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Multifocal IOL Implants: Are They the Right Lenses for You?

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Cataract surgery involves replacing the eye’s cloudy lens with a synthetic intraocular lens (IOL) to restore clear vision. One of the choices available to patients is a multifocal IOL, designed to offer different levels of vision correction, allowing clear vision at various distances.

What Is a Multifocal Lens?

A multifocal lens is an artificial intraocular lens (IOL) designed to provide focus for both near and distance vision. Unlike standard monofocal lenses, which only correct for a single type of vision, multifocal lenses have multiple focal points, allowing patients to see clearly at multiple distances without glasses or contact lenses. They are typically used in cataract surgery to restore the refractive properties of the lens after its removal.

How Does a Multifocal IOL Work?

Multifocal IOLs use different optical powers across the lens. Manufacturers etch concentric rings on the surface of the lens. These rings are designed to focus light from different distances onto the retina. Eye muscles pull on the lens when you need to focus, allowing you to see both near and distant objects more clearly.

Monofocal vs Multifocal IOL

The choice between a basic monofocal or multifocal IOLs depends on your visual needs, lifestyle, and willingness to accept potential visual trade-offs. Here’s a list of what each lens can do for you and the most relevant facts about them:

Monofocal IOLs:

  • Provide clear vision at a single distance, usually for distance vision
  • Patients will likely need glasses for near or intermediate vision
  • Considered the standard or traditional IOL option for cataract surgery
  • Generally less expensive than multifocal IOLs, often covered by insurance

Multifocal IOLs:

  • Provide clear vision at multiple distances – near, intermediate, and far
  • Aim to reduce or eliminate the need for glasses after cataract surgery
  • More expensive than monofocal IOLs, often not fully covered by insurance
  • May have a higher risk of visual side effects like glare, halos, and reduced contrast sensitivity compared to monofocal IOLs, although the risk is very low.
  • Newer multifocal lens designs have improved on these visual side effects compared to older models.

Accommodating vs Multifocal IOL

Accommodating IOLs are a different type of IOL designed to restore the eye’s natural ability to focus on objects at varying distances. Unlike multifocal IOLs, accommodating IOLs are designed to move within the eye to change focus distances, mimicking the natural accommodation process of the eye. These lenses are an effective treatment for presbyopia, significantly reducing the need for reading glasses.

If you are interested in having a fuller range of vision without having to use glasses after surgery, both multifocal and accommodating lenses could be a viable option. You should discuss your case with your surgeon, who may recommend one or the other depending on your visual and lifestyle needs. 

Types of Multifocal IOLs

eye with cataracts

While all multifocal IOLs can help people to see objects clearly after cataract surgery, multiple types are available. Variety ensures that you can work with your doctor to find the lenses that are right for you. 


Three general types of multifocal IOLs exist. They use different techniques to split light into different focal points, allowing the eye to see both near and far objects clearly. 

Types of Multifocal IOLsFeaturesProsCons
RefractiveCorrective zones for far and intermediate visionGood far and intermediate visionClose vision may not be optimized
DiffractiveVision zones in concentric circlesGood far and near visionIntermediate objects could be harder to see
Combined
Combines features of refractive and diffractive lenses
Crisp vision near and farPotential disadvantages depend on individual eye health, occupation, lifestyle

Multifocal IOL Options

The following multifocal IOL implants  are widely used and known to provide outstanding vision results:

  • TECNIS Multifocal: This is a fully diffractive IOL with advanced image quality across all distances under all lighting conditions and for all pupil sizes.
  • AcrySof IQ ReSTOR: This brand has a patented apodized diffractive feature to distribute light based on the ambient lighting in a room. It optimizes your image quality in diverse lighting.
  • ReZoom: The multifocal lenses from this brand have five optical zones etched microscopically into the surface, improving near, distant, and intermediate vision.

The best lens depends on several factors, such as the person’s overall eye health, occupation, and lifestyle. The eye doctor will perform an extensive interview and assessment to recommend the best choice.

Pros & Cons: Are Multifocal IOLs Worth It?

ProsCons
Improved intermediate, far, and near distancesClose distance vision might be an issue
Most people no longer need corrective lensesDifficulty reading in dim light
Long-lasting results with no upkeepPossible halo and glare issues

Multifocal IOL Advantages

  • Multifocal IOLs all work to improve intermediate, far, and near distances.
  • In many cases, after having the lenses implanted, people no longer need to wear corrective lenses to see clearly.
  • The results are usually long-lasting, and there is no upkeep since the lenses are embedded in the eye.

Researchers say close to 96 percent of people with multifocal IOLs achieve vision scores of 20/40 or better, and more than 51 percent get vision scores of 20/20. People like this may not need to wear glasses again. 

Multifocal IOL Disadvantages

There are a few disadvantages to consider before getting a Multifocal IOL. 

  • Seeing at close distances is sometimes an issue for people with multifocal IOLs. However, reading glasses usually correct this problem.
  • People who get these lenses as part of cataract surgery may find it hard to read in dim light.
  • While rare, some people develop halos and glare surrounding lights after dark, which can interfere with safe driving at night. Newer versions are more effective and less likely to cause this problem.

Possible Complications After Surgery

Multifocal intraocular lenses are a good choice for many people. However, it is important to explore the details before agreeing to the procedure.

Possible complications of any cataract surgery include the following:

  • Infections
  • Bleeding
  • Swelling 
  • Detached retina 
  • Pain 
  • Blurry vision
  • Halos, glare, or shadows 
  • Vision loss 

Overall, cataract surgery is very safe.The success rate is around 98%. Complications are rare, and when they do occur, they are usually manageable with proper postoperative care and monitoring by a skilled ophthalmologist.

An eye doctor can answer all your questions. This way, once you agree to the surgery, you can be sure that you have made an informed choice.

References

  1. Quick Facts. (December 2021). The Vision Council.
  2. Multifocal Intraocular Lenses: Types, Outcomes, Complications, and How to Solve Them. (October 2017). Taiwan Journal of Ophthalmology.
  3. Efficacy and Safety of Multifocal Intraocular Lenses Following Cataract and Refractive Lens Exchange: Meta-Analysis of Peer-Reviewed Publications. (February 2016). Journal of Cataract and Refractive Surgery.
  4. Effectiveness of Multifocal and Monofocal Intraocular Lenses for Cataract Surgery and Lens Replacement: A Systematic Review and Meta-Analysis. (January 2019). Graefe’s Archive for Clinical and Experimental Ophthalmology.
  5. Cataract Surgery: Risks, Recovery, Costs. (July 2022). American Academy of Ophthalmology.
  6. What Is the Success Rate for Cataract Surgery? (February 2014). American Academy of Ophthalmology.

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