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Does mix and match improve quality of vision?
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Combining lenses helps meet needs of individual patients
 Magda Rau |
I have done mix and match implantation for many years now. I began in 2002, when there were only refractive multifocal IOLs available, with implantation of the Array (Abbott Medical Optics) in one eye and the MF4 (Carl Zeiss Meditec) in the other eye. Then I started to combine refractive and diffractive IOLs to reduce the disadvantages and enhance the advantages of single lenses. I think mix and match is a great opportunity to widen the indications of multifocal IOLs, meeting the needs of a greater number of patients.
I do not decide on mix and match a priori. I make my patients fill in questionnaires concerning their profession, hobbies, computer use, reading habits and night driving. Then I make them talk about their answers and ask further questions. I have special charts to assess habitual reading, computer distance and the size of text they want to be able to read without spectacles. Then I take the gender aspect into consideration and perform a two-stage implantation. With men, I usually first implant the ReZoom (AMO) in the dominant eye; with women, the Tecnis (AMO) in the nondominant eye. With a young professional woman who works a lot on the computer, I start with the dominant eye with a ReZoom or a Lentis (Oculentis); with a man who needs excellent near vision, I start with the Tecnis in the nondominant eye. I wait 4 to 8 weeks, and if patients are happy with the lens I implanted, I use the same lens in the other eye, perhaps with some fine-tuning. However, if patients are not satisfied with some tasks, such as computer work or distance vision or reading books, I switch to a different lens.
I never had complaints or side effects with mix and match, but only great satisfaction. Also, problems with glare and halos can be reduced by implanting a different lens in the second eye, such as the Lentis Mplus (Oculentis) or an accommodating lens. You can do all sorts of combinations: refractive and diffractive, multifocal and accommodating, multifocal and toric. Careful patient selection is the key to success.
Magda Rau, MD, is the head of Augenklinik Cham, Cham, Germany. Disclosure: Dr. Rau has no direct financial interest in the products discussed in this article, nor is she a paid consultant for any companies mentioned.
Mix and match may lead to decreased binocular summation
 Con Moshegov |
When the ReSTOR +4 D lens (Alcon) became available in Australia in 2003, it soon became apparent that patients with this IOL had fabulous near vision, but their intermediate acuity was suboptimal. They could read the finest print at about 32 cm from their eyes but had difficulty seeing a computer screen at about 60 cm. To compensate for intermediate vision, I decided to try a mixed approach with a ReSTOR in one eye and an Array (AMO) or ReZoom (AMO) in the fellow eye. This was before the American “custom match” approach received any attention.
It was no surprise that patients with the combination of IOLs had better intermediate vision. The problem was that their functional ability at near was compromised, and the biggest surprise of all was that the likelihood of overall spectacle independence was lower than in patients having bilateral ReSTOR implantation. I put this down to the lack of binocular summation, which is a well-documented phenomenon. In simple terms, two eyes for a given visual task will perform better than one.
Now that the ReSTOR comes with a +3 D add for intermediate vision, although still not perfect, it is better than the original version of the lens.
My experience deters me from any sort of mixing of IOLs. If I have promised people unaided reading vision with the least compromise to their distance acuity, the best choice in my practice is a diffractive multifocal IOL in each eye. If there are concerns over intermediate acuity without glasses, the best of these is the aspheric ReSTOR +3 D.
Con Moshegov, MBBS, FRANZCO, FRACS, is an OSN Asia-Pacific Edition Editorial Board Member and the medical director at Perfect Vision Laser Correction, Sydney, Australia. Disclosure: Dr. Moshegov has no direct financial interest in the products discussed in this article, nor is he a paid consultant for any companies mentioned.