Multifocal & EDOF Lens Implant Surgery
Multifocal (trifocal) lens surgery — also known as clear lens extraction or refractive lens exchange — is a procedure to remove the eye's natural lens and replace it with a premium artificial lens (IOL) designed to provide clear vision at near, intermediate, and far distances. It uses the same surgical technique as cataract surgery: for cataract patients, a trifocal lens can be chosen as the replacement implant; for patients without cataracts who simply want to reduce their dependence on glasses, the same procedure is performed as a standalone refractive treatment. Dr Zoran Aleksic consults on multifocal lens patients at his rooms in Sea Point, Cape Town, with surgery performed at Life Peninsula Eye Hospital in Claremont or Life West Coast Private Hospital in Vredenburg on the West Coast.
How Trifocal Lenses Work
A trifocal lens has multiple focusing zones built into it, so instead of focusing at a single distance like a standard monofocal lens, it bends incoming light to create three focal points — near, intermediate, and far. This allows the brain to draw on clear images from each distance, which can reduce the need for glasses during everyday activities such as reading, computer work, driving, or watching television. A trifocal lens becomes a permanent part of your eye once implanted, and does not need to be replaced in future. In some patients, months or years after surgery, the capsule holding the lens in place can become hazy — a condition called posterior capsular opacification, or a "secondary cataract" — which causes vision to blur again. This isn't a problem with the lens itself, and is usually treated quickly with a short outpatient procedure called YAG laser capsulotomy, rather than requiring the lens to be replaced.
Lens Brands We Use
We work with two established trifocal lens platforms: the Zeiss AT ELANA, and the Alcon PanOptix. Both are diffractive trifocal lenses designed to provide near, intermediate, and distance vision from a single implant, and each has its own optical design and trade-offs. Toric versions, which additionally correct astigmatism, are available depending on which lens platform is the best fit for your eyes. Your surgeon can talk you through the differences between manufacturers so you can make an informed choice of lens alongside your surgeon's clinical recommendation.
Who Trifocal (Multifocal) Lenses Suit
Trifocal lenses are generally intended for cataract patients, or for patients aged 50 and over who want reduced dependence on glasses — particularly reading glasses — as part of the natural age-related changes to near vision. They're not usually recommended for healthy younger patients who can still read comfortably without glasses; laser eye surgery is typically the more suitable option in that case.
Trifocal lenses are also generally not recommended for patients with glaucoma, age-related macular degeneration (AMD), or a history of radial keratotomy (RK) surgery, since these conditions can affect how well the eye adapts to a multifocal lens. If you've previously had LASIK or other eye surgeries, it's important to let your surgeon know — prior laser surgery can affect the accuracy of lens power calculations and the predictability of your outcome with a trifocal lens, and this will need to be discussed in detail during your assessment.
As with any lens choice, no outcome can be guaranteed, and your final IOL recommendation will depend on the health of your eye and your test results.
Your Consultation and Surgery Journey
Booking an assessment (consultation) does not commit you to surgery — it's the first step in deciding, together with Dr Aleksic, whether trifocal lens surgery is right for you. The process generally looks like this:
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Assessment: a full series of tests is carried out to assess your candidacy and determine which lens options are appropriate for your eyes. Test results remain valid for 6 months. If you wear contact lenses, please avoid soft lenses for 2 days and hard or rigid gas-permeable lenses for 3 weeks before your assessment, since lenses can temporarily alter the shape of your cornea and affect the accuracy of your measurements.
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Second appointment: your final treatment plan, lens options, and costs are confirmed once your test results are in. Multiple IOL options will be discussed with you to match your lifestyle and visual needs, and your final lens choice depends on the quality of your eye and your test results.
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Scheduling: surgery is typically performed on Tuesdays, generally 2–3 weeks after your first consultation, depending on lens availability. Standard, stock lenses usually need 1–2 weeks to arrange; toric lenses need about 5 weeks' lead time, as they're imported from manufacturers in the USA or Europe, and can only be confirmed once your test results are known.
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Surgery: each eye is operated on separately, usually about a week apart.
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Follow-up: a follow-up visit is required the day after each surgery, and you'll need to remain within the Cape Metro area for at least two weeks after each procedure so you're available for follow-up care.
Please also disclose all prescription medications you're taking — including isotretinoin, prostate medications and blood thinners — to Dr Aleksic before your surgery is scheduled, as some medications can affect healing or surgical planning.
