Multifocal lens in cataract surgery – who it suits, the downsides and how much it costs

In cataract surgery, the cloudy natural lens is removed and an artificial lens is implanted in its place. A regular (monofocal) lens focuses at one range, usually distance, so many patients keep using glasses for reading after surgery. A multifocal lens is designed to give vision at several ranges and to reduce dependence on glasses. On this page we explain how it works, how it differs from an EDOF lens, who it suits and who it suits less, what the downsides are, and how much it adds to the price of surgery.

What is a multifocal lens?

A multifocal lens is an intraocular lens that splits the light entering the eye into several focal points: for distance, for intermediate range (for example a computer screen) and for near (reading). The brain learns to use the right focal point according to what you are looking at. In suitable patients, this makes it possible to see at several ranges without switching glasses.

There is also a multifocal lens with a toric component, for patients who also have astigmatism. Information on lenses that correct astigmatism is on the page Toric lenses and the health basket.

Multifocal, EDOF or regular lens: what is the difference?

• Regular (monofocal) lens: focuses at one range, usually distance. This is the lens included in the health basket. You usually need glasses for reading after surgery.
• Multifocal lens: several focal points, for distance, intermediate and near. It reduces dependence on glasses, but may cause halos around lights at night.
• EDOF lens (extended depth of focus): extends the range of focus, mainly for distance and intermediate range. It usually causes fewer halos than a multifocal lens, but you may need reading glasses for small print.

Another option is monovision: one eye is set for distance and the other for near. A full comparison of lens types is on the page Types of lenses in cataract surgery.

Who may a multifocal lens suit?

A multifocal lens may suit people who want to cut down on glasses as much as possible, including for reading, and whose eye is healthy apart from the cataract. These are usually people who are willing to accept some halos around lights at night in return for less dependence on glasses during the day.

The decision is made with the ophthalmologist, after tests and measurements of the eye. The considerations include your needs for distance, intermediate and near vision, whether you have astigmatism, and the general condition of the eye. Not every lens suits every eye.

Who does it suit less?

A multifocal lens splits light between several focal points, so it needs an eye that makes good use of light. It usually suits less when there is another eye disease, for example in the retina or the macula, advanced glaucoma or a corneal problem. In such cases the doctor may recommend a regular lens or an EDOF lens.

It is also worth thinking carefully if you drive a lot at night, work in dim lighting, or are especially sensitive to the quality of your vision in low contrast. In these cases the halos and the slight drop in sharpness in dim light may bother you more.

The downsides you should know about

• Halos and glare around lights: mainly at night, around car headlights and street lighting. In most patients this becomes less noticeable over time, as the brain adapts to the lens. More information is on the page Glare after cataract surgery.
• Slightly lower sharpness in dim light: because the light is split between several focal points, vision in low contrast, for example in the evening or in fog, may be less sharp than with a regular lens.
• An adaptation period: the brain needs to learn to use the different focal points. At first your vision may feel less natural, and this improves gradually.
• Cost: the lens is not included in the health basket, and it adds to the price of surgery.
• No promise of life without glasses: some patients will still use glasses for certain tasks.

In rare cases, when a patient cannot adapt to the lens and the disturbance is significant, the doctor may discuss with them the option of replacing the lens in a further procedure.

What to expect after surgery

Surgery with a multifocal lens is done like regular cataract surgery: the cloudy lens is removed and the new lens is implanted in its place. The main difference is in the tests before surgery and the expectations after it.

In the first days your vision may be blurry, and the eye may be slightly irritated. In most cases, full recovery usually takes four to eight weeks, and the pace of recovery varies from person to person. With a multifocal lens, there is also the brain's adaptation to the different focal points, so near and intermediate vision may improve gradually. In the period between surgery on the first eye and surgery on the second eye, there may be an imbalance between the eyes, and this is expected.

If you have pain that gets worse, redness that gets worse, discharge or a drop in vision, contact a doctor. General information on the period after surgery is on the page Cataract surgery recovery.

How much does a multifocal lens cost?

Private cataract surgery with a standard lens usually costs NIS 10,000–13,000 per eye, all-in: the surgeon's fee (about NIS 7,500), the operating room (about NIS 3,500) and a standard lens (about NIS 500). A premium lens (multifocal or EDOF) or a toric lens adds about NIS 2,500–5,000 per eye, and the use of laser (femtosecond) adds NIS 2,000–7,000 per eye.

Prices are a general estimate only; an exact quote is given after an examination. Get a personal price quote

Because a multifocal lens gives the best result when both eyes get a similar lens, it is worth calculating the cost for both eyes. Information on the timing between the eyes is on the page Cataract surgery in the second eye, and a full breakdown of prices is on the page Private cataract surgery price.

The health basket and supplementary insurance

The health basket covers cataract surgery with a regular (monofocal) lens only. A multifocal or EDOF lens is not part of the basket entitlement, and choosing one usually involves an extra payment by the patient.

The health funds' supplementary insurance plans (Shaban) cover cataract surgery only when it is done by a surgeon and at an institution in the fund's arrangement, with a co-payment and according to the terms of the plan. The coverage usually refers to surgery with a regular lens. A toric lens or another premium lens usually involves an extra payment. Coverage terms vary between the funds and between plans, so it is advisable to check the current terms with the fund before surgery.

Questions to ask the doctor before you choose

1. According to the tests, is my eye suitable for a multifocal lens, or is an EDOF or regular lens better?
2. Do I have astigmatism that should be corrected with the same lens?
3. For which tasks am I likely to still need glasses?
4. What should I expect regarding halos at night, especially when driving?
5. What is included in the price: the lens, the suitability tests and the follow-up visits?

You can read about the tests before surgery on the page Preparing for cataract surgery.

In summary

A multifocal lens can reduce dependence on glasses after cataract surgery, but it does not suit every eye or every lifestyle. Its price is not only financial: halos around lights at night and an adaptation period are part of the choice. An EDOF lens is a middle path, and a regular lens remains a good choice for people who do not mind using reading glasses. It is best to make the decision after a full examination and an open conversation with the ophthalmologist about your needs.