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Clinical outcomes in 8,260 eyes with an extended-depth-of-focus (EDOF) and low add diffractive aspheric multifocal (MF) IOLs as bilateral and/or a mix and match implantation strategy

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Session Details

Session Title: Pseudophakic IOLs: Enlarged Depth of Focus

Session Date/Time: Tuesday 10/10/2017 | 08:30-10:30

Paper Time: 09:06

Venue: Room 3.1

First Author: : D.Kazakos UK

Co Author(s): :    S. Hannan   D. Teenan   J. Venter              

Abstract Details


This retrospective comparative case series aims to investigate any possible advantages in using mix and match of modern IOLs in a large clinical setting. Similar studies in older generation IOLs have proven the benefit of improving the range of vision whilst minimising some of the unwanted side effects of MF IOLs. Visual outcomes and satisfaction in patients with bilateral clear lens extraction or cataract surgery have been analysed. The implanted IOLs were bilaterally same lens or a mix and match of different lenses from Tecnis Symfony ZXR or ZXT, Tecnis ZKB00 +2.75D and Tecnis ZLB00 +3.25D (Abbott)


All IOL implantations were performed at Optical Express eye clinics in the United Kingdom and Ireland. Eleven sites and ten surgeons were involved.


All consecutive surgeries from October 2014 through November 2016 with follow-up of 3-6 months. Patients were divided into 6 IOL-combination groups. GroupA: Symfony/Symfony(2251 patients), GroupB: Symfony/ZKB (833 patients), GroupC: ZKB/ZKB(455 patients), GroupD: Symfony /ZLB(401 patients), Group E: ZKB/ZLB(114 patients), GroupF: ZLB/ZLB(76 patients). 7880 eyes of 3940 patients from the first four groups reached the required statistical power and were analysed. We evaluated the pre and postoperative uncorrected (UCVA), for distance and near vision monocular and binocular including the predictability of postop mean refractive error. The quality of vision, quality of life and personal satisfaction was assessed with a validated questionnaire.


All groups were well matched for age: 57±7 years; sex: M/F: 50/50(%); mean preoperative myopia -3; hyperopia +2.1; cylinder 0.56±0.4 and Hyperopia/Myopia ratio of 9/1. With a mean follow-up 5.5 months all groups demonstrated excellent but similar results with 93% satisfaction, 96% recommendation, 88% UDVA of 20/20, (98% of 20/25), 15% positive QoV parameters (glare, starbursts, halo, ghosting, double vision) and 90% negative QoL parameters (spectacle use for housework, hobbies, sports & outdoors). Group C performed better on UCNVA (p<0.0005) and postop MSE predictability (p<0.0005). Bilateral Group A reported less dysphotopsias but it did not meet statistical significance (p>0.05).


Patients in all groups achieved excellent binocular visual acuity in distance and near vision with similar QoV and QoL questionnaire scores. The bilateral implantation of Tecnis ZKB00 +2.75D appears to have some advantages over the other combinations. Mix and match of different IOLs offer a blended vision and some degree of reassurance when selecting the IOL for the second eye especially, in an unhappy patient. However, this study does not provide any evidence that there are advantages in using a mix and match strategy with modern low add MF or EDOF IOLs.

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