There is no single best lens. A monofocal lens has fewer optical side effects and is the lens offered on the NHS. Most people choose clear distance vision and wear reading glasses. The Royal College of Ophthalmologists says a modern multifocal lens leaves about four in five people free of glasses, but more people notice halos and glare, and about 1 in 100 have the lens exchanged. Enhanced monofocal and extended depth of focus lenses sit between the two.
At a glance
- Monofocal: one point of focus. Fewer optical side effects. Reading glasses are usually needed.
- Multifocal: more than one point of focus. Less need for glasses. More halos and glare.
- In trials, 880 in every 1,000 people with monofocal lenses needed glasses, against 554 with multifocal lenses.
- NHS: NICE says not to offer multifocal lenses. You cannot pay extra for one during an NHS operation.
- Private: Sapphire Eye Care lists a standard cataract procedure from £2,900 per eye, and a multifocal procedure from £4,300.
The lens types
In cataract surgery the cloudy natural lens is replaced with an artificial one, called an intraocular lens. It stays in the eye for life.
Monofocal
A monofocal lens has a single point of focus. It can give clear vision at distance or near, but not both. The RNIB and Royal College of Ophthalmologists say that most people choose distance, and then need reading glasses for close work such as reading and looking at a phone.
Monovision
Monofocal lenses are used to set one eye for distance and the other for closer vision. In mini-monovision the second eye is set for arm's length. The Royal Free says this may not be advisable if you have a lazy eye, a squint or another eye disease.
Enhanced monofocal
A monofocal lens designed to give better vision at arm's length. In a randomised trial of 139 patients, vision at arm's length was at least one line better on the eye chart than with a standard monofocal lens. Distance vision was comparable. The Royal College of Ophthalmologists told NICE in 2025 that NHS units had been moving to these lenses.
Extended depth of focus (EDOF)
European guidelines describe good vision at distance and arm's length, with glasses for near vision needed in most cases.
Multifocal, including trifocal
A multifocal lens has more than one point of focus. The Royal College of Ophthalmologists says about four out of five patients are completely free of glasses after lens replacement with widely used modern multifocal lenses. Lens replacement is the same operation as cataract surgery.
Toric
A toric lens corrects astigmatism. With a toric monofocal lens you still need reading glasses. There is a small chance that the lens rotates after surgery. A second operation may then be needed to reposition it.
The lens types compared
The same comparison in words:
- Standard monofocal, set for distance: distance: usually without glasses; middle: glasses usually needed; near: glasses usually needed
- Enhanced monofocal: distance: usually without glasses; middle: better than a standard monofocal lens; near: glasses usually needed
- Extended depth of focus (EDOF): distance: usually without glasses; middle: usually without glasses; near: glasses usually needed
- Multifocal, including trifocal: distance: usually without glasses; middle: usually without glasses; near: usually without glasses
What the trials found
A Cochrane review pooled 20 trials that compared multifocal with monofocal lenses. Out of every 1,000 people:
| Result | Monofocal | Multifocal | Certainty of the evidence |
|---|---|---|---|
| Needed glasses | 880 | 554 | low |
| Noticed halos | 80 | 286 | moderate |
| Noticed glare | 180 | 254 | low |
The searches ran to June 2016, and the trials used many makes and models of lens. Newer lenses may perform differently.
A UK trial of 212 patients compared a multifocal lens with monovision. With the multifocal lens 71.3% never wore glasses, against 25.8% with monovision. In the first year, 6 patients (5.7%) with the multifocal lens had it exchanged. Nobody with monovision did.
EDOF or trifocal? A 2024 Cochrane review found the studies too small to detect meaningful differences in glare and halos between the two.
Who may not suit a multifocal lens
- People with other eye conditions. The Royal College of Ophthalmologists says you may not be suitable if you have problems with your eye health. The Dudley Group NHS Foundation Trust says multifocal lenses are usually not suitable if you have other eye conditions.
- People who drive a lot at night. The Royal College says optical side effects may at first interfere with work, leisure activities and night driving.
- People who worry about coping with side effects. The Royal College says a monofocal lens may suit them better.
