part of the preoperative cataract assessment.
COMPARING
Monofocal, enhanced monofocal, EDOF, multifocal: where does it fit?
The range of implants reads like a ladder. At one end, the conventional monofocal: the purest distance vision, glasses for everything else. At the other, the trifocal: three sharp distances, but halos and a loss of contrast in some patients. In between, in increasing order of depth of focus, the enhanced monofocal, then the EDOF implant, with extended depth of focus.
A meta-analysis published in 2026 directly compared the enhanced monofocal and the EDOF in 672 eyes: distance vision, corrected or not, did not differ. For intermediate vision, the studies were too heterogeneous to be pooled, but the EDOF generally keeps an advantage for near vision, at the price of slightly more frequent halos (PMID 41869169).
Mini-monovision: a way to go further without a multifocal
One strategy is gaining ground: implanting an enhanced monofocal in both eyes, aiming for distance in the dominant eye and a slight myopia, of the order of three quarters of a dioptre, in the other. A Turkish study compared this mini-monovision with a trifocal implant: uncorrected binocular vision was comparable, and contrast sensitivity was better in the mini-monovision group (PMID 39205393).
A 2026 review published in Survey of Ophthalmology confirms that mini-monovision, with a gap of 0.75 to 1.50 dioptres between the two eyes, preserves binocular vision and depth perception better than classic monovision, and that enhanced monofocals have broadened its indications (PMID 41232695). It requires precise biometry and a patient who accepts the principle, tested beforehand with contact lenses.
Mini-monovision
Both eyes receive an enhanced monofocal, set slightly differently. The brain combines the two images.
Dominant eye
Other eye
Both eyes
Teaching diagram: the dark shade indicates sharp vision, the medium shade useful vision. The real range depends on each eye.
It is in this context that the ESCRS held a debate in London in September 2026 on the proposal to make it the default implant for routine cataract surgery. The debate does not carry the weight of a recommendation, but it shows where the thinking of European surgeons stands: the enhanced monofocal is no longer a niche option.
IN PRACTICE
Coverage and choice of implant: what it changes for you
In France, the monofocal implant is covered by the French national health insurance (Assurance Maladie) as part of the cataract operation, with no supplement on the implant. Multifocal and EDOF implants, on the other hand, involve a supplement paid by the patient. The enhanced monofocal sits on the monofocal side: Dr Tourabaly offers it with no supplement on the implant, in the same way as a standard monofocal.
The pathway does not change. The preoperative assessment takes place at the Cachan practice, with biometry on the IOLMaster 700 and corneal topography, which determine the power of the implant and any correction of astigmatism. The operation is performed at the Clinique Sainte-Geneviève, in the 14th arrondissement of Paris, after a systematic anaesthetic consultation. Check-ups take place at day 2, at one month, then at one year.
Final glasses, if any are needed, are prescribed at the one-month check-up. If both eyes are operated on, one to two weeks apart, they are prescribed three to four weeks after the second eye, once the refraction has stabilised. With an enhanced monofocal, this is most often reading glasses only.
Who is it a good choice for?
- Patients who want sharp distance vision and to read their computer screen or car dashboard without glasses, and who accept reading glasses for near vision.
- Those who drive a lot at night and want to avoid the halos of a multifocal: driving after cataract surgery is a frequent criterion in the choice.
- Those whose retina, cornea or optic nerve make a multifocal inadvisable, but who would still like a little more depth of focus.
- Those considering mini-monovision, with a prior trial using contact lenses.
Conversely, a patient who wishes to read without glasses or who has significant uncorrected astigmatism risks not gaining the expected benefit. The decision is taken in consultation, after the assessment, and it remains reversible until the day of the operation.
Frequently asked questions
Does the enhanced monofocal let you do without glasses completely?
No. It provides about one line of intermediate vision more than the conventional monofocal, which is often enough for the screen or the car dashboard. For reading a book or a phone held close, reading glasses most often remain necessary (PMID 39893265).
Does it cause halos at night like a multifocal?
The three available meta-analyses do not find more halos or loss of contrast than with a conventional monofocal, because it has no diffractive rings (PMID 35947003, PMID 39893265, PMID 40840532). Some transient night-time discomfort remains possible in the first weeks, as after any cataract surgery.
