Enhancing Visual Outcomes and Patients’ Satisfaction: A Case Series of Mix-and-Match Approach for Unhappy Presbyopic Patients Post-Cataract Surgery

See Yee Bee, Teck Chee Cheng, Jemaima Hamzah, Rona Asnida Nasaruddin

Abstract


This case series explored the mix-and-match approach of implanting an extended depth of focus (EDOF) intraocular lens (IOL) in the fellow eye to improve visual outcomes, reduce spectacle dependence, and enhance satisfaction in presbyopic patients dissatisfied with monofocal IOL outcomes, highlighting personalised refractive solutions for suboptimal results post-cataract surgery. Seven patients dissatisfied with post-operative presbyopia following monofocal IOL in first eye received EDOF IOL in the second eye (mix-and-match approach). Visual outcomes were assessed using a logMAR chart for near (40 cm), intermediate (60 cm and 80 cm) and distance (6 m) visual acuity (VA). Contrast sensitivity was measured using the Pelli-Robson chart, and halos and glare were evaluated with the Zeiss Halo and Glare Stimulator. Patient satisfaction was measured using the CATQUEST-9SF 2011 questionnaire before and after EDOF IOL implantation in the second eyes. Results showed statistically significant improvement in uncorrected near VA at 40cm and intermediate VA at 60cm in eyes with EDOF IOL (0.26 ± 0.18 and 0.11 ± 0.15 respectively) compared to eyes with monofocal IOL (0.64 ± 0.28 and 0.39 ± 0.26 respectively), while maintaining good uncorrected distance VA. Only one patient reported halos with the EDOF IOL, not affecting night driving. Contrast sensitivity showed no significant difference between monofocal IOL (1.60 ± 0.14) and EDOF IOL (1.60 ± 0.17) eyes. All patients were satisfied, experiencing improvements in recognised faces, walking on uneven surfaces, reading newspapers and TV subtitles, engaging in hobbies and seeing price tags. This mix-and-match approach demonstrated efficacy in enhancing near and intermediate vision while maintaining good distance vision, offering a personalised solution to reduce spectacle dependence without compromising contrast sensitivity or causing significant halos and glare.


Keywords


Contrast sensitivity; extended-depth of focus; intraocular lens; intermediate vision; mix-and-match; presbyopia

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References


Mohd Azmi A, Che Omar NA, Wan Abdul Halim WH. Lens-induced glaucoma: An audit of cataract cases in Hospital Sultanah Nur Zahirah, Kuala Terengganu (HSNZKT). Cureus 2022; 14(3): e22875.

Kohnen T, Suryakumar R. Extended depth-of-focus technology in intraocular lenses. J Cataract Refract Surg 2020; 46(2): 298-304.

Kanclerz P, Toto F, Grzybowski A, Alio JL. Extended depth-of-field intraocular lenses: An update. Asia-Pac J Ophthalmol 2020; 9(3): 194-202.

Iida Y, Shimizu K, Ito M. Pseudophakic monovision using monofocal and multifocal intraocular lenses: Hybrid monovision. J Cataract Refract Surg 2011; 37(11): 2001-5.

Greenbaum S. Monovision pseudophakia. J Cataract Refract Surg 2002; 28(8):1439-43.

Finkelman YM, Ng JQ, Barrett GD. Patient satisfaction and visual function after pseudophakic monovision. J Cataract Refract Surg 2009; 35(6): 998-1002.

Greenstein S, Pineda R. The quest for spectacle Independence: A comparison of multifocal intraocular lens implants and pseudophakic monovision for patients with presbyopia. Semin Ophthalmol 2017; 32(1): 111-5.

Jain S, Arora I, Azar DT. Success of monovision in presbyopes: Review of the literature and potential applications to refractive surgery. Surv Ophthalmol 1996; 40(6): 491-9.

Wright KW, Guemes A, Kapadia MS, Wilson SE. Binocular function and patient satisfaction after monovision induced by myopic photorefractive keratectomy. J Cataract Refract Surg 1999; 25(2): 177-82.

Handa T, Mukuno K, Uozato H, Niida T, et.al. Ocular dominance and patient satisfaction after monovision induced by intraocular lens implantation. J Cataract Refract Surg 2004; 30(4): 769-74.

Rodov L, Reitblat O, Levy A, Assia EI, et al. Visual outcomes and patient satisfaction for trifocal, extended depth of focus and monofocal intraocular lenses. J Refract Surg 2019; 35(7): 434-40.

Woodward MA, Randleman J, Stulting R. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg 2009; 35(6): 992-7.

Zhang F, Sugar A, Jacobsen G, Collins M. Visual function and spectacle independence after cataract surgery: Bilateral diffractive multifocal intraocular lenses versus monovision pseudophakia. J Cataract Refract Surg 2011; 37(3): 446-53.

Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, et al. Mini-monovision versus multifocal intraocular Lens implantation. J Cataract Refract Surg 2015; 41: 53-7.

Adnan TH, Mohamed Apandi M, Kamaruddin H, Salowi MA, et al. Catquest-9SF questionnaire: Validation of Malay and Chinese-language versions using Rasch analysis. Health Qual Life Outcomes 2018; 16(1): 1-9.

Alice CC, Gurusamy B, Andrew LK, Bastion ML. Comparison of contrast sensitivity between three aspheric acrylic monofocal intraocular lenses: a prospective randomised trial. Malaysian J Ophthalmol 2020; 1(4): 259-83.

Song JE, Khoramnia R, Son HS, Knorz MC, et.al. Comparison between bilateral implantation of a trifocal IOL and mix-and-match implantation of a bifocal IOL and an extended depth of focus IOL. J Refract Surg 2020; 36(8): 528-35.

Van Amelsfort T, Webers VS, Bauer NJ, Clement LH, et al. Visual outcomes of a new nondiffractive extended depth-of-focus intraocular lens targeted for minimonovision: 3-month results of a prospective cohort study. J Cataract Refract Surg 2022; 48(2): 151-6.

Zeilinger J, Kronschläger M, Schlatter A, Georgiev S, et al. Comparing an advanced monofocal with a non-diffractive extended depth of focus intraocular lens using a mini-monovision approach. Am J Ophthalmol 2025; 271: 86-95.

Pieh S, Weghaupt H, Skorpik C. Contrast sensitivity and glare disability with diffractive and refractive multifocal intraocular lenses. J Cataract Refract Surg 1998; 24(5): 659-62.

Tarib I, Kasier I, Herbers C, Hagen P, et al. Comparison of visual outcomes and patient satisfaction after bilateral implantation of an EDOF IOL and a mix-and-match approach. J Refract Surg 2019; 35(7): 408-16.

Tomagova N, Elahi S, Vandekerckhove K. Clinical outcomes of a new non-diffractive extended depth-of-focus intraocular lens targeted for mini-monovision. Clin Ophthalmol 2023; 17: 981-90.




DOI: http://dx.doi.org/10.17576/JSA.2025.1501.03

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