Multifocal IOLs: Pros, Cons, Outcomes & More

If you are having cataract removal surgery, you may be offered the option of a multifocal intraocular lens.

This lens will allow you to see at different ranges of vision. A multifocal lens may potentially remove the need for glasses or contact lenses once your surgery is over.

What Are Multifocal IOLs & Why Are They Used?

Multifocal IOLs are a type of artificial lens that replaces the natural lens during cataract surgery. 

As you age, or due to a disease or some sort of eye damage, you may develop a cataract, which leads to cloudy vision. A majority of older Americans currently have a cataract or have had one removed already. 

A cataract can cause minor vision issues at first, meaning you may be able to simply wear glasses and see properly, but it will grow over time to the point where a majority of your lens is clouded. In these cases, surgery must be performed to remove the cataract.

Unfortunately, a cataract cannot be isolated from the lens it is found in, meaning the entire lens in the afflicted eye must be removed. This natural lens is removed due to the presence of the cataract, and it is replaced with an intraocular lens (IOL).

Some types of intraocular lenses, known as monofocal IOLs, only allow a patient to focus on objects at a specific, predetermined range. This can lead to patients needing to resort to glasses or contact lenses when trying to focus on objects outside of the range allowed by their IOL.

Multifocal IOLs, on the other hand, are meant to allow a patient to focus at multiple different ranges. This may enable a patient to focus on objects close by or at a distance without needing to use glasses or contact lenses.

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Types of Multifocal IOLs

There are two main types of multifocal IOLs: refractive and diffractive. The primary difference between the two types of lenses is the way they handle light entering the eye.

Refractive multifocal IOLs generally allow patients to focus well on objects at both long and medium distances. However, patients with a refractive multifocal IOL may have trouble focusing perfectly at shorter distances.

Patients with refractive multifocal IOLs may also experience glare or halos due to light sources. They may have reduced contrast sensitivity, which is what allows you to distinguish between what is in the foreground and what is in the background.

Patients with diffractive multifocal IOLs, on the other hand, are generally able to focus well at both long and short distances. However, these patients may instead have trouble when it comes to focusing at medium distances.

Diffractive multifocal IOLs may also affect contrast sensitivity more than refractive multifocal IOLs, meaning it may be more difficult to distinguish between foreground and background.

While both types of IOL can affect contrast sensitivity, most patients do not have a severe problem. They can generally differentiate foreground and background. Some forms of multifocal IOLs are specifically made to not reduce contrast sensitivity.

Who Is a Candidate for Multifocal IOLs?

Determining whether you are a candidate for multifocal IOLs is primarily dependent on the measurements your doctor takes before recommending an IOL to you.

If you have astigmatism, or a problem with the shape of your cornea, a doctor may be more likely to suggest a toric IOL, which is specifically designed to help with astigmatism. In some cases, a doctor may suggest a monofocal IOL depending on whether your eye may be prone to issues with a more complicated, multifocal IOL.

If you do not have astigmatism, and a doctor believes your eye is healthy and not prone to diseases, your doctor may suggest a multifocal IOL. Your doctor will inform you of potential risks with a multifocal IOL and help you determine if it is the right choice for your situation. 

Outcomes of Multifocal IOL Surgery

The outcome of cataract surgery and the placement of a multifocal IOL is generally positive. 

One study found that a majority of patients who received multifocal IOLs did not need to use glasses or contacts after their operation regardless of the distance on which they were attempting to focus.

Available Brands of Multifocal IOLs

The main difference between brands of multifocal IOLs is whether the lens itself is refractive or diffractive.

Some of the commonly used brands for refractive IOLs are Oculentis, which generally does not affect contrast sensitivity, and Rayner, which may decrease contrast sensitivity.

For diffractive IOLs, a wider variety of brands is available. Some of the more common ones include ZEISS, PhysIOL, Alcon Labs, Hanita, and AMO.

When your doctor examines your eye and takes measurements before cataract surgery, they will recommend and determine which brand of multifocal IOL is right for you.