Does it cost more than a conventional monofocal?
No: Dr Tourabaly offers it with no supplement on the implant, in the same way as a standard monofocal covered by the French national health insurance. Supplements apply to multifocal and EDOF implants.
What is the difference from an EDOF implant?
The EDOF extends the depth of focus further and generally gives better near vision, with slightly more halos. Distance vision is the same. The enhanced monofocal is the compromise closest to the conventional monofocal (PMID 41869169).
Can it be combined with mini-monovision?
Yes, it is an increasingly used strategy: the dominant eye aims for distance, the other for a slight myopia. It preserves binocular vision better than classic monovision and can be tested with contact lenses before deciding (PMID 41232695).
Is there a toric version for astigmatism?
Yes. Beyond about one dioptre of corneal astigmatism, the toric version corrects the astigmatism in the same procedure. Without this correction, the additional depth of focus does not translate into sharp vision.
Is it suitable if I have early AMD or glaucoma?
It is the condition that dictates the choice. The enhanced monofocal does not have the contrast drawbacks of the multifocal, which sometimes makes it an acceptable option, but the decision is made case by case, on the OCT and the fundus examination, in consultation.
Consultations in Cachan, Paris 13 and at the Sorbonne Saint-Michel practice (Paris 5th) · Tel. +33 1 45 47 08 11
Scientific sources
- Wan KH, et al. Enhanced monofocal versus conventional monofocal intraocular lens in cataract surgery: a meta-analysis. J Refract Surg. 2022. PMID 35947003
- Fernández J, et al. Visual and patient-reported outcomes of an enhanced versus monofocal intraocular lenses in cataract surgery: a systematic review and meta-analysis. Eye (Lond). 2025. PMID 39893265
- Loh NC, et al. Enhanced monofocal versus conventional monofocal intraocular lenses: a systematic review and meta-analysis of randomized controlled trials. Can J Ophthalmol. 2026. PMID 40840532
- Donoso R, et al. Enhanced vs conventional monofocal intraocular lens clinical results in patients with cataract: randomized clinical trial. J Cataract Refract Surg. 2023. PMID 37232418
- Ang RET, et al. Comparison of visual acuity outcomes of enhanced monofocal versus standard monofocal intraocular lenses from a randomized, multicenter, active-controlled trial. J Refract Surg. 2025. PMID 40197064
- Hayashi S, et al. Comparison of visual performance among three higher-order aspheric enhanced monofocal intraocular lenses and a standard aspheric monofocal lens. J Cataract Refract Surg. 2025. PMID 40623059
- Garzón N, et al. Visual and optical quality of enhanced intermediate monofocal versus standard monofocal intraocular lens. Graefes Arch Clin Exp Ophthalmol. 2022. PMID 35622140
- Komatsu K, et al. Postoperative visual function of enhanced monofocal intraocular versus monofocal lenses. J Refract Surg. 2025. PMID 40488482
- Barpaki D, et al. Visual performance comparison between enhanced monofocal and extended depth of focus intraocular lenses: a systematic review and meta-analysis. Cureus. 2026. PMID 41869169
- Can İ. Clinical outcomes of enhanced monofocal (mono-EDOF) intraocular lenses with the mini-monovision technique versus trifocal intraocular lenses: a comparative study. Turk J Ophthalmol. 2024. PMID 39205393
- Kang S, et al. Pseudophakic mini-monovision. Surv Ophthalmol. 2026. PMID 41232695
Further reading
- Cataract surgery: how the operation goes and how to choose your implant
- The preoperative cataract assessment
- Astigmatism and cataract: the toric implant
- The cost of cataract surgery: reimbursement and out-of-pocket costs
This article is intended to inform and does not replace a medical consultation. Indications, expected benefits and risks depend on each individual situation. If you have any question about your vision, consult an ophthalmologist.
Written and reviewed by Dr Moïse Tourabaly, ophthalmic refractive surgeon — former chef de clinique (Quinze-Vingts National Eye Hospital).
Last updated: October 4, 2026
