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A Cochrane review of randomized trials comparing multifocal and monofocal intraocular lenses found that multifocal IOLs improve unaided near vision and increase the likelihood of spectacle independence. Distance visual acuity was broadly similar between lens strategies. The trade-off was a higher frequency of optical phenomena, particularly glare and halos, with the certainty of evidence varying across outcomes. The review is highly relevant to contemporary presbyopia-correcting cataract practice because the decision is not simply about maximizing an acuity number. Patient selection, expectations, ocular surface status, macular health, contrast sensitivity, and tolerance for night-vision phenomena all influence satisfaction. For surgeons, the evidence supports individualized lens counseling rather than a one-size-fits-all approach. A patient who values spectacle independence may accept a higher risk of glare or halos, while a patient with demanding night-driving requirements may prefer a different optical strategy. The review also illustrates why patient-reported outcomes should sit alongside visual acuity when evaluating premium IOLs. In clinic, discussing benefits and trade-offs before surgery can be as important as the choice of IOL platform itself.
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A Cochrane review of randomized trials comparing multifocal and monofocal intraocular lenses found that multifocal IOLs improve unaided near vision and increase the likelihood of spectacle independence. Distance visual acuity was broadly similar between lens strategies. The trade-off was a higher frequency of optical phenomena, particularly glare and halos, with the certainty of evidence varying across outcomes. The review is highly relevant to contemporary presbyopia-correcting cataract practice because the decision is not simply about maximizing an acuity number. Patient selection, expectations, ocular surface status, macular health, contrast sensitivity, and tolerance for night-vision phenomena all influence satisfaction. For surgeons, the evidence supports individualized lens counseling rather than a one-size-fits-all approach. A patient who values spectacle independence may accept a higher risk of glare or halos, while a patient with demanding night-driving requirements may prefer a different optical strategy. The review also illustrates why patient-reported outcomes should sit alongside visual acuity when evaluating premium IOLs. In clinic, discussing benefits and trade-offs before surgery can be as important as the choice of IOL platform itself.
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