So, you’re trying to decide between multifocal and trifocal intraocular lenses (IOLs)? You’re not alone. As cataract surgery becomes increasingly advanced and patient expectations rise, choosing the right IOL is no longer just a clinical decision—it’s a lifestyle one. Whether you’re looking to ditch the glasses or maximise clarity across all distances, understanding the differences between these lenses is key. In this article, we’re going to unpack the science, weigh the practical pros and cons, and talk about what real-world vision looks like with multifocal versus trifocal IOLs.
A Quick Primer: What Are Multifocal and Trifocal IOLs?
Let’s start with the basics. After cataract surgery, the cloudy natural lens is removed and replaced with an artificial one. That lens—your new IOL—determines not just how well you see, but how freely you live. Multifocal IOLs were one of the first innovations to let people see at more than one distance. They use concentric rings with different focal points to split incoming light so you can see both near and far.
Trifocal IOLs took that concept a step further. Instead of two focal distances (near and far), they add a third—intermediate. That means they’re designed to improve your ability to do things like read your phone (near), work on a computer (intermediate), and drive (distance) without constantly swapping between glasses.
Both types have trade-offs. Multifocal lenses tend to offer stronger near vision but may leave a bit of a gap in intermediate tasks. Trifocal lenses attempt to smooth that out—but nothing’s ever perfect, right?
Functional Vision: What Does It Actually Mean?
Before we dive into the differences, let’s define “functional vision.” We’re not talking about perfect vision on a Snellen chart. We’re talking about how well you function in your daily life. Can you comfortably drive at night? Read a menu in a dim restaurant? Use your tablet without squinting or adjusting the screen? Functional vision is about clarity, comfort, and consistency.
The goal of any IOL isn’t just to restore sight—it’s to enhance your ability to engage with the world. So when we talk about which lens is “better,” we’re talking about which lens helps you live better.
Near Vision: Reading and Detail Work
Let’s start with up-close vision. Multifocal IOLs tend to have strong performance when it comes to reading books, newspapers, or doing things like knitting. This is because many of them are specifically designed to give a high level of clarity at very close distances.
Trifocal IOLs, on the other hand, slightly reduce the emphasis on near vision in favour of spreading it across three distances. While you can still read well with a trifocal, the ultra-crisp clarity you might get from a near-dominant multifocal could be slightly diminished—especially in low light.
That said, it depends on your needs. If you’re someone who spends a lot of time doing fine detail work—think sewing, model building, or close-up crafting—you might prefer the sharper near vision that multifocals offer. But if you’re more of an all-rounder, trifocals give you a bit more versatility.
Intermediate Vision: The Trifocal Advantage
Here’s where trifocals really shine. Intermediate vision is often overlooked—until you realise how much of your life relies on it. Using a computer, looking at a dashboard while driving, cooking, even having face-to-face conversations—all of these depend on intermediate vision.
Multifocal IOLs often fall a bit short in this zone. There’s a bit of a “dead zone” between the near and far focal points, which can lead to blurry or strained intermediate sight. Trifocals eliminate this by adding a third focal point that targets intermediate vision directly.
So if you’re someone who spends hours at a computer or does a lot of work at arm’s length, the trifocal might offer a smoother and more natural visual experience.
Distance Vision: Who Comes Out on Top?
For driving, watching TV, or taking in panoramic views, distance vision matters. Both multifocal and trifocal IOLs do a good job here, but traditional monofocal lenses still reign supreme for pure distance clarity.
That said, modern multifocal and trifocal designs have come a long way. Many trifocals in particular—such as the AcrySof IQ PanOptix—are engineered to maintain strong distance performance without sacrificing intermediate or near clarity.
Real-world studies have shown comparable satisfaction with distance vision between the two lens types, though trifocals may have a slight edge in environments where lighting varies—like driving during dusk or dawn.
Night Vision, Halos and Glare: The Downsides You Should Know About
Now for the elephant in the room: side effects. Both multifocal and trifocal IOLs can cause halos around lights, glare, or reduced contrast sensitivity—especially at night. It’s a consequence of how these lenses split light to serve multiple distances.