Side effects tend to diminish with time. The Royal College says 19 out of 20 patients are satisfied or very satisfied with their vision three to six months after multifocal lens surgery. About 1% cannot adapt. They choose to have the lens exchanged for a monofocal lens, which the College calls a potentially complicated procedure.
What the NHS offers
NICE's cataract guideline says: “Do not offer multifocal intraocular lenses for people having cataract surgery.” On the NHS you are offered a monofocal lens. Multifocal and EDOF lenses are only available privately.
The Royal Free says these lenses cannot be bought separately and fitted during an NHS operation.
Toric lenses are not available on the NHS in most areas. Moorfields Eye Hospital says you may be eligible for one at its sites if your astigmatism is 1.75 dioptres or more.
Clinic prices
Prices are per eye, and each is a “from” price.
| Lens | Sapphire Eye Care | Blue Fin Vision |
|---|---|---|
| Monofocal | from £2,900 (standard cataract procedure) | from £4,000 (premium monofocal) |
| Monofocal toric | not on its price list | from £4,500 (premium monofocal toric) |
| Extended depth of focus | from £3,796 | not on its price list |
| Multifocal | from £4,300 | from £4,500 (premium trifocal) |
| Multifocal toric | not on its price list | from £5,000 (premium trifocal toric) |
Blue Fin Vision's prices exclude anaesthetist fees, if an anaesthetist is required. Sapphire Eye Care's clinics are in Berkshire and Surrey, Hampshire and Dorset, and Sussex. Blue Fin Vision's are in London, Hertfordshire and Essex. Payment terms are set by each clinic, so ask for them in writing before you book.
Blue Fin Vision is listed for reference. Enquiries for its clinics are not handled through Eye Surgery Clinic at present.
Want to talk through lens choices with a cataract surgeon? Send one enquiry form. If a partner clinic covers your area and treatment, it contacts you to arrange a consultation.
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Sources
Every clinical statement on this page comes from the sources below. They were read on 27 September 2026.
- Cataracts in adults: management, guideline NG77: recommendations, NICE — multifocal lenses and monovision in NHS cataract surgery, how the lens is chosen
- May 2025 surveillance of guideline NG77: evidence and intelligence, NICE — use of enhanced monofocal lenses in the NHS
- Understanding cataracts (booklet), RNIB and the Royal College of Ophthalmologists — monofocal lenses, glasses after surgery, what the NHS offers, toric lenses
- Refractive lens exchange: patient information, Royal College of Ophthalmologists — multifocal lenses: freedom from glasses, side effects, satisfaction, lens exchange
- What my choices are for vision and glasses after cataract surgery, Royal Free London NHS Foundation Trust — monofocal lenses, mini-monovision, toric lenses, paying for a lens during NHS surgery
- Cataract, Moorfields Eye Hospital NHS Foundation Trust — toric lenses on the NHS, how long a lens stays in the eye
- Cataract surgery: patient leaflet, The Dudley Group NHS Foundation Trust — who multifocal lenses suit, toric lenses
- ESCRS recommendations for cataract surgery, European Society of Cataract and Refractive Surgeons — extended depth of focus lenses
- de Silva SR and others. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews 2016, PubMed Central — glasses, halos and glare per 1,000 people
- Tavassoli S and others. Trifocal versus extended depth of focus intraocular lenses after cataract extraction. Cochrane Database of Systematic Reviews 2024, PubMed record 38984608 — trifocal and extended depth of focus lenses compared
- Wilkins MR and others. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology 2013;120:2449-2455, PubMed record 24070808 — UK trial of a multifocal lens against monovision
- Auffarth GU and others. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. Journal of Cataract and Refractive Surgery 2021;47:184-191, PubMed record 32932369 — enhanced monofocal lens trial
- Our prices, Sapphire Eye Care — the partner clinic's published prices
- Cataract surgery costs, Blue Fin Vision — the clinic's published prices (listed for reference)
About this page
Written by the Eye Surgery Clinic editorial team from the sources listed above. We do not provide treatment: Eye Surgery Clinic is an independent information and introduction service, and treatment is provided by partner clinics. This page is general information and cannot replace advice from a clinician who has examined you.
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