What Happens on the Day
The procedure is a day case, so there's no overnight hospital stay. Most patients are treated under local anaesthetic with the option of a light sedative; general anaesthetic can also be considered and discussed with your surgeon if it's the better option for you. Wear your own comfortable clothes — ideally something warm, as theatres can be cool — and arrange for someone to drive you home afterwards, as you won't be able to drive yourself.
Recovery
Recovery generally follows the same pattern as cataract surgery: mild discomfort or light sensitivity on the day is normal, an eye shield is worn for protection while sleeping in the first night or two, and strenuous exercise is best avoided for the first few days while your eye heals. See our cataract surgery page for full details on what to expect during recovery.
Medical Aid and Cost
Premium lens implants such as trifocal IOLs are not typically covered in full by medical aid, and cover depends on your specific scheme. If you're having clear lens extraction without cataracts, medical aid schemes generally treat this as an elective procedure and do not cover it at all — cover for a premium lens is generally only available if cataracts are present. For your information, you'll receive three separate accounts for this surgery: one from the hospital, one from the anaesthetist, and one from your surgeon. Your specific costs and lens options are confirmed at your consultation, once your tests and treatment plan are complete.
Helpful Resources
For a full walkthrough covering cataract and IOL surgery in detail, you can watch this explanation video. For further reading on IOL options generally, Zeiss also has a helpful overview of cataract surgery procedures, risks, and costs.
Extended Depth of Field (EDOF) Lenses
Not everyone is well suited to a trifocal lens — for patients with certain retinal conditions, higher expected sensitivity to glare and halos, or simply a preference for a more natural quality of vision, an extended depth of field (EDOF) lens can be a good alternative. Rather than splitting light into three distinct focal points, an EDOF lens stretches a single focal point into a longer zone of clear vision, typically covering distance and intermediate vision well, with some improvement at near — generally with fewer visual disturbances such as glare or halos than a trifocal lens, though usually with less complete near vision than a trifocal provides. We implant the Alcon Vivity EDOF lens for patients in this category. Whether an EDOF or a trifocal lens is the better fit depends on your eyes, lifestyle, and tolerance for visual side effects, and this will be part of the lens discussion during your consultation.
Frequently Asked Questions
Is trifocal lens surgery the same as laser eye surgery (LASIK)?
No. Laser eye surgery (LASIK/PRK) reshapes the cornea and doesn't treat presbyopia or replace the eye's natural lens. Trifocal lens surgery removes and replaces the natural lens itself, and is generally the more relevant option for patients past their mid-40s to 50s who want reduced dependence on glasses at multiple distances, including near vision.
What's the difference between a monofocal and a trifocal lens?
A monofocal lens has a single, fixed focusing strength, usually set for distance vision, meaning reading glasses are generally still needed afterwards. A trifocal lens has multiple focusing zones, aiming to provide clear vision at near, intermediate, and far distances from one implant, reducing — though not always eliminating — the need for glasses.
Can I have trifocal lenses if I don't have cataracts?
Yes. This is known as refractive lens exchange or clear lens extraction, and uses the same procedure as cataract surgery. It's an option for patients who want to reduce their dependence on glasses, particularly once presbyopia (the natural age-related loss of near focus) has set in, though it's typically not recommended for younger patients who don't yet need reading glasses.
Will I still need glasses at all after trifocal lens surgery?
Many patients achieve a good range of functional vision without glasses for most daily activities, but a small number still need glasses for specific tasks, particularly in low light or for very fine near work. No specific outcome can be guaranteed, and this is something your surgeon will discuss with you based on your eyes.
Are trifocal lenses covered by medical aid?
Most medical aid schemes contribute only at the rate of a standard monofocal lens, and premium lenses such as trifocal IOLs typically carry an out-of-pocket shortfall. Clear lens extraction without cataracts is generally not covered at all, as it's considered elective. Please confirm your specific benefits with your scheme, and your exact costs will be confirmed at your consultation.
Are there any downsides to trifocal lenses?
Because trifocal lenses divide light between several focal points, some patients experience glare, halos, or reduced contrast sensitivity, particularly at night. This is worth discussing with your surgeon if night driving or low-light work is a significant part of your life, as it may affect whether a trifocal lens is the right choice for you.
If you'd like to find out whether trifocal lens surgery is suitable for your eyes, book a consultation with Dr Zoran Aleksic at The Eye Surgery in Sea Point or Vredenburg. You can also read patient reviews online.
