• by Dr. Z Aleksic

Taking the muddles out of Multifocal Lens Surgery

Hello! Me again. Since I have started addressing my most commonly asked procedure questions in my blog I have been overwhelmed by the response. And since I am constantly in the pursuit of putting my patients and readers’ minds at rest, I am going to use this blog format more frequently to solve any of your procedure and eye disease quandaries.

This week’s focus is Multifocal Lens Surgery. Cataract surgery is performed on patients who do not see well due to cataract development. The cataract can be replaced with a number of intraocular lenses (all depending on medical factors and patient desires) and one of the options is to use a multifocal lens for patients who would like to have less dependence on spectacles after the surgery.

Multifocal Lens Surgery may also be used for Clear Lens Extraction surgery; this is when patients do not have a cataract but would like to reduce dependence on spectacles. This is only done in very selected cases and is done on patients who are already dependant on reading glasses (at 45 years of age or above). This procedure is done to the lens of your eye and is usually done in our operating theatres at Life Peninsula Eye Hospital in Claremont and at the West Coast Private Hospital in Vredenburg.

Put simply, Multifocal Lens Surgery entails removing the lens of the eye and then replaces it with an artificial lens to improve vision.

If you are someone who wears spectacles but desires a high degree of independence from glasses, or if you are someone who leads an active life and wants to do so without the cumbersome nature of visual aids, then this procedure could be perfectly suited for you and we suggest you book an appointment to come in for a consultation. Trifocal (multifocal) lenses are the most advanced intraocular lenses (IOLs) available today, providing clear vision for close, intermediate and far distances, without gaps in between.

Oh yes, before I go too far off track, let’s get into my most commonly asked questions.

1. First things first. Why Multifocal lenses?

The world today is demanding on our eyes, expecting an array of different behaviours from us, most of which entail some sort of technology, iPad or iPhone or laptop. Let’s be honest, screens are everywhere these days. And with working from home, #WFH, becoming more common, the computer screen is becoming even more ubiquitous as it invades our personal life. Multifocal lenses are a great aid to this situation for those with spectacles.

Unlike monofocal and bifocal lenses, Multifocal lenses also provide comfortable intermediate vision, which is important for various daily activities, such as computer work. That being said, you may need to adjust your reading and working distances to allow for the best focus.

2. What is the difference between Multifocal IOLS and Multifocal spectacles?

It is crucial to understand that Multifocal Intraocular Lens (IOL) are not the same as multifocal spectacles. It is totally different. This is because a Multifocal IOL does not give you the same optical disturbance as spectacles:

- You will not have distortions in your peripheral vision.

- You do not have to adjust your head position while reading or walking down the stairs.

- You will not experience difficulties in judging distance or depth as you look down.

- There is no feeling of dizziness or unbalance.

3. What is the advantage of Multifocal Lenses?

The biggest advantage of Multifocal Intraocular Lenses is the possibility to see clearly at all distances without glasses. As a result, you may no longer need to wear glasses when pursuing most of your daily activities.

4. Do Multifocal IOLs correct astigmatism?

Not only do Multifocal IOLs allow for the treatment of pre-existing vision disorders, such as myopia or hyperopia, but with a toric version of the trifocal lens, pre-existing astigmatism can be corrected too.

5. Do Multifocal IOLS fix Presbyopia?

Yes. Multifocal intraocular lenses are very effective for treating age-related vision changes such as presbyopia, which affects nearly everyone after the age of 43-45 plus.

6. Which eye condition is Multifocal Lens Surgery correcting?

It is used for patients who would like to be more independent of any spectacles for the many reasons mentioned in the first question. It is used only in a specific middle or older age group and in younger patients if they develop cataract problem in one eye only.


7. What are the signs that you should have Multifocal Lens Surgery?

If you develop a cataract, then you will need surgery to correct your vision. In this case you have a choice of lenses to choose from. If you are aiming to have minimum spectacle dependency after your cataract surgery one of the choices is to choose a multifocal lens.

Alternatively, if you are in the correct age group and want to be less dependent of spectacles or contact lenses (for any reason, including those mentioned in the first question) then this is a good sign that you would benefit from Multifocal Lens Surgery. We recommend that you book a consultation to hear about your options and discuss whether or not you would be a good candidate for this procedure.

8. Can a Multifocal Lens be removed?

Any implant can be removed, but it will have to be replaced with an alternative IOL. If you ever need to remove the lens, it is easier to do so early. After the 3-6 months healing time it becomes more and more difficult to do so.

9. Can a multifocal lens be replaced? What is a multifocal lens replacement?

Yes. There are medical reasons to replace the lens. These reasons are very few and far between. There are also patients who experience some optical problems with some of the implants. The replacement is similar to the original surgery performed, but in this case we would remove the initially used artificial lens to replace it with another artificial lens.

10. Which Mutifocal Lens is best?


When you develop a cataract or when you do not want to wear glasses for far and for near anymore, then we discuss different lens options that are available. The most straightforward, basic option is a monofocal lens. This will be the lens we use that will enable you to see far, such as watching television, driving, going to the movies, but for anything arm's length and closer you'll have to put on your glasses -- these may be the over-the-counter plus 2, plus 2.5 reading glasses. This means that with a monofocal lens, the total independence of spectacles is not achieved, as the patient will still use glasses for activities like reading a price tag or their phone.

The second option which is becoming more popular, is the multifocal intraocular lens. With the optics of the lens, the lens will enable you to see both far and near, however, for those using this lens replacement take note: when you look at lights when you drive at night, you will see a halo around them -- many patients have said that it rarely bothers them.

11. What does Multifocal Lens Surgery Cost?

Generally, medical aids will cover this type of surgery, but we cannot generalise the price as it differs from the lens option you choose.

The downside of Multifocal Lens Surgery is the cost. Medical Aids in South Africa are only prepared to pay for a basic monofocal implant like in option 1. They do not cover the difference for the Multifocal Technology unless you have gap cover or a “savings" account. We always recommend that you speak directly to your medical aid provider about how much they will cover.