A Staged “Custom Match” Strategy For Premium Iol Implantation: Optimising Binocular Vision Across The Visual Life Cycle

To evaluate premium intraocular lens (IOL) selection patterns and binocular visual outcomes using a staged implantation strategy designed to balance spectacle independence with night-driving quality.

Wellington Eye Clinic, Dublin, Ireland

A retrospective analysis was performed of 122 consecutive patients (244 eyes) undergoing cataract surgery or custom lens replacement (CLR) with full-range-of-focus (FROF, trifocal) and extended-depth-of-focus (IROF, increased range of focus) IOLs. The cohort included 90 CLR patients (180 eyes) and 32 cataract patients (64 eyes). Patients were counselled using a structured protocol in which the first eye was selected according to patient priority (maximal range of vision versus night-driving quality). The second eye was subsequently optimised based on the functional visual experience of the first eye (“Custom Match”). Final binocular strategies included FROF/FROF, FROF/IROF, and IROF/IROF.

Application of the staged protocol revealed a clear age-dependent pattern of premium IOL selection, with bilateral FROF implantation predominating in younger patients, increasing use of blended FROF/IROF strategies in mid-life, and bilateral IROF implantation in older patients prioritising night-driving quality. In the blended FROF/IROF cohort (102 eyes), binocular outcomes were strong: 59% achieved 20/20 or better distance vision and 90% achieved 20/25 or better; near acuity was N5 or better in 69% and N6 or better in 91%. Over five years of applying this protocol, no trifocal IOL explantations occurred.

A staged premium IOL strategy guided by patient priorities and first-eye experience produces predictable binocular visual outcomes while preserving night-driving quality and reducing the risk of dissatisfaction with trifocal IOL implantation.