When it comes to refractive lens exchange (RLE), one size doesn't fit all — and mixing lens types might actually be the smarter play. At the American Academy of Ophthalmology's Refractive Surgery Subspecialty Day, Dr. R. Luke Rebenitsch presented findings from a retrospective study comparing bilateral same-lens implantation against "mix-and-match" IOL combinations across three cohorts of 50 patients each.

The study compared patients receiving bilateral Tecnis Odyssey lenses, a Synergy/Symfony combo, or an Odyssey/Symfony combo. All groups showed high overall satisfaction and strong uncorrected distance vision, with most patients achieving 20/20. Notably, the mix-and-match groups had lower IOL exchange rates than the same-lens group — a meaningful outcome for both surgeons and patients.

Key Takeaways:

• Mix-and-match IOL combinations yielded lower exchange rates vs. bilateral same-lens implantation
• Approximately 25% of patients still required an IOL exchange, primarily due to intermediate vision or distance contrast complaints
• Near vision outcomes were slightly lower in the Odyssey-Symfony group, but patients remained satisfied
• When patients are unhappy post-RLE, Rebenitsch recommends first correcting refractive misses, optimizing the ocular surface, and addressing floaters or opacities

Why it matters: RLE patients arrive with high expectations and highly individual visual needs. This study reinforces that a personalized, mix-and-match lens strategy — rather than a one-lens-fits-all approach — can better meet those demands and potentially reduce the need for lens exchanges down the line.