Mixing & matching IOLs not always to patient's advantage

Using various types of IOLs in the same patient has been trumpeted as a way to achieve better vision correction than bilaterally implanting the same IOL. Yet, this concept of “mix and match” is not quite that simple, said Rubens Belfort, MD, Vision Institute, Federal University, Sao Paulo, Brazil.

“Our experience tells us that such decisions depend on individual situations and patient expectations,” Dr Belfort said. “In each case, we must understand the patient and adopt his or her expectations.”

Dr Belfort compared and contrasted three studies. In the first, 40 patients received contralateral implantation with the apodized diffractive (ReSTOR; Alcon)/multifocal (ReZoom; AMO) lenses and were followed up at three months. In the second, 24 patients received bilateral implantation with the apodized diffractive IOL and were followed up at six months. The third study consisted of the label information for the apodized diffractive lens: 69 patients followed up at six months.

The studies had some similarities, such as inclusion criteria and methodology. They also had some differences: for example, the first study was randomized, while the other two were not.

Postoperative evaluation conducted by Dr Belfort included only those criteria that were the same for all three groups. In comparing the results of the three studies, Dr Belfort and his colleagues found that the best-corrected distance acuity was comparable across the three studies. “There were no advantages to mix and match, or mix and unmatch,” he said.The apodized diffractive lens pairing demonstrated improvements in near visual acuity compared with the patients who received the apodized diffractive/multifocal lenses.

“This is something we were not expecting,” Dr Belfort said. The same held true for intermediate visual acuity, as the apodized diffractive lens patients demonstrated improvement in intermediate vision compared with the apodized/multifocal lenses.

“We often hear how wonderful the mix-and-match concept is, but we didn't find that here,” Dr Belfort said. “The thing to remember is to put patients and their expectations first, in spite of all the technology and all the marketing.”