The aim of this study is to observe the visual quality after mix-and-match implantation of bifocal and extended depth-of-focus intraocular lenses (IOLs) versus bilateral bifocal IOL implantation.

A total of 46 patients (92 eyes) who underwent cataract surgery at the First Affiliated Hospital of Zhengzhou University from June 2023 to September 2024 were enrolled. Among them, there were 20 males (40 eyes) and 26 females (52 eyes); their ages ranged from 16 to 80 years, with an average age of (51.6±15.2) years. According to the type of implanted IOL, they were divided into a hybrid group of 20 cases (40 eyes) and a bifocal group of 26 cases (52 eyes). In the hybrid group, the dominant eye was implanted with a TECNIS Symfony ZXR00 EDoF IOL, while the non-dominant eye was implanted with a Tecnis ZMB00 bifocal IOL; in the bifocal group, both eyes were implanted with Tecnis ZMB00 IOL. At 6 months postoperatively, uncorrected distance, intermediate, and near visual acuities, defocus curves, contrast sensitivity, stereoacuity, dynamic visual acuity, and subjective visual quality were compared between the two groups. After shapiro-wilk test for normality of measurement data, age, area under defocus curve, stereoacuity and subjective visual quality (average score of the scale) conformed to normal distribution and were described by ±s . Uncorrected long-range vision, uncorrected medium-range vision, uncorrected short-range vision, subjective visual quality (mean score of difference events) and other non conformities to the normal distribution were described by M(P25, P75). The counting data of gender, mirror removal rate and optical interference phenomenon were described by frequency and percentage (%). The contrast sensitivity, uncorrected long-range DVA, uncorrected medium-range DVA and uncorrected short-range DVA at different visual target speeds of the two groups were not uniform. The normal distribution was described by ±s and M(P25, P75).

At 6 months postoperatively, the uncorrected intermediate visual acuity, uncorrected distance visual acuity, and uncorrected near visual acuity in the mix-and-match group were 0.00 (-0.08, 0.00) logMAR, -0.10 (-0.20, -0.10) logMAR, and 0.00 (-0.07, 0.00) logMAR, respectively; while those in the bifocal group were 0.21 (0.10, 0.30) logMAR, -0.04 (-0.10, 0.00) logMAR, and 0.00 (-0.02, 0.10) logMAR, respectively. The area under the defocus curve was (1.54±0.19) D·logMAR in the mix-and-match group and (1.03±0.17) D·logMAR in the bifocal group. Under specific spatial frequencies under photopic, photopic with glare, and scotopic with glare conditions, contrast sensitivity was higher in the mix-and-match group than in the bifocal group. The mix-and-match group showed superior distance, intermediate, and near dynamic visual acuity (DVA) at medium and high speeds compared to the bifocal group. Stereopsis was (24.75±10.57)″ in the mix-and-match group and (26.92±9.60)″ in the bifocal group. The VF-14-CN scores were (98.15±2.64) scores and (97.12±3.03) scores , respectively. The proportion of patients without optical disturbances was 70.00% (14/20) in the mix-and-match group and 46.15% (12/26) in the bifocal group. The spectacle independence rate was 95.00% (19/20) in the mix-and-match group and 88.46% (23/26) in the bifocal group.

The mix-and-match implantation of bifocal and extended depth-of-focus IOLs can provide better intermediate and distance visual acuity, photopic contrast sensitivity, medium-to-high-speed dynamic visual acuity, and subjective visual satisfaction while maintaining good near visual acuity and stereoacuity. It represents an effective strategy for refractive cataract surgery.