Factors for good near and distance visual outcomes of multifocal intraocular lens with inferior segmental near add



This study was conducted to investigate factors related to postoperative good near and distance visual outcomes in the Lentis Mplus LS-313 MF20 (Oculentis Gmbh, Berlin, Germany) intraocular lens (IOL)-implanted eye.


A retrospective cross-sectional study analyzed a total of 198 eyes of 198 patients. Patients with 20/20-or-more uncorrected distance visual acuity (UDVA, 5 m) and J2-or-more uncorrected near visual acuity (UNVA, 40 cm) were distributed into the good visual outcome (GVO) group (n = 96), and the remaining patients were distributed into the moderate visual outcome (MVO) group (n = 102). Differences between the two groups were compared for patient age, preoperative measurements (kappa distance, kappa angle, and pupil size), and postoperative measurements (residual sphere, cylinder, and spherical equivalent) to explore factors related to good visual outcomes after IOL implantation.


The average age of the GVO group (56.2 years) was significantly lower than that of the MVO group (58.6 years), and the average kappa distance of the former was significantly smaller than that of the latter. However, there were no significant differences between the two groups in kappa angle and pupil size. Notably, multivariate binary regression analysis revealed that multiple factors including age, residual cylinder, and spherical equivalent were associated with good visual outcomes. Based on the receiver operating characteristic curve, cutoff values regarded as good visual outcome following cataract surgery were calculated to be − 0.38 CD in residual cylinder and − 0.32 D in residual spherical equivalent.


Patients with implanted Lentis Mplus LS-313 MF20 IOL who are young, had small kappa distance, and had low levels of postoperative residual cylinder and spherical equivalent tended to exhibit good vision at both near and distance. These results imply that surgeons should minimize postoperative residual cylinder and spherical equivalent to provide good visual outcomes to patients with implanted Lentis Mplus LS-313 MF20 IOL.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


  1. 1.

    Alio JL, Plaza-Puche AB, Fernandez-Buenaga R, Pikkel J, Maldonado M (2017) Multifocal intraocular lenses: an overview. Surv Ophthalmol 62:611–634

    Article  Google Scholar 

  2. 2.

    Chung JK, Lee HK, Kim MK, Kim HK, Kim SW, Kim EC, Kim HS (2019) Cataract surgery practices in the Republic of Korea: a survey of the Korean Society of Cataract and Refractive Surgery 2018. Korean J Ophthalmol 33:451–457

    Article  Google Scholar 

  3. 3.

    Kim MJ, Zheleznyak L, Macrae S, Tchah H, Yoon G (2011) Objective evaluation of through-focus optical performance of presbyopia-correcting intraocular lenses using an optical bench system. J Cataract Refract Surg 37:1305–1312

    CAS  Article  Google Scholar 

  4. 4.

    Montes-Mico R, Lopez-Gil N, Perez-Vives C, Bonaque S, Ferrer-Blasco T (2012) In vitro optical performance of nonrotational symmetric and refractive-diffractive aspheric multifocal intraocular lenses: impact of tilt and decentration. J Cataract Refract Surg 38:1657–1663

    Article  Google Scholar 

  5. 5.

    Karhanova M, Maresova K, Pluhacek F, Mlcak P, Vlacil O, Sin M (2013) The importance of angle kappa for centration of multifocal intraocular lenses. Cesk Slov Oftalmol 69:64–68

    CAS  PubMed  Google Scholar 

  6. 6.

    Moore JE, McNeely RN, Pazo EE, Moore TC (2017) Rotationally asymmetric multifocal intraocular lenses: preoperative considerations and postoperative outcomes. Curr Opin Ophthalmol 28:9–15

    Article  Google Scholar 

  7. 7.

    Alio JL, Plaza-Puche AB, Javaloy J, Ayala MJ, Moreno LJ, Pinero DP (2012) Comparison of a new refractive multifocal intraocular lens with an inferior segmental near add and a diffractive multifocal intraocular lens. Ophthalmology 119:555–563

    Article  Google Scholar 

  8. 8.

    Alio JL, Plaza-Puche AB, Pinero DP (2012) Rotationally asymmetric multifocal IOL implantation with and without capsular tension ring: refractive and visual outcomes and intraocular optical performance. J Refract Surg 28:253–258

    Article  Google Scholar 

  9. 9.

    Eom Y, Kim DW, Ryu D, Kim JH, Yang SK, Song JS, Kim SW, Kim HM (2017) Ring-shaped dysphotopsia associated with posterior chamber phakic implantable collamer lenses with a central hole. Acta Ophthalmol 95:e170–e178

    Article  Google Scholar 

  10. 10.

    Kim JS, Jung JW, Lee JM, Seo KY, Kim EK, Kim TI (2015) Clinical outcomes following implantation of diffractive multifocal intraocular lenses with varying add powers. Am J Ophthalmol 160(702–709):e701

    Google Scholar 

  11. 11.

