If you’re planning cataract or lens-replacement surgery, you may be wondering whether it’s possible to choose different types of intraocular lenses (IOLs) for each eye. Perhaps you’ve heard of friends who mixed a multifocal lens with a monofocal, or someone who paired an extended depth-of-focus (EDOF) lens with a multifocal lens and now enjoys a wide range of focus. You might even be thinking about combining designs to get the best of all worlds.
This approach often called “mix-and-match” IOLs is far more common than many people realise. In fact, surgeons frequently use it to fine-tune vision across distance, intermediate and near tasks. But as with any personalised treatment, mixing lens types is not right for everyone.
In this guide, I’ll take you through exactly how mix-and-match works, what combinations are most successful, how the brain adapts to different optical patterns and when surgeons recommend caution. By the end, you’ll have a clear sense of whether mixing lenses could enhance your visual outcome.
Why Patients Consider Mixing IOL Types
Your eyes work together to give you a complete and balanced view of the world. Because each intraocular lens (IOL) type has its own strengths and limitations, some patients choose to mix different lenses between their eyes. This approach can expand your visual range and reduce reliance on glasses more effectively than using the same lens type in both eyes.
People often consider mixing lenses because they want:
- Better near and reading vision – Having a near-focused lens in one eye can make reading, phone use, and other close-up tasks clearer and more comfortable.
- Clearer intermediate vision for screens – An intermediate-focused lens can improve clarity for computer work, tablets, or cooking tasks without needing reading glasses.
- Strong distance clarity – A distance-focused lens ensures sharp vision for driving, outdoor activities, and watching TV.
- Reduced halos and glare – Mixing a monofocal lens with an extended depth-of-focus or multifocal lens can reduce unwanted visual phenomena like halos, especially at night.
- More natural contrast sensitivity – A combination approach helps maintain better perception of contrasts and colours in different lighting conditions.
- Balanced performance in different lighting – By leveraging the strengths of each lens type, patients can enjoy clearer vision both in bright daylight and dim or indoor lighting.
- Greater overall lifestyle flexibility – Mix-and-match IOL strategies aim to provide the most practical balance for work, reading, driving, and recreational activities.
Instead of being limited by the strengths and weaknesses of a single lens type, mixing IOLs creates a synergy between both eyes, giving a more natural, functional visual experience tailored to your daily life.
How Your Brain Blends Vision From Two Different Lenses
One of the most fascinating aspects of a mix-and-match IOL approach is how your brain adapts to different lenses in each eye. Even when each eye has a different optical design, your brain can select and prioritise the clearest image from each eye depending on the task, creating a seamless visual experience.
For example:
The eye with a monofocal lens gives crisp distance vision – This eye handles far-away tasks like driving, watching TV, or seeing street signs clearly and consistently.
The eye with a multifocal or EDOF lens supports reading or intermediate tasks – This eye helps with close-up activities, such as reading, using a computer, or cooking, providing the necessary focus for near and intermediate distances.
The brain blends both images to create a smooth overall visual experience – Rather than seeing a double image or noticing a difference between eyes, your brain gradually integrates the input, giving the impression of a continuous, natural visual range.
This process is called neuroadaptation. It occurs naturally and gradually, usually over several weeks to a few months, as your brain learns to rely on each eye for the tasks it handles best.
The goal isn’t for each eye to do everything perfectly on its own it’s for both eyes to cooperate, giving you the broadest possible functional vision for daily life.
Understanding the Lens Types You Can Mix
Before diving into combinations, it helps to understand what each lens design offers.
Monofocal IOLs – Monofocal intraocular lenses provide sharp distance vision with the highest contrast sensitivity and minimal halos or glare. However, they require glasses for reading and other near tasks. These lenses are valued for their simplicity, predictability, and reliable visual clarity, making them a popular choice for patients prioritising distance vision.
EDOF (Extended Depth of Focus) IOLs – EDOF lenses provide excellent distance vision along with strong intermediate vision, making tasks like computer or tablet use easier. They also offer some functional near vision, though not as strong as multifocal lenses, and produce fewer halos and glare. These lenses are designed to give a long, smooth range of focus, balancing clarity across multiple distances while minimising common side effects of multifocal lenses.
Multifocal IOLs – Multifocal intraocular lenses provide clear distance vision along with strong near and reading vision and good intermediate performance. However, they may cause halos or glare, particularly in low-light or nighttime conditions. These lenses are designed to offer the greatest potential for glasses-free vision, allowing patients to perform a wide range of tasks without needing corrective eyewear.
