Mix-and-match vs bilateral trifocal and bilateral EDOF intraocular lens implantation: the spline curve battle

Purpose: To compare the postoperative visual acuity curves following 3 pseudophakic presbyopic correction techniques. Setting: Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece. Design: Prospective, randomized, comparative trial. Methods: For this study, patients with stage 2 Lens Opacities Classification System III cataract were divided into 3 study groups: (1) premium monovision group, including patients who received the Panoptix intraocular lens (IOL) in the recessive eye and Vivity IOL in the dominant one; (2) bilateral trifocal group, including those who received bilaterally the Panoptix IOL; and (3) bilateral xEDOF group, including patients who received bilaterally the Vivity IOL. Postoperative bilateral uncorrected distance visual acuity was measured at 25.5, 28, 33, 40, 50, 66, 100, 200, and 300 cm distances. Spline curve fitting was attempted, and areas of the curves (AOCs) and curvature k were calculated. All patients responded to the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Results: 90 patients were equally divided into the 3 groups. Premium monovision and bilateral trifocal implantations delivered similar visual acuity (all AOC P > .05); however, the trifocal patients suffered from drops in vision acuity in certain distance ranges as expressed by negative curvature values. Bilateral xEDOF patients demonstrated worse near vision acuity ( P < .05). Premium monovision patients reported better scores in NEI-VFQ 25 ( P = .03) and in the near activities ( P = .02) and distant activities ( P = .04) subscales. Conclusions: All surgical options provided impressive outcomes. Premium monovision appeared to deliver the best results.