    Walkow L, Klemen UM (2001) Patient satisfaction after implantation of diffractive designed multifocal intraocular lenses in dependence on objective parameters. Graefes Arch Clin Exp Ophthalmol 239:683–687

    CAS  Article  Google Scholar 

  12. 12.

    Woodward MA, Randleman JB, Stulting RD (2009) Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg 35:992–997

    Article  Google Scholar 

  13. 13.

    Prakash G, Prakash DR, Agarwal A, Kumar DA, Agarwal A, Jacob S (2011) Predictive factor and kappa angle analysis for visual satisfactions in patients with multifocal IOL implantation. Eye (Lond) 25:1187–1193

    CAS  Article  Google Scholar 

  14. 14.

    Tchah H, Nam K, Yoo A (2017) Predictive factors for photic phenomena after refractive, rotationally asymmetric, multifocal intraocular lens implantation. Int J Ophthalmol 10:241–245

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Song IS, Yoon SY, Kim JY, Kim MJ, Tchah H (2016) Influence of near-segment positioning in a rotationally asymmetric multifocal intraocular Lens. J Refract Surg 32:238–243

    Article  Google Scholar 

  16. 16.

    Yoshino M, Bissen-Miyajima H, Minami K (2013) Assessment of whether visual outcomes with diffractive multifocal intraocular lenses vary with patient age. J Cataract Refract Surg 39:1502–1506

    Article  Google Scholar 

  17. 17.

    Plaza-Puche AB, Alio JL, Sala E, Mojzis P (2016) Impact of low mesopic contrast sensitivity outcomes in different types of modern multifocal intraocular lenses. Eur J Ophthalmol 26:612–617

    Article  Google Scholar 

  18. 18.

    Pinero DP, Camps VJ, Ramon ML, Mateo V, Perez-Cambrodi RJ (2015) Error induced by the estimation of the corneal power and the effective lens position with a rotationally asymmetric refractive multifocal intraocular lens. Int J Ophthalmol 8:501–507

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Ramji H, Moore J, Moore CB, Shah S (2016) Can the accuracy of multifocal intraocular lens power calculation be improved to make patients spectacle free? Cont Lens Anterior Eye 39:160–166

    Article  Google Scholar 

  20. 20.

    Calvo-Sanz JA, Sanchez-Tena MA (2018) Characterization of optical performance with defocusing curve: analysis of two refractive intraocular lens models with high and medium addition. J Optom

  21. 21.

    Kohnen T, Hemkeppler E, Herzog M, Schonbrunn S, DeLorenzo N, Petermann K, Bohm M (2018) Visual outcomes after implantation of a segmental refractive multifocal intraocular lens following cataract surgery. Am J Ophthalmol 191:156–165

    Article  Google Scholar 

  22. 22.

    Kohnen T, Titke C, Bohm M (2016) Trifocal intraocular Lens implantation to treat visual demands in various distances following lens removal. Am J Ophthalmol 161:71–77 e71

    Article  Google Scholar 

  23. 23.

    Mastropasqua L, Toto L, Mattei PA, Vecchiarino L, Mastropasqua A, Navarra R, Di Nicola M, Nubile M (2014) Optical coherence tomography and 3-dimensional confocal structured imaging system-guided femtosecond laser capsulotomy versus manual continuous curvilinear capsulorhexis. J Cataract Refract Surg 40:2035–2043

    Article  Google Scholar 

  24. 24.

    Lee DH, Lee HY, Lee KH, Chung KH, Joo CK (2001) Effect of a capsular tension ring on the shape of the capsular bag and opening and the intraocular lens. J Cataract Refract Surg 27:452–456

    CAS  Article  Google Scholar 

  25. 25.

    Kim JH, Kim H, Joo CK (2005) The effect of capsular tension ring on posterior capsular opacity in cataract surgery. Korean J Ophthalmol 19:23–28

    Article  Google Scholar 

Download references


This study was supported by Korea University grants (K1625491, K1722121, K1811051, K1913161, and K2010921) and by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (2018R1C1B6002794). The funding source had no role in the design or conduct of this research.

Author information



Corresponding author

Correspondence to Youngsub Eom.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Public Institutional Bioethics Committee (no. P01-202003-21-002) and the Institutional Review Board of Korea University Ansan Hospital (IRB no. 2020AS0015) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

According to the IRB standard operating procedures on retrospective clinical study, the Ethics Committee ruled that subject consent was not required for this study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, J.W., Eom, Y., Chung, H.W. et al. Factors for good near and distance visual outcomes of multifocal intraocular lens with inferior segmental near add. Graefes Arch Clin Exp Ophthalmol 258, 1735–1743 (2020). https://doi.org/10.1007/s00417-020-04761-1

Download citation


  • Visual outcomes
  • Refractive
  • Multifocal
  • Intraocular lens
  • Kappa distance
  • Residual refractive error