Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 Dec 12;12(12):CD003169.
doi: 10.1002/14651858.CD003169.pub4.

Multifocal versus monofocal intraocular lenses after cataract extraction

Samantha R de Silva  1 , Jennifer R Evans  2 , Varo Kirthi  3 , Mohammed Ziaei  4 , Martin Leyland  5
Affiliations
Meta-Analysis

Multifocal versus monofocal intraocular lenses after cataract extraction

Samantha R de Silva et al. Cochrane Database Syst Rev. .

Abstract

Background: Good unaided distance visual acuity (VA) is now a realistic expectation following cataract surgery and intraocular lens (IOL) implantation. Near vision, however, still requires additional refractive power, usually in the form of reading glasses. Multiple optic (multifocal) IOLs are available which claim to allow good vision at a range of distances. It is unclear whether this benefit outweighs the optical compromises inherent in multifocal IOLs.

Objectives: To assess the visual effects of multifocal IOLs in comparison with the current standard treatment of monofocal lens implantation.

Search methods: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 5), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to June 2016), Embase (January 1980 to June 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov), and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2016.

Selection criteria: All randomised controlled trials comparing a multifocal IOL of any type with a monofocal IOL as control were included. Both unilateral and bilateral implantation trials were included. We also considered trials comparing multifocal IOLs with "monovision" whereby one eye is corrected for distance vision and one eye corrected for near vision.

Data collection and analysis: We used standard methodological procedures expected by Cochrane. We assessed the 'certainty' of the evidence using GRADE.

Main results: We found 20 eligible trials that enrolled 2230 people with data available on 2061 people (3194 eyes). These trials were conducted in Europe (13), China (three), USA (one), Middle East (one), India (one) and one multicentre study in Europe and the USA. Most of these trials compared multifocal with monofocal lenses; two trials compared multifocal lenses with monovision. There was considerable variety in the make and model of lenses implanted. Overall we considered the trials at risk of performance and detection bias because it was difficult to mask participants and outcome assessors. It was also difficult to assess the role of reporting bias.There was moderate-certainty evidence that the distance acuity achieved with multifocal lenses was not different to that achieved with monofocal lenses (unaided VA worse than 6/6: pooled RR 0.96, 95% confidence interval (CI) 0.89 to 1.03; eyes = 682; studies = 8). People receiving multifocal lenses may achieve better near vision (RR for unaided near VA worse than J3/J4 was 0.20, 95% CI 0.07 to 0.58; eyes = 782; studies = 8). We judged this to be low-certainty evidence because of risk of bias in the included studies and high heterogeneity (I2 = 93%) although all included studies favoured multifocal lenses with respect to this outcome.People receiving multifocal lenses may be less spectacle dependent (RR 0.63, 95% CI 0.55 to 0.73; eyes = 1000; studies = 10). We judged this to be low-certainty evidence because of risk of bias and evidence of publication bias (skewed funnel plot). There was also high heterogeneity (I2 = 67%) but all studies favoured multifocal lenses. We did not additionally downgrade for this.Adverse subjective visual phenomena were more prevalent and more troublesome in participants with a multifocal IOL compared with monofocals (RR for glare 1.41, 95% CI 1.03 to 1.93; eyes = 544; studies = 7, low-certainty evidence and RR for haloes 3.58, 95% CI 1.99 to 6.46; eyes = 662; studies = 7; moderate-certainty evidence).Two studies compared multifocal lenses with monovision. There was no evidence for any important differences in distance VA between the groups (mean difference (MD) 0.02 logMAR, 95% CI -0.02 to 0.06; eyes = 186; studies = 1), unaided intermediate VA (MD 0.07 logMAR, 95% CI 0.04 to 0.10; eyes = 181; studies = 1) and unaided near VA (MD -0.04, 95% CI -0.08 to 0.00; eyes = 186; studies = 1) compared with people receiving monovision. People receiving multifocal lenses were less likely to be spectacle dependent (RR 0.40, 95% CI 0.30 to 0.53; eyes = 262; studies = 2) but more likely to report problems with glare (RR 1.41, 95% CI 1.14 to 1.73; eyes = 187; studies = 1) compared with people receiving monovision. In one study, the investigators noted that more people in the multifocal group underwent IOL exchange in the first year after surgery (6 participants with multifocal vs 0 participants with monovision).