Trifocal IOLs – Trifocal intraocular lenses are designed to provide clear vision at distance, intermediate, and near ranges, offering an excellent visual experience across varied daily tasks. They require a higher level of neuroadaptation, as the brain adjusts to multiple focal points. Trifocals represent an advanced form of multifocal technology, giving patients more comprehensive glasses-free vision.
Common Mix-and-Match Combinations
Surgeons tailor combinations to your lifestyle and your visual priorities.
1. Monofocal + Multifocal: This combination is one of the most popular choices for intraocular lens setups. Patients benefit from crisp distance vision in the monofocal eye and strong near vision in the multifocal eye, creating a balanced visual experience. Halos are often reduced since only one eye uses a multifocal lens. This approach is ideal for those who want reading freedom while maintaining clarity and comfort during night driving.
2. EDOF + Multifocal: Combining an EDOF lens with a multifocal lens provides a wide-ranging focus across distance, intermediate, and near tasks. The EDOF eye delivers smooth intermediate vision, ideal for screens and everyday tasks, while the multifocal eye provides good near vision. Distance clarity remains excellent, and there are fewer optical disturbances compared to having multifocals in both eyes. This setup is perfect for those seeking a balanced compromise between visual clarity and reduced reliance on glasses.
3. Monofocal (Distance) + Monofocal (Near): This approach is known as monovision, where one eye is corrected for distance and the other for near vision.
– Pros: It is predictable, carries a low risk of halos, provides excellent distance clarity, and offers functional near vision.
– Cons: Some patients may find adapting to monovision challenging, and depth perception can be slightly reduced initially.
Monovision is a good option for those who prefer to avoid multifocal lenses entirely while still achieving a range of vision.
4. EDOF in Both Eyes With a Multifocal “Boost”: In this approach, surgeons may place an EDOF lens in one eye and a multifocal lens in the other to optimise vision across distances.
– Benefits: The EDOF eye provides good night vision, while the multifocal eye offers strong reading ability, resulting in an excellent overall range of vision.
This combination is considered a premium mix-and-match option, ideal for patients seeking the best balance of clarity, range, and reduced optical disturbances.
5. Trifocal + Monofocal: Less common but helpful for selected patients wanting crisp distance clarity while still gaining some near support from the trifocal eye.
Who Benefits Most From Mix-and-Match IOLs
Mix-and-match IOLs work best for people whose eyes have different visual priorities. They are ideal if your lifestyle demands a wide range of vision, you want to minimise reliance on glasses, and you are comfortable allowing your brain some time to adapt.
This approach suits those who prefer one eye optimised for distance while valuing intermediate or near vision in the other. Many become excellent candidates simply because their eyes naturally differ for example, a dominant distance eye and a non-dominant eye better suited for reading or intermediate tasks.
When Surgeons Recommend Caution
Mix-and-match IOLs are not suitable for everyone, so a personalised assessment is crucial. Surgeons may advise caution if you are sensitive to glare or halos, require perfect night vision for your profession, have irregular astigmatism, suffer from ocular surface disease, or have significant retinal problems.
This approach may also be unsuitable if you struggle to adapt to visual changes or prefer identical vision in both eyes. Using mismatched lenses without proper evaluation can result in visual imbalance or discomfort.
How Neuroadaptation Works With Mixed Lenses
Neuroadaptation is the brain’s natural ability to ignore blur, select the sharper image, merge input from both eyes, and build new neural pathways. With mix-and-match IOLs, this process is essential for achieving clear, comfortable vision at all distances.
Neuroadaptation helps you see clearly at near and far, reduce awareness of halos, and switch effortlessly between tasks. Most patients adapt within three to six months, so patience and flexibility greatly increase the likelihood of a successful outcome with mixed lenses.
Real-Life Examples of Mix-and-Match Success
Many patients achieve excellent outcomes by combining different IOL types, enjoying both clear distance vision and comfortable near reading without relying on glasses.
Example 1: Desk-Based Professional
The patient had an EDOF lens in the dominant eye and a multifocal lens in the non-dominant eye. The result was crisp distance vision, smooth intermediate focus for screens, and comfortable reading.
Example 2: Frequent Night Driver
The patient received a monofocal lens in the dominant eye and a multifocal lens in the other eye, resulting in excellent night vision while still maintaining functional reading ability.
