title: Combining zonal refractive and diffractive aspheric multifocal intraocular lenses.
abstract: OBJECTIVE
  To assess visual performance with the combination of a zonal refractive aspheric multifocal intraocular lens (MIOL) (Lentis Mplus, Oculentis GmbH) and a diffractive aspheric MIOL (Acri.Lisa 366, Acri.Tech GmbH).
  
  
  METHODS
  This prospective interventional cohort study comprised 80 eyes from 40 cataract patients (mean age: 65.5±7.3 years) who underwent implantation of the Lentis Mplus MIOL in one eye and Acri.Lisa 366 MIOL in the fellow eye. The main outcome measures were refraction; monocular and binocular uncorrected and corrected distance, intermediate, and near visual acuities; monocular and binocular defocus curves; binocular photopic contrast sensitivity function compared to a monofocal intraocular lens (IOL) control group (40 age-matched pseudophakic patients implanted with the AR-40e [Abbott Medical Optics]); and quality of vision questionnaire.
  
  
  RESULTS
  Binocular uncorrected visual acuities were 0.12 logMAR (0.76 decimal) or better at all distances measured between 6 m and 33 cm. The Lentis Mplus provided statistically significant better vision than the Acri.Lisa at distances between 2 m and 40 cm, and the Acri.Lisa provided statistically significant better vision than the Lentis Mplus at 33 cm. Binocular defocus curve showed little drop-off at intermediate distances. Photopic contrast sensitivity function for distance and near were similar to the monofocal IOL control group except for higher frequencies. Moderate glare (15%), night vision problems (12.5%), and halos (10%) were reported. Complete independence of spectacles was achieved by 92.5% of patients.
  
  
  CONCLUSIONS
  The combination of zonal refractive aspheric and diffractive aspheric MIOLs resulted in excellent uncorrected binocular distance, intermediate, and near vision, with low incidence of significant photic phenomena and high patient satisfaction.
authors.affiliation: Centro Oftalmológico Marqués de Sotelo, Valencia, Spain. gon.munoz@ano.com
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Muñoz
authors.forename: César
authors.initials: C
authors.lastname: Albarrán-Diego
authors.forename: Jaime
authors.initials: J
authors.lastname: Javaloy
authors.forename: Hani F
authors.initials: HF
authors.lastname: Sakla
authors.forename: Alejandro
authors.initials: A
authors.lastname: Cerviño
mesh_terms: D000368:Aged; D001699:Biometry; D019923:Capsulorhexis; D015350:Contrast Sensitivity / Q000502:physiology; D005260:Female; D006801:Humans; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018918:Phacoemulsification; D011446:Prospective Studies; D019591:Pseudophakia / Q000503:physiopathology*; D012029:Refraction, Ocular / Q000502:physiology; D015348:Vision, Binocular / Q000502:physiology*; D014792:Visual Acuity / Q000502:physiology*