Authors' conclusions: Multifocal IOLs are effective at improving near vision relative to monofocal IOLs although there is uncertainty as to the size of the effect. Whether that improvement outweighs the adverse effects of multifocal IOLs, such as glare and haloes, will vary between people. Motivation to achieve spectacle independence is likely to be the deciding factor.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot of comparison: 1 Multifocal versus monofocal intraocular lenses, outcome: 1.10 Spectacle dependence (any).
1.1
1.1. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 1 Unaided distance visual acuity (VA) worse than 6/6.
1.2
1.2. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 2 Mean unaided distance VA.
1.3
1.3. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 3 Corrected distance VA worse than 6/6.
1.4
1.4. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 4 Mean corrected distance VA.
1.5
1.5. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 5 Mean intermediate VA.
1.6
1.6. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 6 Unaided near VA worse than J3/J4 or equivalent.
1.7
1.7. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 7 Mean unaided near VA.
1.8
1.8. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 8 Corrected near VA worse than J3/J4 or equivalent.
1.9
1.9. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 9 Mean corrected near VA.
1.10
1.10. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 10 Spectacle dependence (any).
1.11
1.11. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 11 Spectacle dependence (distance or near).
1.12
1.12. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 12 Contrast sensitivity.
1.13
1.13. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 13 Participant‐reported outcomes: visual function questionnaires.
1.14
1.14. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 14 Participant‐reported outcomes: vision‐related quality‐of‐life questionnaires.
1.15
1.15. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 15 Participant‐reported outcomes: satisfaction scores.
1.16
1.16. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 16 Participant‐reported outcomes: "good" or "satisfied" with vision.
1.18
1.18. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 18 Participant‐reported outcomes: cataract symptom scores.
1.19
1.19. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 19 Participant‐reported outcomes: glare.
1.20
1.20. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 20 Participant‐reported outcomes: haloes.
1.21
1.21. Analysis
Comparison 1 Multifocal versus monofocal intraocular lenses, Outcome 21 Participant‐reported outcomes: dysphotopsia.
2.1
2.1. Analysis
Comparison 2 Multifocal versus monovision, Outcome 1 Visual acuity (VA).
2.2
2.2. Analysis
Comparison 2 Multifocal versus monovision, Outcome 2 Spectacle dependence.
2.3
2.3. Analysis
Comparison 2 Multifocal versus monovision, Outcome 3 Contrast sensitivity.
2.4
2.4. Analysis
Comparison 2 Multifocal versus monovision, Outcome 4 Participant‐reported outcomes: visual function.
2.5
2.5. Analysis
Comparison 2 Multifocal versus monovision, Outcome 5 Participant‐reported outcomes: glare.
2.6
2.6. Analysis
Comparison 2 Multifocal versus monovision, Outcome 6 Participant‐reported outcomes: glare mean score.
2.7
2.7. Analysis
Comparison 2 Multifocal versus monovision, Outcome 7 Participant‐reported outcomes: shadows mean score.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Cillino 2008 {published data only}
    1. Cillino S, Casuccio A, Pace F, Morreale R, Pillitteri F, Cillino G, et al. One‐year outcomes with new‐generation multifocal intraocular lenses. Ophthalmology 2008;115(9):1508‐16. - PubMed
el Maghraby 1992 {published data only}
    1. Maghraby A, Marzouky A, Gazayerli E, Karr M, DeLuca M. Multifocal versus monofocal intraocular lenses. Visual and refractive comparisons. Journal of Cataract and Refractive Surgery 1992;18(2):147‐52. - PubMed
Haaskjold 1998a {published data only}
    1. Allen ED, Burton RL, Webber SK, Haaskjold E, Sandvig K, Jyrkkio H, et al. Comparison of a diffractive bifocal and a monofocal intraocular lens. Journal of Cataract and Refractive Surgery 1996;22(4):446‐51. - PubMed
    1. Haaskjold E, Allen ED, Burton RL, Webber SK, Sandvig KU, Jyrkkio H, et al. Contrast sensitivity after implantation of diffractive bifocal and monofocal intraocular lenses. Journal of Cataract and Refractive Surgery 1998;24(5):653‐8. - PubMed
    1. Pharmacia, Upjohn, Ltd. Unpublished data 1995.
Harman 2008 {published data only}
