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    Finding the ideal mix-and-match IOL strategy

    Combination of low-add multifocal and extended-range-of-vision lens may be solution for many patients

    Take-home message: Two clinicians explore why an optimal visual solution for patients may be using both a low-add multifocal and an extended-range-of-vision lens.



    Toronto—For surgeons who may have had a bad experience with earlier multifocal IOLs and vowed not to implant another presbyopia-correcting lens, times have changed.

    The latest presbyopia-correcting lenses are not just incrementally better—they represent a dramatic improvement in patient satisfaction, night vision quality, and functional vision. It would be a mistake not to revisit the category, especially since surgeons can now mix and match within a single lens platform to meet a patient’s visual goals.

    A variety of mix-and-match strategies have been used in the past. Surgeons have tried to combine various multifocal lenses to maximize functionality, with limited success. A year ago, we had been using a combination of the Crystalens (Bausch + Lomb) for the dominant eye and a Tecnis Multifocal +4.00 add (Abbott Medical Optics) for the non-dominant eye, to give patients both reading and intermediate vision, as well as their distance. Both of these lenses had significant drawbacks, though.

    Now, two lenses that have recently been introduced to market—the Tecnis Multifocal low add and the Tecnis Symfony extended range of vision IOL (Abbott Medical Optics)—seem to provide the ideal combination.

    When the Symfony lens was introduced in Canada, we began implanting it bilaterally, with great results. It provides about 1.5 D of accommodative amplitude, so patients could be counseled to expect to use a pair of +1.00 readers for small print.

    Then, we began trying to give patients a “boost” for their near vision by implanting a Symfony lens in the dominant eye for intermediate and a +3.25 low-add multifocal in the non-dominant eye for near. Both eyes, together or individually, see really well at distance.

    A prospective study of outcomes with this combination is under way, but after implanting 800 of these lenses in the past year, this may be the best combination available for a full range of vision.

    For surgeons who do not yet have access to the Symfony lens, the combination of a 2.75-add lens in the dominant eye and 3.25-add lens in the non-dominant eye could achieve similar results.

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