Two Eyes, One Functional Visual Unit: Refractive And Visual Outcomes Of A Complementary Hybrid Multifocal–Edof Concept

To evaluate a complementary hybrid multifocal–EDOF strategy (Artis Symbiose IOL - Cristalens, France) designed to function as a single binocular visual unit, reporting refractive accuracy, a range of uncorrected vision, and patient-reported photic phenomena at 6 months.

Instituto Oftalmológico Hoyos, Sabadell, Barcelona (Spain)

Prospective single-centre case series including 50 patients (100 eyes) undergoing crystalline lens surgery. The Artis Symbiose complementary multifocal IOL platform was implanted (MID in the dominant eye, PLUS in the non-dominant eye) to extend binocular range through a complementary hybrid multifocal–EDOF design. Exclusion criteria were maculopathy, dry eye, scotopic pupil >6.0 mm, and corneal HOAs >0.300 µm. Six-month outcomes included spherical equivalent accuracy (±0.50 D), monocular and binocular UDVA and UNVA (logMAR). Binocular defocus curves were obtained under photopic conditions in 7 randomly selected patients. Photic phenomena were recorded spontaneously and with directed questioning.

One hundred IOLs were implanted (mean power +21.0 D; 50% toric). At 6 months, mean postoperative SE was −0.01 D (range −0.75 to +0.50 D), with 94% of eyes within ±0.50 D. Mean UDVA improved from 0.52 (range 2.00 to 0.05) to 0.02(range 0.40 to −0.08 logMAR. For near vision, 96% achieved uncorrected 20/20. Binocular defocus curves demonstrated a continuous functional range from distance to near without significant troughs, supporting effective complementary binocular integration. Photic phenomena were not reported spontaneously; 10% reported mild halos/glare on direct questioning, decreasing after 4–6 weeks, and none reported interference with daily activities.

Our results suggest that the Artis Symbiose complementary IOL system provides accurate refractive outcomes with high predictability. The combination of the two different IOL models function as one unit, creating a full range of high-quality vision and with a minimal level of visual disturbance.