The mix-and-match method for bilateral intraocular lens implantation aims to take advantage of a patient’s ability to neuroadapt—which can yield improved visual outcomes. Extended depth-of-focus (EDOF) and diffractive multifocal (DMF) IOLs are strong candidates for this method because of their various optic designs and near additions. Researchers evaluated the clinical outcomes after bilateral mix-and-match cataract surgery and found that the method produces good vision with high levels of patient satisfaction.

The prospective clinical study took place at a single center in Seoul. A total of 37 patients were implanted with Tecnis Symfony EDOF (ZXR00) in the dominant eye and Tecnis +3.25 DMF (ZLB00) in the nondominant eye. Each patient was followed for three months and underwent testing for visual acuity, contrast sensitivity, defocus curves, stereopsis and patient satisfaction.

The researchers reported positive three month visual acuity outcomes (Table 1). Most patients (81.1%) reported satisfaction with near vision and eight patients (21.6%) complained of glare and halo. Additionally, 34 patients (91.9%) achieved spectacle independence for near vision, and 31 patients (83.8%) had better than a 50-second arc of stereopsis.  

“In this study, the limitation of decreased near visual acuity in EDOF IOLs was overcome by mix-and-match implantation of a DMF IOL in the nondominant eye,” the researchers wrote in their paper.  

They concluded that the mix-and-match method with these lenses produces good outcomes with acceptable levels of photic phenomena. Binocular uncorrected visual acuity showed a wide range of good postoperative vision across all distances, which the researchers considered an adequate outcome, as this approach enabled subjects to read books or use smartphones without glasses. “Binocular uncorrected visual outcome was relatively better compared with monocular outcomes at all ranges in both groups, and it can be supposed that this is a result of bilateral summation.”

Table 1. Average Uncorrected Vision at Three Months Post-op (logMAR)

(logMAR) EDOF eyes DMF eyes Both eyes
 UDVA 0.07 0.12 0.02
 UIVA 0.11 0.16 0.04
 UNVA 0.250.22  0.13


Lee J, Chung H, Moon S, et al. Clinical outcomes after mix-and-match implantation of extended depth of focus and diffractive multifocal intraocular lenses. Hindawi J Ophthalmol 2021. August 3, 2021. [Epub ahead of print].