Pros & Cons of Multifocal IOLs

When compared to monofocal IOLs, the primary advantage of multifocal IOLs is the possibility of not requiring glasses or contact lenses after surgery since you can see clearly at various distances. 

Multifocal IOLs are made with more complicated technology, meaning they may not be right for everyone, especially people with eye damage or who are prone to eye diseases.

In order to determine whether a multifocal IOL is right for you, speak with a medical professional.

Costs

There are many variables when it comes to the costs of cataract surgery and IOL placement. Generally, multifocal IOLs are considered premium lenses. Because of this, they will usually add an additional $500 to $1,000 to the cost of the surgery per eye.

Insurance generally covers the cost of cataract surgery and a basic IOL. You will usually have to cover the difference in price between a standard IOL and a premium lens.

Multifocal IOLs Surgery

While multifocal IOLs may be more complicated than other types of intraocular lenses, the surgery required to put them in place is relatively straightforward.

During cataract surgery, your doctor will cut into your eye to remove the lens clouded by a cataract. Once the lens is broken into pieces and removed, the multifocal IOL will be put in its place.

Surgery should be painless and relatively quick, lasting less than an hour. Following surgery, you will have to wait for a short while in a designated area. Your doctor will check up on your condition and healing process immediately after this period, as well as in multiple follow-up sessions after your surgery.

Potential Complications

While cataract surgery and the placement of an IOL is generally considered to be a very safe operation, there are some potential risks and side effects. These are some of the potential complications:

• Dry eyes
• Size of pupil remains small
• Not being able to focus at some distances
• Posterior capsule opacification, which is blurry vision that is caused by damage to the area behind the lens during cataract surgery
• IOL shifting away from its designated place, leading to discomfort and blurred vision

The vast majority of complications that could occur during cataract surgery or with intraocular lenses are easily fixable. While the exact fix varies depending on which complication or side effect you may be dealing with, many of these issues can be solved through simple surgical procedures.

Multifocal IOL FAQs

Are multifocal IOLs worth it? 

Many people don’t want to have to wear glasses or contact lenses after cataract surgery, and a multifocal IOL can make that possible. Since you’ll save money on glasses and contacts over the years, a multifocal IOL can be worth the additional upfront cost. The added convenience and lifestyle benefits of not having to carry corrective lenses can make multifocal IOLs very worth it.  

What is the cost of a multifocal IOL? 

On average, a multifocal IOL will add $500 to $1,000 per eye to the price tag of your cataract surgery. The exact cost of a multifocal IOL completely depends on your location, insurance coverage, and various other factors.

As a premium lens, a multifocal IOL may not be covered by your insurance. You’ll likely have to pay the difference between a standard lens and a multifocal IOL out of pocket. 

Are multifocal IOLs effective?

According to research, multifocal IOLs often result in patients being able to see clearly without the use of glasses or contact lenses. 

As with cataract surgery in general, placement of a multifocal IOL boasts high success rates and high levels of patient satisfaction following surgery. Speak with your doctor to determine which type of intraocular lenses is the best choice for your personal situation.

References

1. Multifocal Intraocular Lenses: Types, Outcomes, Complications and How to Solve Them. (October – December 2017). Taiwan Journal of Ophthalmology.

2. Cataracts. (August 2022). National Eye Institute.

3. Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020. (September 2020). Ophthalmology.

4. Candidacy for Multifocal IOLs. (October 2014). Cataract & Refractive Surgery Today.

5. Cataract Surgery. (September 2020). National Eye Institute.

6. Posterior Capsule Opacification. (January 2022). EyeWiki, American Academy of Ophthalmology.

7. Effect of Intraocular Lens Tilt and Decentration on Visual Acuity, Dysphotopsia and Wavefront Aberrations. (September 2020). Vision.

8. Optimizing Outcomes With Multifocal Intraocular Lenses. (December 2017). Indian Journal of Ophthalmology.