    1. Harman FE, Maling S, Kampougeris G, Langan L, Khan I, Lee N, et al. Comparing the 1CU accommodative, multifocal, and monofocal intraocular lenses: a randomized trial. Ophthalmology 2008;115(6):993‐1001. - PubMed
Javitt 2000 {published data only}
    1. Javitt J, Brauweiler HP, Jacobi KW, Klemen U, Kohnen S, Quentin CD, et al. Cataract extraction with multifocal intraocular lens implantation: clinical functional, and quality‐of‐life outcomes: multicenter clinical trial in Germany and Austria. Journal of Cataract and Refractive Surgery 2000;26(9):1356‐66. - PubMed
    1. Javitt J, Steinert R. Cataract extraction with multifocal intraocular lens implantation. A multinational clinical trial evaluating clinical, functional, and quality‐of‐life outcomes. Ophthalmology 2000;107(11):2040‐8. - PubMed
Ji 2013 {published data only}
    1. Ji J, Huang X, Fan X. Luo M. Visual performance of acrysof ReSTOR compared with a monofocal intraocular lens following implantation in cataract surgery. Experimental and Therapeutic Medicine 2013;5(1):277‐81. - PMC - PubMed
Jusufovic 2011 {published data only}
    1. Jusufovic V, Sarajlic D, Zvornicanin J, Musanovic Z, Halilbasic M. Comparison of the binocular vision quality after implantation of monofocal and multifocal intraocular lenses. Acta Medica Saliniana 2011;40(2):63‐8.
Kamlesh 2001 {published data only}
    1. Kamlesh M, Dadeya S, Kaushik S. Contrast sensitivity and depth of focus with aspheric multifocal versus conventional monofocal intraocular lens. Canadian Journal of Ophthalmology 2001;36(4):197‐201. - PubMed
Labiris 2015 {published data only}
    1. Labiris G, Giarmoukakis A, Patsiamanidi M, Papadopoulos Z, Kozobolis VP. Mini‐monovision versus multifocal intraocular lens implantation. Journal of Cataract and Refractive Surgery 2015;41(1):53‐7. - PubMed
Leyland 2002 {published data only}
    1. Leyland M, Langan L, Goolfee F, Lee N, Bloom P. Prospective randomised double‐masked trial of bilateral multifocal, bifocal or monofocal intraocular lenses. Eye 2002;16(4):481‐90. - PubMed
Nijkamp 2004 {published data only}
    1. Nijkamp MD, Dolders MG, Brabander J, Borne B, Hendrikse F, Nuijts RM. Effectiveness of multifocal intraocular lenses to correct presbyopia after cataract surgery: a randomized controlled trial. Ophthalmology 2004;111(10):1832‐9. - PubMed
Palmer 2008 {published data only}
    1. Palmer AM, Faina PG, Albelda AE, Serrano MC, Saad DN, Cespedes MC. Visual function with bilateral implantation of monofocal and multifocal intraocular lenses: a prospective, randomized, controlled clinical trial. Journal of Refractive Surgery 2008;24(3):257‐64. - PubMed
Peng 2012 {published data only}
    1. Peng C, Zhao J, Ma L, Qu B, Sun Q, Zhang J. Optical performance after bilateral implantation of apodized aspheric diffractive multifocal intraocular lenses with +3.00‐D addition power. Acta Ophthalmologica 2012;90(8):e586‐93. - PubMed
Percival 1993 {published data only}
    1. Percival SP, Setty SS. Prospectively randomized trial comparing the pseudoaccommodation of the AMO ARRAY multifocal lens and a monofocal lens. Journal of Cataract and Refractive Surgery 1993;19(1):26‐31. - PubMed
Rasp 2012 {published data only}
    1. Rasp M, Bachernegg A, Seyeddain O, Ruckhofer J, Emesz, M, Stoiber J, et al. Bilateral reading performance of 4 multifocal intraocular lens models and a monofocal intraocular lens under bright lighting conditions. Journal of Cataract and Refractive Surgery 2012;38(11):1950‐61. - PubMed
Rossetti 1994 {published data only}
    1. Rossetti L, Carraro F, Rovati M, Orzalesi N. Performance of diffractive multifocal intraocular lenses in extracapsular cataract surgery. Journal of Cataract and Refractive Surgery 1994;20(2):124‐8. - PubMed
Sen 2004 {published data only}
    1. Sen HN, Sarikkola AU, Uusitalo RJ, Laatikainen L. Quality of vision after AMO Array multifocal intraocular lens implantation. Journal of Cataract and Refractive Surgery 2004;30(12):2483‐93. - PubMed
Steinert 1992 {published data only}
    1. Steinert RF, Post CT Jr, Brint SF, Fritch CD, Hall DL, Wilder LW, et al. A prospective, randomized, double‐masked comparison of a zonal‐progressive multifocal intraocular lens and a monofocal intraocular lens. Ophthalmology 1992;99(6):853‐61. - PubMed
Wilkins 2013 {published data only}
    1. Wilkins MR, Allan BD, Rubin GS, Findl O, Hollick EJ, Bunce C, et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology 2013;120(12):2449‐55. - PubMed
Zhao 2010 {published data only}
    1. Zhao G, Zhang J, Zhou Y, Hu L, Che C, Jiang N. Visual function after monocular implantation of apodized diffractive multifocal or single‐piece monofocal intraocular lens randomized prospective comparison. Journal of Cataract and Refractive Surgery 2010;36(2):282‐5. - PubMed