Example 3: Avid Reader
This patient had multifocal lenses in both eyes, achieving strong near and distance vision without needing any supplementary EDOF support.
Example 4: Sports Enthusiast
The patient opted for monovision, with the distance-dominant eye preserving crisp depth perception. This highlights how lens combinations are tailored to lifestyle, rather than following a one-size-fits-all approach.
Advantages of Mixing IOL Types
Mix-and-match IOLs allow for a personalised vision profile with a wider range of focus, letting you see clearly at both near and distance. Depending on the lens combination, they can also improve night-time performance and reduce your reliance on spectacles.
This approach offers flexibility for different tasks, making it particularly effective for people who do detailed near work as well as active outdoor activities, providing a balance between comfort and visual freedom.
Disadvantages You Should Be Aware Of
While mix-and-match IOLs can deliver excellent results, they are not without potential downsides. Some patients experience longer neuroadaptation, a slight initial imbalance, or occasional differences in clarity between eyes.
There may also be a mild reduction in contrast sensitivity, and the approach can be more complex if touch-ups are needed. A skilled surgeon carefully weighs these factors against the benefits to ensure the best possible outcome.
How Surgeons Decide Which Lens Goes in Which Eye
When considering a mix-and-match IOL approach, surgeons carefully evaluate several factors to determine which lens type is best for each eye. The goal is to optimise your vision for distance, intermediate, and near tasks while ensuring comfort and ease of adaptation.
Surgeons look at:
- Eye dominance – Your dominant eye the one your brain naturally relies on more usually receives the lens optimised for distance. This helps maintain sharp clarity for driving, sports, and other distance activities.
- Your lifestyle needs – Daily activities like reading, computer work, driving at night, or hobbies influence which eye may benefit from near or intermediate correction.
- Lighting environments – Some lenses perform better in low-light conditions. Your surgeon considers where you spend most of your time to minimise halos, glare, or contrast loss.
- Occupational demands – If your job requires extended screen use, fine detail work, or night driving, this will affect the lens choice for each eye.
- Amount of astigmatism – Eyes with significant astigmatism may require toric lenses, which can influence which eye is prioritised for distance or near vision.
- Eye shape and health – Corneal thickness, macular health, and other anatomical factors help guide lens selection and placement.
- Your personality type (important for neuroadaptation!) – Some people adapt quickly to differences between eyes, while others may need more time. Understanding your adaptability helps ensure you’re comfortable with mix-and-match vision.
Practical approach:
- The dominant eye usually receives the lens optimised for distance.
- The non-dominant eye is generally corrected for near or intermediate tasks, supporting reading, screens, or close work.
This strategic planning allows your brain and eyes to work together naturally, maximising visual performance across all ranges while maintaining comfort and reducing reliance on glasses.
FAQs:
1. Can I choose different lens types for each eye?
Yes, it is possible to choose different intraocular lenses (IOLs) for each eye, a practice often called “mix-and-match.” This approach allows each eye to be optimised for specific visual tasks. For example, one eye can be corrected for crisp distance vision while the other focuses on near or intermediate tasks. Surgeons use careful assessments of eye dominance, lifestyle, and ocular health to decide which lens goes in which eye. The goal is to create a seamless visual experience across multiple distances.
2. How does the brain adapt to different lenses?
The brain has a remarkable ability to blend images from both eyes even when the lenses differ. This process, called neuroadaptation, allows you to see clearly at multiple distances without noticing the differences between eyes. The dominant eye typically handles distance tasks while the non-dominant eye supports reading or screen use. Over several weeks to a few months, the brain gradually learns to prioritise the sharpest image from each eye, providing a natural and continuous visual experience.
3. What combinations of IOLs are most common?
Common combinations include pairing a monofocal lens with a multifocal lens, an EDOF lens with a multifocal lens, or using monovision with a distance-focused monofocal lens in one eye and a near-focused monofocal in the other. Each combination is chosen based on the patient’s lifestyle, visual priorities, and tolerance for phenomena such as halos or glare. Surgeons tailor the setup to provide the broadest practical range of vision while maintaining comfort and functional performance.
4. Who benefits most from mixing IOL types?
Patients whose daily activities demand a range of vision distances tend to benefit the most. This includes people who read frequently, use computers, drive at night, or engage in both near and distance hobbies. Individuals with a natural difference in eye dominance, where one eye is better suited for distance tasks and the other for near work, are particularly well-suited for mix-and-match strategies. The approach provides flexibility, reducing the reliance on glasses while accommodating lifestyle needs.
