Comparison of visual outcomes between bilateral EDOF IOL implantation and combined EDOF and bifocal IOL implantation

To compare the visual outcomes between bilateral implantation of Tecnis ZXR00 extended depth-of-focus (EDOF) intraocular lenses (IOLs) and mixed implantation of Tecnis ZXR00 (EDOF) with Tecnis ZMB00 (bifocal) IOLs.

This postoperative cross-sectional study enrolled patients who underwent phacoemulsification combined with IOL implantation. Patients were divided into two groups: the bilateral ZXR00 group (ZXR00-only group) and the mixed IOL group (ZXR00+ZMB00 group). Primary outcome measures included uncorrected and corrected distance visual acuity (UDVA, CDVA), uncorrected and distance-corrected near visual acuity (UNVA, DCNVA), uncorrected and distance-corrected intermediate visual acuity (UIVA, DCIVA), and defocus curves. Secondary outcome measures were visual quality, spectacle independence, patient satisfaction, photic phenomena, and stereopsis.

A total of 47 patients (94 eyes) were included, with 26 patients (11 males, 15 females) in the ZXR00-only group (mean age: 62.73±7.24y) and 21 patients (7 males, 14 females) in the mixed group (mean age: 65.71±9.16y). There was no statistically significant difference in age between the two groups (P=0.218). The mixed group showed significantly better binocular DCNVA compared to the ZXR00-only group (P=0.002). Defocus curve analysis revealed that the mixed group exhibited superior performance at -2.5 to -4.0 D but inferior performance at -0.5 and -1.5 D. Near stereoacuity was significantly poorer in the mixed group (Randot: 5.589±0.744 vs 6.240±0.394 ln arcsec; Contour: 4.966±0.973 vs 5.740±0.833 ln arcsec; both P<0.01). Both groups achieved high levels of spectacle independence and patient satisfaction, with no significant differences in photic phenomena or questionnaire scores.

Mixed implantation of EDOF and bifocal IOLs improve near visual acuity but may compromise near stereopsis. This approach provides a viable option for patients prioritizing near vision; however, caution is recommended for individuals requiring fine stereoscopic vision for daily or professional tasks.