References to studies excluded from this review

Alio 2011a {published data only}
    1. Alio JL, Pinero DP, Plaza‐Puche AB, Chan MJ. Visual outcomes and optical performance of a monofocal intraocular lens and a new‐generation multifocal intraocular lens. Journal of Cataract and Refractive Surgery 2011;37(2):241‐50. - PubMed
Alio 2011b {published data only}
    1. Alio JL, Pinero DP, Plaza‐Puche AB, Amparo F, Jimenez R, Rodriguez‐Prats JL, et al. Visual and optical performance with two different diffractive multifocal intraocular lenses compared to a monofocal lens. Journal of Refractive Surgery 2011;27(8):570‐81. - PubMed
Alio 2011c {published data only}
    1. Alio JL, Plaza‐Puche AB, Pinero DP, Amparo F, Rodriguez‐Prats JL, Ayala MJ. Quality of life evaluation after implantation of 2 multifocal intraocular lens models and a monofocal model. Journal of Cataract and Refractive Surgery 2011;37(4):638‐48. - PubMed
Alio 2015 {published data only}
    1. Alio JL, Vega‐Estrada A, Plaza‐Puche AB. Clinical outcomes with a new microincisional diffractive multifocal IOL. Eye and Vision 2015;2(2). [DOI: 10.1186/s40662-015-0012-8] - DOI - PMC - PubMed
Allen 2009 {published data only}
    1. Allen R, Ho‐Yen GO, Beckingsale AB, Fitzke FW, Sciscio AG, Saleh GM. Post‐capsulotomy dysphotopsia in monofocal versus multifocal lenses. Clinical and Experimental Optometry 2009;92(2):104‐9. - PubMed
Cionni 2009 {published data only}
    1. Cionni RJ, Chang D, Donnenfeld ED, Lane SS, McCulley JP, Solomon KD. Clinical outcomes and functional visual performance: comparison of the ReSTOR apodised diffractive intraocular lens to a monofocal control. British Journal of Ophthalmology 2009;93(9):1215‐9. - PubMed
Hayashi 2009a {published data only}
    1. Hayashi K, Manabe S, Hayashi H. Visual acuity from far to near and contrast sensitivity in eyes with a diffractive multifocal intraocular lens with a low addition power. Journal of Cataract and Refractive Surgery 2009;35(12):2070‐6. - PubMed
Hayashi 2009b {published data only}
    1. Hayashi K, Masumoto M, Hayashi H. All‐distance visual acuity in eyes with a nontinted or a yellow‐tinted diffractive multifocal intraocular lens. Japanese Journal of Ophthalmology 2009;53(2):100‐6. - PubMed
Hayashi 2009c {published data only}
    1. Hayashi K, Yoshida M, Hayashi H. All‐distance visual acuity and contrast visual acuity in eyes with a refractive multifocal intraocular lens with minimal added power. Ophthalmology 2009;116(3):401‐8. - PubMed
Hayashi 2010 {published data only}
    1. Hayashi K, Manabe S, Yoshida M, Hayashi H. Effect of astigmatism on visual acuity in eyes with a diffractive multifocal intraocular lens. Journal of Cataract and Refractive Surgery 2010;36(8):1323‐9. - PubMed
Hida 2009 {published data only}
    1. Hida WT, Motta AF, Kara‐Jose N Jr, Alves E, Tadeu M, Cordeiro LN, et al. Comparison between OPD‐Scan results and visual outcomes of monofocal and multifocal intraocular lenses. Arquivos Brasileiros De Oftalmologia 2009;72(4):526‐32. - PubMed
Huang 2010 {published data only}
    1. Huang BY, Tan SJ, Liang H, Li X. Distant, near and intermediate vision of the apodized diffractive AcrySof ReSTOR multifocal intraocular lens. International Journal of Ophthalmology 2010;10(5):856‐8.
Ji 2011 {published data only}
    1. Ji J, Luo M, Fan XQ, Lu JF. Clinical observations of monofocal intraocular lens and multifocal intraocular lens implantation in cataract surgery. Journal of Shanghai Jiaotong University (Medical Science) 2011;31(8):1073‐7.