Some users report that multifocals are more prone to noticeable halos, especially with older designs. Trifocals, while not halo-free, often receive slightly better ratings for night-time performance in recent clinical trials. However, this can vary widely based on the specific brand, your eye’s anatomy, and your brain’s adaptability.
For most people, these effects lessen over time as your brain learns to adapt. But it’s something you need to be aware of. If you drive a lot at night or have a job that requires sharp contrast sensitivity—say you’re a pilot or a night-shift nurse—you may want to discuss these concerns in detail with your surgeon.
Patient Satisfaction: What the Surveys Say
So, what do actual patients think? Surveys and real-world outcome studies often show high satisfaction rates for both multifocal and trifocal lenses, but trifocals usually edge ahead in overall quality-of-life scores.
In particular, trifocal users report fewer instances of needing glasses for intermediate tasks. Multifocal users often say they still need a pair of readers or intermediate specs occasionally—particularly in dim lighting or when using screens.
Interestingly, the more active and digitally engaged the patient, the higher the satisfaction tends to be with trifocals. On the flip side, some patients who focus primarily on reading and simple daily routines might lean towards multifocals and find them perfectly adequate.
The Latest Research: What Do Studies Show?
Let’s look at some evidence. In a multicentre trial comparing PanOptix trifocals to ReSTOR multifocals, trifocal users reported significantly better intermediate vision without sacrificing distance or near clarity. Contrast sensitivity was marginally better as well, though night-time halos were reported in both groups.
Another study published in Ophthalmology found that trifocal lenses led to greater spectacle independence overall. Around 85% of trifocal users reported never needing glasses, compared to about 70% in the multifocal group.
It’s worth noting that these studies often include variables like lens brand, surgical technique, and patient eye health—so results can differ. Still, the general consensus in peer-reviewed research is leaning in favour of trifocal IOLs for broader functional outcomes.
Who Should Consider Multifocal IOLs?
Multifocal IOLs may be ideal for:
- Patients who read a lot or do close-up work
- People with less concern about intermediate vision (e.g. non-computer users)
- Those looking for a slightly more budget-friendly option
- Patients sensitive to night-time glare or halos (depending on the model)
They’re often a good choice for individuals who are used to wearing reading glasses and simply want to improve that close-up experience without needing constant corrections.
Who Should Consider Trifocal IOLs?
Trifocal IOLs might be better suited for:
- People who want glasses-free living across all distances
- Professionals who use screens or tablets regularly
- Patients looking for a balanced vision profile
- Those willing to adapt to the visual quirks in exchange for greater freedom
If you’re the type who wants to move seamlessly from reading to texting to driving—all without switching specs—trifocals deliver a lot of functional convenience.
Other Considerations: Cost, Availability, and Surgeon Experience
Lens cost can be a deciding factor for many. Trifocals, being newer and more advanced, are often more expensive. Not all clinics offer them, and not all surgeons are equally experienced in implanting them. Some multifocal IOLs are more widely available and might come at a lower out-of-pocket cost.
Your surgeon’s familiarity with a particular lens type matters too. A highly experienced surgeon using a premium multifocal might deliver better results than a less experienced one using a trifocal.
Always ask your clinic about the brands they offer, what outcomes they’ve seen, and whether a custom solution (like mixing lens types between eyes) might work best for you.
Frequently Asked Questions
- What’s the main difference between multifocal and trifocal IOLs?
The core difference lies in how many distances each lens is designed to correct. Multifocal IOLs typically provide two focal points—usually near and distance. Trifocal IOLs go a step further by adding a third focal point specifically for intermediate vision, like looking at a computer or dashboard. This extra range can make trifocals feel more “natural” in everyday life, especially for people who multitask across various distances. - Will I still need glasses after getting multifocal or trifocal IOLs?
