Should multifocal lenses be avoided in patients with concurrent pathology affecting the retina? A systematic review
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Purpose It is common for cataract surgeons to avoid implanting multifocal intraocular lenses (MIOLs) during cataract surgery in patients with concurrent retinal pathology, primarily for fear of poorer postoperative visual outcomes compared with monofocal lenses. However, there has been little literature seeking to affirm or challenge this practice. Thus, this systematic review aims to evaluate the visual outcomes of MIOL use in patients with concurrent retinal pathology to date. Methods This systematic review complied with PRISMA2022 reporting guidelines and was prospectively registered on PROSPERO (CRD42025646744). We identified articles describing MIOL implantation during cataract surgery in patients with coexisting retinal pathology by systematically searching PubMed, Medline, EMBASE and SCOPUS, on June 7th, 2025. Results We identified 2031 papers in the initial search. After screening 981 papers, 11 were included for review. Visual outcomes after trifocal IOL implantation in 520 eyes with concurrent retinal pathologies were similar to those achieved in comparator lenses, albeit with more variability when retinal disease was more advanced. Contrast sensitivity with MIOLs was more significantly reduced in patients with more advanced retinal disease staging for dry age-related macular degeneration, epiretinal membrane and manifest but not preperimetric glaucoma. Conclusion The findings of this systematic review suggest multifocal IOLs have led to acceptable postoperative visual outcomes in some patients with early, but not more advanced retinal disease including glaucoma at the time of cataract surgery. Insufficient data exists to guide when to strictly disadvise MIOLs. However, preliminary evidence suggests visual and functional outcomes to be inferior in eyes with advanced retinal disease and manifest glaucoma, which may discourage MIOLs in eyes with even early-stage disease given the risk of disease progression.