Liang 2005 {published data only}
    1. Liang XJ, Yu JH, He JX, Lin YJ. Comparison of pseudoaccommodation and visual quality between monofocal and multifocal intraocular lens implantation. International Journal of Ophthalmology 2005;5(4):672‐4.
Maxwell 2008 {published data only}
    1. Maxwell WA, Waycaster CR, D'Souza AO, Meissner BL, Hileman K. A United States cost‐benefit comparison of an apodized, diffractive, presbyopia‐correcting, multifocal intraocular lens and a conventional monofocal lens. Journal of Cataract and Refractive Surgery 2008;34(11):1855‐61. - PubMed
NCT01088282 {published data only}
    1. NCT01088282. Visual and economic profits of ReSTOR® multifocal intraocular lenses (IOL) on public health patients in Spain. clinicaltrials.gov/ct2/show/NCT01088282 Date first received: 16 March 2010.
Ortiz 2008 {published data only}
    1. Ortiz D, Alio JL, Bernabeu G, Pongo V. Optical performance of monofocal and multifocal intraocular lenses in the human eye. Journal of Cataract and Refractive Surgery 2008;34(5):755‐62. - PubMed
Puell 2015 {published data only}
    1. Puell MC, Pérez‐Carrasco MJ, Hurtado‐Ceña FJ, Álvarez‐Rementería L. Disk halo size measured in individuals with monofocal versus diffractive multifocal intraocular lenses. Journal of Cataract and Refractive Surgery 2015;41(11):2417‐23. - PubMed
Richter‐Mueksch 2002 {published data only}
    1. Richter‐Mueksch S, Weghaupt H, Skorpik C, Velikay‐Parel M, Radner W. Reading performance with a refractive multifocal and a diffractive bifocal intraocular lens. Journal of Cataract and Refractive Surgery 2002;28(11):1957‐63. - PubMed
Rocha 2005 {published data only}
    1. Rocha KM, Chalita MR, Souza CE, Soriano ES, Freitas LL, Muccioli C, et al. Postoperative wavefront analysis and contrast sensitivity of a multifocal apodized diffractive IOL (ReSTOR) and three monofocal IOLs. Journal of Refractive Surgery 2005;21(6):S808‐12. - PubMed
Shah 2010 {published data only}
    1. Shah VC, Russo C, Cannon R, Davidson R, Taravella MJ. Incidence of Nd:YAG capsulotomy after implantation of AcrySof multifocal and monofocal intraocular lenses: a case controlled study. Journal of Refractive Surgery 2010;26(8):565‐8. - PubMed
Souza 2006 {published data only}
    1. Souza CE, Muccioli C, Soriano ES, Chalita MR, Oliveira F, Freitas LL, et al. Visual performance of AcrySof ReSTOR apodized diffractive IOL: a prospective comparative trial. American Journal of Ophthalmology 2006;141(5):827‐32. - PubMed
Walkow 1997 {published data only}
    1. Liekfeld A, Walkow T, Anders N, Pham DT, Wollensak J. Prospective comparison of 2 multi‐focal lens models [Prospektiver vergleich zweier multifokallinsenmodelle]. Ophthalmologe 1998;95(4):253‐6. - PubMed
    1. Walkow T, Liekfeld A, Anders N, Pham DT, Hartmann C, Wollensak J. A prospective evaluation of a diffractive versus a refractive designed multifocal intraocular lens. Ophthalmology 1997;104(9):1380‐6. - PubMed
Xu 2007 {published data only}
    1. Xu M, Li WS, Zhao YE, Wang QM. The clinical efficacy of accommodative intraocular lens and multifocal intraocular lens in pseudophakic after phacoemulsification. Chinese Journal of Ophthalmology 2007;43(2):104‐7. - PubMed
Zhang 2011 {published data only}
    1. Zhang F, Sugar A, Jacobsen G, Collins M. Visual function and spectacle independence after cataract surgery: bilateral diffractive multifocal intraocular lenses versus monovision pseudophakia. Journal of Cataract and Refractive Surgery 2011;37(5):853‐8. - PubMed