5. Are there situations where mixing lenses is not recommended?
Mix-and-match IOLs are not suitable for everyone. Surgeons may advise caution if a patient is highly sensitive to glare or halos, requires perfect night vision for professional purposes, has irregular astigmatism, suffers from significant ocular surface disease, or has retinal issues. Patients who prefer identical vision in both eyes or have difficulty adapting to visual changes may also find mixed lenses uncomfortable. A personalised assessment is essential to determine suitability.
6. How long does it take to adapt to different lenses?
Most patients adapt within three to six months. During this period, neuroadaptation helps the brain merge the images from both eyes smoothly. Some people notice improvement more quickly, while others may require a longer adjustment period. Patience is crucial, as early differences in clarity or minor visual disturbances usually settle as the brain learns to optimise the contribution of each eye.
7. Will mixing lenses affect night vision or contrast sensitivity?
Mixing IOLs can influence visual phenomena such as halos, glare, and contrast sensitivity, depending on the lens types used. For instance, multifocal lenses are more prone to causing halos, particularly in dim lighting, while EDOF and monofocal lenses generally produce fewer optical disturbances. Surgeons consider these factors when planning lens combinations to minimise night-time issues and preserve natural contrast perception across different lighting environments.
8. Can mix-and-match IOLs eliminate the need for glasses entirely?
Mix-and-match strategies aim to reduce dependence on glasses, but complete spectacle independence is not guaranteed. Many patients achieve functional vision for most daily activities without corrective lenses, particularly when a multifocal or EDOF lens is used in one eye. However, reading very small print, performing detailed near work, or prolonged screen tasks may still occasionally require glasses, depending on individual visual demands and the lens combination chosen.
9. What role does eye dominance play in lens selection?
Eye dominance is a key factor in determining which lens goes into each eye. The dominant eye usually receives the lens optimised for distance, as it provides the primary visual input for tasks such as driving, sports, or viewing distant objects. The non-dominant eye is generally corrected for near or intermediate tasks to support reading, screen use, or close work. This strategic placement ensures a natural balance and helps the brain integrate vision efficiently.
10. How do surgeons personalise mix-and-match IOL plans?
Surgeons consider multiple factors, including eye shape, corneal health, astigmatism, lifestyle requirements, occupational demands, lighting conditions, and the patient’s ability to adapt to visual changes. The lens combination is customised to optimise visual performance across distances while minimising side effects. This careful planning ensures that both eyes work together harmoniously, giving a wide functional range of vision that matches the patient’s daily activities and personal preferences.
Final Thoughts: Considering Mix-and-Match IOLs?
Mixing IOL types between eyes can offer a personalised visual experience, improving distance, intermediate, and near vision while potentially reducing reliance on glasses. This approach works best for patients whose lifestyle demands a broad range of focus and who are willing to allow their brain time to adapt through neuroadaptation.
If you’re looking for multifocal lenses in London, you can reach out to us at the London Cataract Centre to schedule a consultation with one of our expert specialists.
References:
1. Nemet, A., Kanclerz, P. & Tuuminen, R., 2023. Should Multifocal Intraocular Lenses Become a Standard in Phacoemulsification Cataract Surgery? Journal of Clinical Medicine, 12(5), 1983. https://www.mdpi.com/2077-0383/12/5/1983
2. Naujokaitis, T., et al., 2025. The mix‑and‑match approach and binocular IOL systems: a review. Journal of Clinical Medicine, 14(12), 4263. https://www.mdpi.com/2077-0383/14/12/4263
3. Lacmanović‑Lončar, V., Pavičić‑Astaloš, J., Petrić‑Vicković, I. & Mandić, Z., 2008. Multifocal intraocular “mix and match” lenses. Acta Clinica Croatica, 47, 217–220. https://pubmed.ncbi.nlm.nih.gov/19388468/
4. Lee, J.H., Chung, H.S., Moon, S.Y., Park, S.Y., Lee, H. & Kim, J.Y., 2021. Clinical outcomes after mix‑and‑match implantation of extended depth of focus and diffractive multifocal intraocular lenses. https://pubmed.ncbi.nlm.nih.gov/34394981/ 5. Zhou, I.S. et al., 2025. Clinical and patient‑reported outcomes after mix‑and‑match implantation of a trifocal and extended‑depth‑of‑focus IOL. https://pmc.ncbi.nlm.nih.gov/articles/PMC12345935/