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Purpose: To describe long-term functional and structural outcomes after implantation of the EyeMax Mono extended macular vision (EMV) intraocular lens (IOL) in eyes with age-related macular degeneration (AMD) using spectral-domain optical coherence tomography (OCT) and corrected distance visual acuity (CDVA).

Methods: This retrospective longitudinal case series included eyes with dry, exudative, or atrophic AMD that underwent cataract surgery with EyeMax Mono IOL implantation. CDVA was anchored at 1 month postoperatively to reduce confounding from lens extraction. OCT (Heidelberg Spectralis) was qualitatively graded for intraretinal fluid (IRF), subretinal fluid (SRF), pigment epithelial detachment (PED), subretinal hyperreflective material (SHRM), foveal ellipsoid zone (EZ) integrity, and atrophy or fibrosis. Eyes with ≥3 OCT examinations including baseline and ≥1 visit at ≥12 months were included; outcomes were analyzed descriptively per eye.

Results: Six eyes of five patients (mean age 79.5 years) were included: four with neovascular AMD (nAMD) receiving concurrent intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy, one with dry AMD, and one with geographic atrophy with complete RPE and outer retinal atrophy (cRORA). From the 1-month CDVA anchor over a follow-up of 24–36 months, one eye improved by 0.5 logMAR, one remained stable, and four declined by 0.2–0.6 logMAR. SRF was present at the anchor in two nAMD eyes and resolved with continued therapy; declining eyes showed progressive central EZ loss with subretinal fibrosis despite eventual fluid control.

Conclusions: In this small case series, eyes with preserved or recovering foveal EZ maintained or improved CDVA, whereas progressive central fibrosis was associated with visual decline regardless of fluid control. These preliminary findings suggest that foveal EZ integrity and fibrotic status may be more informative than fluid biomarkers alone when assessing visual prognosis after EyeMax Mono IOL implantation in AMD. Larger prospective studies are warranted.