Additional references

Allen 1996
    1. Allen ED, Burton RL, Webber SK, Haaskjold E, Sandvig K, Jyrkkio H, et al. Comparison of a diffractive bifocal and a monofocal intraocular lens. Journal of Cataract and Refractive Surgery 1996;22(4):446‐51. - PubMed
Ang 2012
    1. Ang M, Evans JR, Mehta JS. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2012, Issue 4. [DOI: 10.1002/14651858.CD008811.pub2] - DOI - PubMed
Bailey 1978
    1. Bailey I. Specification of near point performance. Optometric Monthly 1978;69(September):134‐7.
Cochener 2011
    1. Cochener B, Lafuma A, Khoshnood B, Courouve L, Berdeaux G. Comparison of outcomes with multifocal intraocular lenses: a meta‐analysis. Clinical Ophthalmology 2011;5:45‐56. - PMC - PubMed
Covidence 2016 [Computer program]
    1. Veritas Health Innovation. Covidence systematic review software. Melbourne: Veritas Health Innovation, (accessed prior to 24 October 2016).
de Silva 2014
    1. Silva SR, Riaz Y, Evans JR. Phacoemulsification with posterior chamber intraocular lens versus extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2014, Issue 1. [DOI: 10.1002/14651858.CD008812.pub2] - DOI - PMC - PubMed
de Vries 2013
    1. Vries NE, Nuijts RMMA. Multifocal intraocular lenses in cataract surgery: literature review of benefits and side effects. Journal of Cataract and Refractive Surgery 2013;39(2):268‐78. - PubMed
Deeks 2011
    1. Deeks JJ, Higgins JPT, Altman DG editor(s). Chapter 9: Analysing data and undertaking meta‐analyses. In Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Department of Health 2015
    1. Department of Health, England. Hospital episode statistics: admitted patient care, England 2014‐15. content.digital.nhs.uk/catalogue/PUB19124/hosp‐epis‐stat‐admi‐summ‐rep‐2... (accessed 18 October 2016).
Desai 1993
    1. Desai P. The National Cataract Surgery Survey: II. Clinical outcomes. Eye 1993;7(Pt 4):489‐94. - PubMed
Desai 1996
    1. Desai P, Reidy A, Minassian DC, Vafidis G, Bolger J. Gains from cataract surgery: visual function and quality of life. British Journal of Ophthalmology 1996;80(10):868‐73. - PMC - PubMed
Desai 1999
    1. Desai P, Minassian DC, Reidy A. National cataract surgery survey 1997‐8: a report of the results of the clinical outcomes. British Journal of Ophthalmology 1999;83(12):1336‐40. - PMC - PubMed
Gimbel 1991
    1. Gimbel HV, Sanders DR, Raanan MG. Visual and refractive results of multifocal intraocular lenses. Ophthalmology 1991;98(6):881‐7. - PubMed
Glanville 2006
    1. Glanville JM, Lefebvre C, Miles JN, Camosso‐Stefinovic J. How to identify randomized controlled trials in MEDLINE: ten years on. Journal of the Medical Library Association 2006;94(2):130‐6. - PMC - PubMed
GRADEpro 2014 [Computer program]
    1. GRADE Working Group. McMaster University. GRADEpro GDT. Version accessed 26 July 2016. GRADE Working Group. McMaster University, 2014.
Haaskjold 1998b
    1. Haaskjold E, Allen ED, Burton RL, Webber SK, Sandvig KU, Jyrkkio H, et al. Contrast sensitivity after implantation of diffractive bifocal and monofocal intraocular lenses. Journal of Cataract and Refractive Surgery 1998;24(5):653‐8. - PubMed
Higgins 2003
    1. Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2011
    1. Higgins JP, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JP, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.
