A comparative study of extended depth of focus, bifocal intraocular lenses and their mix-and-match

To compare the visual performances of extended depth of focus (EDOF) lenses, diffractive bifocal intraocular lenses (IOLs) and their combination.

This was a prospective, consecutive observational comparative study performed from Dec 2020 to Dec 2021. Cataract patients who meet the indications for multifocal IOLs implantation were divided into three groups, including binocular diffractive bifocal IOL (Human Optics Diff-aAY) implantation group, binocular EDOF IOL (Tecnis Symfony ZXR00) group and mix-and-match group (Symfony in one eye and Diff-aAY in the other). Follow-ups were scheduled at 1d, 3d, 2wk, and 6mo. Visual acuities (VA) at different distances were examined at every follow-up. At 6mo, optic path difference (OPD) scans, and questionnaire answers were evaluated.

Thirty patients (60 eyes) were included in the binocular Diff-aAY group [age 63 (59-68), 11 males], 29 patients (58 eyes) in the binocular Symfony group [age 62 (56.75-68), 15 males] and 27 patients in mix-and-match group [age 65 (51-71), 11 males]. There was no significant difference in binocular uncorrected distance VA, uncorrected intermediate VA, or uncorrected near VA among the three groups (P=0.082, 0.151, and 0.703, respectively) at the last follow-up. The mix-and-match group had a superior Strehl ratio (SR; P=0.025) and modulation transfer function (MTF; P<0.05) and an inferior root mean square (RMS; P<0.05) in OPD scan. The three groups reported comparable level of postoperative satisfaction (P=0.141) and spectacle independence (P=0.278). Mild subjective dysphotopsia was more common (22.22%) in mix-and-match group (P=0.030).

Bilateral Symfony, bilateral Diff-aAY, and the combination of these two IOLs are all remarkable regarding all range vision, objective visual quality, and spectacle independence.