Comparison of Visual Outcomes Between Bilateral Implantation of Multifocal Intraocular Lens and Mix-and-Match Strategy.

PURPOSE: To compare postoperative visual outcomes between bilateral multifocal intraocular lens (IOL) implantation and mix-and-match strategies.

METHODS

This prospective multicenter observational study enrolled 156 patients (312 eyes) who underwent uneventful cataract surgery with IOL implantation in both eyes. Patients were divided into five groups based on binocular IOL strategy: mix-and-match of monofocal and bifocal IOLs (MB group), bilateral bifocal IOLs (BB group), monofocal and trifocal IOLs (MT group), bifocal and trifocal IOLs (BT group), and bilateral trifocal IOLs (TT group). Binocular visual outcomes, including visual acuity, defocus curves, contrast sensitivity, stereoacuity, and subjective visual quality measures such as Visual Function Index 14 scores, spectacle independence, and patient satisfaction were assessed at 6 months after surgery.

RESULTS

All patients showed significant improvement in binocular visual acuity after surgery. Binocular distance visual acuity, contrast sensitivity, Visual Function Index 14 scores, spectacle independence, and satisfaction were comparable between the MB and BB groups and among the MT, BT, and TT groups. BB yielded slightly better binocular near visual acuity than MB. TT achieved mildly superior intermediate and near visual acuity than MT. Near stereoacuity was significantly better for BB than MB and for BT than MT. TT showed superior intermediate and near stereoacuity than MT. Patients who had MT and BT were more likely to report difficulty with distance perception than those who had TT. Photic disturbances were relatively more common in the BB and TT groups compared to the mix-and-match groups.

CONCLUSIONS

The mix-and-match strategy provided comparable binocular distance visual acuity, contrast sensitivity, and subjective visual quality to bilateral multifocal IOL implantation. Intermediate and near visual acuity and stereoacuity may be compromised in monofocal-multifocal combinations.