Holladay 1990
    1. Holladay JT, Dijk H, Lang A, Portney V, Willis TR, Sun R, et al. Optical performance of multifocal intraocular lenses. Journal of Cataract and Refractive Surgery 1990;16(4):413‐22. - PubMed
Javitt 1997
    1. Javitt JC, Wang F, Trentacost DJ, Rowe M, Tarantino N. Outcomes of cataract extraction with multifocal intraocular lens implantation: functional status and quality of life. Ophthalmology 1997;104(4):589‐99. - PubMed
Kirkham 2010
    1. Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, et al. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 2010;340:c365. - PubMed
Knorz 1993
    1. Knorz MC. Results of a European multicenter study of the True Vista bifocal intraocular lens. Journal of Cataract and Refractive Surgery 1993;19(5):626‐34. - PubMed
Lang 1993
    1. Lang A, Portney V. Interpreting multifocal intraocular lens modulation transfer functions. Journal of Cataract and Refractive Surgery 1993;19(4):505‐12. - PubMed
Legeais 1999
    1. Legeais JM, Werner L, Werner L, Abenhaim A, Renard G. Pseudoaccommodation: BioComFold versus a foldable silicone intraocular lens. Journal of Cataract and Refractive Surgery 1999;25(2):262‐7. - PubMed
Lindstrom 1993
    1. Lindstrom RL. Food and Drug Administration study update. One‐year results from 671 patients with the 3M multifocal intraocular lens. Ophthalmology 1993;100(1):91‐7. - PubMed
MECIR 2013
    1. Higgins JP, Lasserson T, Chandler J, Tovey D, Churchill R. Standards for the conduct of new Cochrane Intervention Reviews 2012 V2.3. Methodological Expectations of Cochrane Intervention Reviews: Standards for the conduct and reporting of new Cochrane Intervention Reviews 2012. Version 2. Cochrane, London 2013.
Pharmacia 1995
    1. Pharmacia, Upjohn Ltd. Unpublished data 1995.
RevMan 2014 [Computer program]
    1. Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: Nordic Cochrane Centre, The Cochrane Collaboration, 2014.
Riaz 2013
    1. Riaz Y, Silva SR, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age‐related cataract. Cochrane Database of Systematic Reviews 2013, Issue 10. [DOI: 10.1002/14651858.CD008813.pub2] - DOI - PMC - PubMed
Steinberg 1994
    1. Steinberg EP, Tielsch JM, Schein OD, Javitt JC, Sharkey P, Cassard SD, Legro MW, Diener‐West M, Bass EB, Damiano AM, Steinwachs DM, Sommer A. The VF‐14. An Index of Functional Impairment in Patients With Cataract. Arch Ophthalmol 1994;112:630‐638. - PubMed
Steinert 1999
    1. Steinert RF, Aker BL, Trentacost DJ, Smith PJ, Tarantino N. A prospective comparative study of the AMO ARRAY zonal‐progressive multifocal silicone intraocular lens and a monofocal intraocular lens. Ophthalmology 1999;106(7):1243‐55. - PubMed

References to other published versions of this review

Calladine 2012
    1. Calladine D, Evans JR, Shah S, Leyland M. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews 2012, Issue 9. [DOI: 10.1002/14651858.CD003169.pub3] - DOI - PubMed
Leyland 2001
    1. Leyland M, Zinicola E. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews 2001, Issue 3. [DOI: 10.1002/14651858.CD003169] - DOI - PubMed
Leyland 2006
    1. Leyland M, Pringle E. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews 2006, Issue 4. [DOI: 10.1002/14651858.CD003169.pub2] - DOI - PubMed

Publication types