What are the pros and cons of Multifocal IOLs vs. EDOF IOLs?

Multifocal IOLs provide excellent near, intermediate, and distance vision with high spectacle independence, making them attractive for patients who prioritize reading and near tasks, but they achieve this via light-splitting diffractive optics that reduce contrast sensitivity and can cause significant photic phenomena (halos, glare, starbursts), limiting their suitability for patients with night-driving demands, mesopic pupil issues, or subtle macular pathology. EDOF IOLs instead extend a single focal point into a range of functional vision (typically distance through intermediate) with better contrast sensitivity and fewer dysphotopsias than multifocals, at the cost of weaker near vision that often still requires readers for fine print. In...

Any retinal comorbidity can make a multifocal IOL visually debilitating and decisively disadvantageous. This includes DR, RVO, age-related maculopathy, ERM, and others, even glaucoma. Patients must be counselled on this.

Cataract surgery is not just for the present; it is for the rest of the patient's life, so I would strongly discourage the use of multifocal IOLs in anyone who either has or might develop any retinal condition in the future.

Even a macular sparing retinal tear or RD can result in ERM later on. Multifocal optics also make it much more difficult to evaluate, laser, or operate on the posterior segment.

I would recommend avoiding multifocal IOLs altogether unless everything else is perfect and expected to remain perfect in both...