Spawns two items instead of one in each Treasure Room. Only one item can be chosen; the other disappears.
Two items won't be generated in small Treasure Rooms.
If the Treasure Room has already been entered and the item was not taken, then picking up More Options later on the same floor will not retroactively add a second item to the room.
The very rare Treasure Rooms that have either no item or two items that can both be picked up will be replaced with a one-out-of-two choice room, like other treasure rooms. In the latter case, this is a downgrade.
More Options will work for item rooms during the Ascent as long as those rooms were never originally entered.
Crooked Penny / Diplopia: Both items are copied, allowing Isaac to take both copied items without the other disappearing. The original pedestal items will function as normal, disappearing the other if one is collected.
Devil's Crown: Both items can be taken, although they must be paid for with hearts.
Jacob and Esau: Both characters can take one item each if they are lined up properly.
Prior to Repentance, this item's description was "There are even more options!"
There's Options' description is "More options". For this item, it's the other way around.