Comparison of Visual Performance Between Mix-and-Match and Bilateral Implantation of Rotationally Asymmetric Multifocal Intraocular Lenses

To evaluate and compare the clinical outcomes of rotationally asymmetric multifocal intraocular lenses (IOLs) in a mix-and-match approach or bilateral implantation. In this prospective study, patients were split into two groups based on the types of IOLs implanted. The mix group received mix-and-match implantation of a LENTIS Mplus LS-313 +1.50D IOL in the dominant eye and a LENTIS Mplus LS-313 +3.0D IOL in the fellow eye. The bilateral group received bilateral implantation of LENTIS Mplus LS-313 +3.00D IOLs. A three-month follow-up was performed after the surgery. Binocular visual acuity at various distances, subjective refraction and defocus curves were assessed. Subjective questionnaires included the overall satisfaction, a self-assessment of visual quality, spectacle independence, and presence of photic phenomena were completed. The study was completed by 52 patients in total (25 mix-and-match, 27 bilateral). The mean binocular uncorrected intermediate visual acuity in the mix group and the bilateral group were 0.10 ± 0.12 logMAR and 0.23 ± 0.14 logMAR, respectively, demonstrating a significant difference (P = 0.005). The mix group performed better in intermediate vision (range: -1.00 to -2.00 D) than the bilateral group (all P< 0.05), according to binocular defocus curves. About 92.0% of patients in the mix group did not need spectacles for intermediate distance vision compared to 59.26% in the bilateral group (P = 0.0001). The mix-and-match implantation of the +1.50D and +3.00D rotationally asymmetric multifocal IOLs provided good binocular visual outcomes and resulted in better intermediate vision than bilateral implantation of +3.00D IOLs.