Short answer
Multifocal lenses usually reduce the need for reading glasses after cataract surgery, but they cause more halos and glare around lights than standard monofocal lenses. Distance vision is broadly similar with either type. Whether the trade-off is worthwhile depends mainly on how strongly someone wants to avoid glasses, how much they drive or work at night, and whether their eyes have other conditions that make multifocal lenses less suitable.
Key points
- Monofocal lenses focus at one distance; multifocal lenses split light between distances.
- Trials show better unaided near vision and less glasses use with multifocal lenses.
- Halos were more than three times as likely with multifocal lenses.
- NICE advises against offering multifocal lenses in NHS cataract surgery.
- Monovision is an alternative way to reduce reading-glasses use.
How multifocal and monofocal lenses differ
In cataract surgery, the cloudy natural lens is replaced with a clear artificial lens, called an intraocular lens (IOL)4. A monofocal lens, the most common type, has one focusing distance, usually set for distance, so reading glasses are often still needed3.
A multifocal lens has zones of different power, providing distance and near focus at the same time. Related “presbyopia-correcting” designs include extended depth-of-focus (EDOF) lenses, which stretch one focal zone across a range of distances, and accommodative lenses, which move inside the eye. Toric versions of lenses correct astigmatism3. Presbyopia is the age-related loss of close focusing.
Pros and cons at a glance
| Outcome | Multifocal compared with monofocal | Review authors’ certainty rating |
|---|---|---|
| Unaided distance vision | No clear difference1 | moderate |
| Unaided near vision | Better with multifocal1 | low |
| Needing glasses | Less likely with multifocal1 | low |
| Glare | More common with multifocal1 | low |
| Halos around lights | Much more common with multifocal1 | moderate |
What the evidence says
A Cochrane review of 20 randomised trials (2,230 people) compared multifocal with monofocal lenses after cataract removal. People with multifocal lenses were about a third less likely to depend on glasses (risk ratio 0.63) and had better unaided near vision, while distance vision did not clearly differ1.
The cost was optical side effects. Glare was about 1.4 times as likely, and halos about 3.6 times as likely, with multifocal lenses1. The authors concluded that multifocal lenses are effective at improving near vision but that the size of the benefit is uncertain, and that motivation to be free of glasses is likely to be the deciding factor1. Overall: Moderate evidence that multifocal lenses improve near vision at the cost of more halos, but Limited evidence on how large the benefit is.
In the two trials that compared multifocal lenses with monovision, glasses dependence was lower with multifocal lenses, but glare was more common, and in one study more multifocal patients needed the lens exchanged in the first year1. Newer lens designs have appeared since the review, and comparative evidence for them is still developing.
The NHS position
NICE guidance for adults having cataract surgery in England states: “Do not offer multifocal intraocular lenses for people having cataract surgery.” It recommends basing lens choice on the person’s chosen refractive outcome, and offering monovision to people who already have it, or who have a large difference in prescription between the eyes2. Multifocal lenses are therefore mainly obtained privately in the UK.
Who may be less suited to multifocal lenses
The Royal College of Ophthalmologists notes that multifocal lenses may not suit people with pre-existing eye problems, and that most people notice some halos or light scatter early on that usually lessen over time. About 1% cannot adapt and may need the lens exchanged for a monofocal one5. A complication during surgery, such as a tear in the lens capsule, can also make a multifocal lens unsafe to implant5.
People who drive a lot at night, or whose work depends on fine contrast in low light, may weigh the halo risk more heavily. Those who are content to wear reading glasses may gain little from a multifocal lens.
When to seek medical advice
Whatever lens is used, call NHS 111 or seek urgent eye care after cataract surgery for sudden new floaters, flashes of light, a dark curtain or shadow across your vision, or sudden blurring, which may signal a detached retina4.
Common questions
Will multifocal lenses mean I never need glasses?
Not always; they make glasses less likely to be needed, but some people still use them for particular tasks15.
Do halos go away?
Usually they lessen over time, but a small minority of people cannot adapt and may need the lens exchanged5.
What is monovision?
Monovision sets one eye for distance and the other for nearer vision, partly restoring near sight with relatively little optical compromise5.
Can astigmatism be corrected at the same time?
Yes, toric lenses are designed to correct astigmatism3.
Bottom line
Multifocal lenses trade some night-time visual quality for a better chance of reading without glasses. The trial evidence supports that trade-off being real, but whether it is worth making is a personal judgement that depends on lifestyle, priorities and the health of the eye.
Related reading
- Cataract surgery
- How Long Is Recovery After Cataract Surgery?
- What Is Refractive Lens Exchange?
- Why Can Vision Become Cloudy Again After Cataract Surgery?
Sources
- de Silva SR, Evans JR, Kirthi V, Ziaei M, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews; 2016;(12):CD003169. https://doi.org/10.1002/14651858.CD003169.pub4.
- National Institute for Health and Care Excellence. Cataracts in adults: management (NG77). NICE; 2017. https://www.nice.org.uk/guidance/ng77/chapter/Recommendations. Accessed 5 November 2026.
- American Academy of Ophthalmology. IOL implants: lens replacement after cataracts. AAO EyeSmart; 2026. https://www.aao.org/eye-health/diseases/cataracts-iol-implants. Accessed 5 November 2026.
- NHS. Cataract surgery. NHS website; reviewed 2025. https://www.nhs.uk/tests-and-treatments/cataract-surgery/. Accessed 5 November 2026.
- The Royal College of Ophthalmologists. Refractive lens exchange: patient information. RCOphth; 2024. https://rcophth.ac.uk/wp-content/uploads/2020/05/Refractive-Lens-Exchange-Patient-Information-1.pdf. Accessed 5 November 2026.
Article history
- — First published.