Cataract and multifocal implant: getting free of glasses after 60

Becoming free of glasses after cataract surgery is now an achievable goal for many patients over 60. Trifocal multifocal implants restore vision at three distances — far, intermediate, near — and represent a relevant option, provided that patient selection is rigorous.

Contents

Cataracte : essayez les trois familles d'implants

Basculez d'un implant à l'autre. Les scènes nettes correspondent aux distances vues sans lunettes ; les scènes floues à un appoint lunettes souvent utile.

Vision nette ou floue selon l'implant et la distance Trois scènes côte à côte représentant la vision de près (un menu), intermédiaire (un écran) et de loin (un panneau de rue). Selon l'implant choisi, chaque scène apparaît nette ou floue. Monofocal : net de loin seulement. EDOF : net de loin et en intermédiaire. Multifocal : net aux trois distances, avec halos possibles la nuit et lecture de près plus confortable avec un bon éclairage. Menu Velouté de saison Filet de bar, beurre blanc Tarte fine aux pommes 12249 Près lecture, ~30 cm net sans lunettes lunettes utiles Intermédiaire écran, ~60 cm net sans lunettes lunettes utiles RUE DE L'ÉGLISE Loin conduite, panneaux net sans lunettes lunettes utiles Schéma pédagogique. Le rendu réel dépend de chaque œil.

Multifocal : des halos peuvent être perçus la nuit en vision de loin ; la lecture de près est plus confortable avec un bon éclairage.

Le choix de l'implant dépend de votre œil et de votre mode de vie ; il se décide avec le chirurgien.

Net sans lunettes Appoint lunettes souvent utile

UNDERSTANDING

Understanding multifocal implants

A trifocal multifocal implant is an intraocular lens with a diffractive profile that splits incoming light into three focal points: far, intermediate (around 60-80 cm) and near (40 cm). The brain learns to select the useful focal point at each distance, a phenomenon called neuroadaptation, which develops over 3 to 6 months.

According to Rampat and Gatinel (Ophthalmology, 2021), multifocal and EDOF implants offer proven benefits in terms of spectacle independence, while nonetheless carrying optical trade-offs (halos, nighttime glare) that should be anticipated with the patient. Reference models include PanOptix (Alcon), FineVision (BVI/PhysIOL), and Synergy (J&J Vision).

WHO IS IT FOR

Who is a multifocal implant for?

The multifocal implant is offered to patients over 60 undergoing cataract surgery who wish to free themselves from glasses for most daily tasks. Several criteria determine whether it is indicated:

  • Motivation: spectacle independence as a priority, acceptance of moderate nighttime halos
  • Visual profile: active life with screen work + reading, mixed near-and-far activities
  • Astigmatism: if > 0.75 D, a toric multifocal is preferable
  • Night driving: to be discussed, possible limitation with a trifocal

Contraindications: progressive AMD, advanced glaucoma, significant diabetic retinopathy, macular disease, irregular cornea (keratoconus, scarring). Cho et al. (JAMA Ophthalmol, 2022) emphasize the importance of preoperative selection: optical visual quality depends on the integrity of the retina and cornea. A macular examination by OCT is performed routinely before any decision to use a multifocal implant.

COMPARISON

Multifocal, EDOF or monofocal?

Three main families of implants exist for cataract surgery:

  • Monofocal: sharp vision at a single distance (usually far). Glasses needed for reading. Fully reimbursed option, safe, with simple neuroadaptation.
  • EDOF (Extended Depth of Focus): extended depth of field from far to intermediate. Fewer halos than a trifocal; glasses are often still needed for fine reading.
  • Trifocal multifocal: three distances restored, greater spectacle independence, more pronounced nighttime halos, neuroadaptation over 3-6 months.

The choice must be individualized. An avid reader with little nighttime activity may be a good candidate for the trifocal; a night driver or a screen worker will often prefer an EDOF. Cataract surgery is the opportunity to discuss all of these options, also detailed on the page dedicated to multifocal implants.

CARE PATHWAY

The care pathway

The preoperative work-up for a multifocal implant includes: optical biometry, corneal topography, routine macular OCT, pupil assessment, and screening for dry eye. A lifestyle questionnaire is completed to guide the choice of implant.

Dr Tourabaly sees patients at his practice in Cachan (94) and in Paris 13. The procedure is performed at the Clinique Sainte-Geneviève (Paris 14), with follow-up at day 1, 1 week and 1 month. To book an appointment: practice line at 01 45 47 08 11 or via Doctolib.

Dr Tourabaly’s view

“The trifocal multifocal genuinely transforms daily life for the right candidates. But I also regularly turn this option down for patients who would not tolerate nighttime halos, or whose retina does not allow the optics to be optimized. I would rather offer a monofocal or an EDOF than a multifocal that the patient comes to regret. This preoperative honesty avoids disappointment.”

FAQ

Frequently asked questions

A trifocal multifocal implant is an intraocular lens that splits light into three focal points (far, intermediate, near). It restores sharp vision at all distances, with spectacle independence for most daily tasks.

Most patients perceive moderate nighttime light halos in the first few months, which gradually fade through neuroadaptation. Some patients find them bothersome in the long term. A preoperative questionnaire and a pupil examination help identify at-risk profiles.

Yes. Toric multifocal implants can simultaneously correct cataract, presbyopia and corneal astigmatism. Their custom manufacturing and precise intraoperative alignment optimize the cylindrical result and spectacle independence.

The main contraindications are progressive AMD, advanced glaucoma, significant diabetic retinopathy, active macular disease, irregular corneas (keratoconus, scarring), severe uncontrolled dry eye and certain marked pupil dysfunctions.

The surgical procedure is reimbursed by the French national health insurance (Sécurité sociale) as cataract surgery. The multifocal implant (trifocal or toric trifocal) carries an additional fee of roughly €800 to €1,500 per eye, partially covered by some complementary health insurers (mutuelles) offering a premium implant package.

Multifocal implant consultation with Dr Tourabaly

Book an appointment on Doctolib
Learn more — cataract surgery

Sources

  1. Rampat R, Gatinel D. Multifocal and Extended Depth-of-Focus Intraocular Lenses in 2020. Ophthalmology. 2021;128(11):e164-e185. PMID 32980397
  2. Cho JY, Won YK, Park J, et al. Visual Outcomes and Optical Quality of Accommodative, Multifocal, Extended Depth-of-Focus, and Monofocal Intraocular Lenses. JAMA Ophthalmol. 2022;140(10):993-1001. PMID 36136323

This article is for informational purposes. A personalized ophthalmological opinion remains essential for any treatment decision.

Written and reviewed by Dr Moïse Tourabaly, ophthalmic refractive surgeon — former chief resident (Quinze-Vingts National Eye Hospital).

Last updated: July 6, 2026

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