You might not need glasses for most daily activities, but there’s no absolute guarantee. With trifocal lenses, a higher percentage of people achieve complete spectacle independence, especially for intermediate tasks like using a computer or cooking. Multifocal lenses may leave a small gap in intermediate vision, meaning you could still reach for reading glasses or screen specs in some situations. It all depends on your visual demands and how well your eyes adapt. - Are trifocal IOLs better for people who use screens often?
Yes, trifocal IOLs tend to be better suited for screen use. That’s because they include a dedicated intermediate focal point, which covers the typical distance between your eyes and a laptop or tablet. If your day involves frequent transitions between screen work, reading, and distance viewing, trifocals usually offer smoother, more seamless vision across the board. - Do these lenses affect night driving?
They can, especially in the early weeks after surgery. Both multifocal and trifocal lenses may cause halos around lights or glare when driving at night. However, these effects often fade as your brain adapts. Some people continue to notice these visual disturbances long-term, so it’s important to raise any concerns with your surgeon—especially if you rely on night driving regularly. - Is one type of lens more expensive than the other
Generally speaking, trifocal IOLs are more expensive than multifocal ones. This is due to the added complexity of their design and the enhanced vision range they provide. Not all healthcare systems cover premium IOLs, so you may need to pay out of pocket. Always ask your clinic for a breakdown of costs and whether payment plans or private options are available. - How do I know which lens is right for me?
It comes down to your lifestyle, your visual goals, and the health of your eyes. If you value crisp reading vision and don’t mind wearing glasses for other tasks, a multifocal might suit you. If you’re aiming for all-round freedom from glasses—especially for work involving screens or dynamic tasks—a trifocal could be the better fit. A good surgeon will walk you through your options and help match the lens to your personal needs. - Are there any risks unique to trifocal IOLs?
Not particularly unique, but trifocal IOLs do carry similar risks to other premium lenses, including the potential for visual disturbances like glare, halos, or reduced contrast sensitivity. Because they split light into three focal points instead of two, some people may experience slightly longer adaptation periods. That said, recent trifocal designs are becoming increasingly refined, and patient satisfaction continues to improve.
Final Thoughts: It’s About You, Not Just the Lens
So—multifocal vs trifocal IOLs? There’s no one-size-fits-all answer. Both offer impressive benefits, and both have limitations. The real question is: what do you need from your vision? What does your day-to-day look like, and where do you want to minimise the reliance on glasses?
Trifocals tend to offer better all-around functional vision, especially in modern lifestyles dominated by screens and multitasking. But multifocals are still a great option, particularly if near vision is your top priority.
Whichever route you choose, make sure it’s one that reflects your life—not just your eyesight. And if you are considering cataract surgery and would like to consult with an expert cataract surgeon, you can get in touch with us here at the London Cataract Centre.
References
- Cochener, B., Vryghem, J.C., Rozot, P., Lesieur, G., Heireman, S., Labelle, M. and Tassignon, M.J., 2016. Clinical outcomes with a trifocal intraocular lens: a prospective study in European sites. Journal of Cataract & Refractive Surgery, 42(4), pp.533–539. Available at: https://www.sciencedirect.com/science/article/abs/pii/S0886335016000286
- Ruiz-Mesa, R., Abengózar-Vela, A. and Ruiz-Santos, M., 2017. Comparative analysis of visual outcomes and patient satisfaction with bifocal and trifocal intraocular lenses. European Journal of Ophthalmology, 27(4), pp.460–465. Available at: https://journals.sagepub.com/doi/abs/10.5301/ejo.5000932
- Kohnen, T., Titke, C. and Böhm, M., 2016. Trifocal intraocular lenses: a new trend in refractive surgery. Der Ophthalmologe, 113(3), pp.189–195.
- Akman, A., Asena, L. and Gülkilik, G., 2014. Comparison of visual performance with bifocal and trifocal intraocular lenses. International Journal of Ophthalmology, 7(6), pp.1020–1024. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257091/
- Mojzis, P., Peña-García, P., Liehneova, K., Klár, M. and Nekolova, J., 2014. Outcomes of a new diffractive trifocal intraocular lens. Journal of Cataract & Refractive Surgery, 40(1), pp.60–69.