Multifocal Intraocular Lenses: Historical Perspective

  • Kenneth J. HofferEmail author
  • Giacomo Savini
Part of the Essentials in Ophthalmology book series (ESSENTIALS)


The first concept of a truly multifocal intraocular lens (IOL) was conceived in 1982 by Kenneth J. Hoffer, MD, in Santa Monica, CA, USA, following the examination of a patient with bilaterally decentered posterior chamber IOLs. Each optic was decentered such that the IOL optic only partially covered the pupil. The patient refracted to 20/25 (0.80) best corrected visual acuity (BCVA) with a standard refractive error and then did the same with a large aphakic (+10) refractive correction. The patient had no adverse symptoms (glare, haloes) which could only be explained by a concept of simultaneous image formation of two different foci where the brain is selecting the most beneficial image. This concept led to the fabrication by Iolab of the first multifocal IOL by slicing in half two different powered IOLs (an 18D and a 21D) and gluing the opposite halves together.

This chapter describes the people involved who made this happen and the measures taken to get this concept accepted as well as how the fabricated Split Bifocal IOLs were finally implanted in two American patients in 1990 after cleaning and sterilization by Ioptex. No manufacturer became interested in following up with the idea until the author discovered the Oculentis Mplus bifocal IOL at the Paris ESCRS Meeting in September 2010. This lens is almost an exact copy of the original Hoffer Split Bifocal and has had tremendous success in the EU by many respected surgeons. This has proven that the original concept of brain selectivity from 1983 is correct.


Refractive error Corneal power Diffractive lens Multifocal lens Multifocal intraocular lens, Split Bifocal IOL 


Compliance with Ethical Requirements

Kenneth J. Hoffer MD and Giacomo Savini MD have no conflict of interest in the topic of the chapter.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000 (5). Informed consent was obtained from all patients for being included in the study.

No animal studies were carried out by the authors for this article.


  1. 1.
    Hoffer KJ. Personal history in bifocal intraocular lenses, (Chapter 12). In: Maxwell A, Nordan LT, editors. Current concepts of multifocal intraocular lenses. Thorofare: Slack, Inc; 1991. p. 127–32.Google Scholar
  2. 2.
    Holladay JT, van Dijk H, Lang A, Portney V, Willis TR, Sun R, Oksman HC. Optical performance of multifocal intraocular lenses. J Cataract Refract Surg. 1990;16(4):413–22.CrossRefGoogle Scholar
  3. 3.
    Duffey RJ, Zabel RW, Lindstrom RL. Multifocal intraocular lenses. J Cataract Refract Surg. 1990;16(4):423–9.CrossRefGoogle Scholar
  4. 4.
    Alio JL, Piñero DP, Plaza-Puche AB, Rodriguez Chen MJ. Visual outcomes and optical performance of a monofocal intraocular lens and a new-generation multifocal intraocular lens. J Cataract Refract Surg. 2011;37(2):241–50.CrossRefGoogle Scholar
  5. 5.
    Alio JL, Plaza-Puche AB, Piñero DP, Javaloy J, Ayala MJ. Comparative analysis of the clinical outcomes with 2 multifocal intraocular lens models with rotational asymmetry. J Cataract Refract Surg. 2011;37(9):1605–14.CrossRefGoogle Scholar
  6. 6.
    Muñoz G, Diego CA, Ferrer-Blasco T, Hani F, Sakla HF, García-Lazaro S. Visual function after bilateral implantation of a new zonal refractive aspheric multifocal intraocular lens. J Cataract Refract Surg. 2011;37:2043–52.CrossRefGoogle Scholar
  7. 7.
    Gárate JO, González BD, Cruchaga EV, Moreno IR, Barrenetxea IB, Larracoechea UA. Clinical analysis of the LS-312MF Mplus intraocular lens. J Emmetropia. 2011;2:13–20.Google Scholar
  8. 8.
    McAlinden C, Moore JE. Multifocal intraocular lens with a surface-embedded near section: short-term clinical outcomes. J Cataract Refract Surg. 2011;37:441–5.CrossRefGoogle Scholar
  9. 9.
    van der Linden JW, van Velthoven M, van der Meulen I, Nieuwendaal C, Mourits M, Lapid-Gortzak R. Comparison of a new-generation sectorial addition multifocal intraocular lens and a diffractive apodized multifocal intraocular lens. J Cataract Refract Surg. 2012;38:68–73.CrossRefGoogle Scholar
  10. 10.
    Alió JL, Plaza-Puche AB, Montalban R, Javaloy J. Visual outcomes with a single-optic accommodating intraocular lens and a low-addition-power rotational asymmetric multifocal intraocular lens. J Cataract Refract Surg. 2012;38:978–85.CrossRefGoogle Scholar
  11. 11.
    Alio JL, Plaza-Puche AB, Javaloy J, José Ayala M, Moreno LJ, Piñero DP. Comparison of a new refractive multifocal intraocular lens with an inferior segmental near add and a diffractive multifocal intraocular lens. Ophthalmology. 2012;119:555–63.CrossRefGoogle Scholar
  12. 12.
    Auffarth GU, Rabsilber TM, Philips R, Novak J. Oculentis LENTIS Mplus: a new concept of multifocal intraocular lens technology. In: Presented at the XXVII Congress of the European Society of Cataract and Refractive Surgeons, Barcelona, Sept 2009. Summary available at: Accessed 15 Oct 2010.
  13. 13.
    Advanced multifocal IOL technology, Supplement to Cataract and Refractive Surgery Today: Europe. Vol I; 2012.Google Scholar
  14. 14.
    Hoffer KJ. Lens power calculation for multifocal IOL’s, (Chapter 17). In: Maxwell A, Nordan LT, editors. Current concepts of multifocal intraocular lenses. Thorofare: Slack, Inc; 1991. p. 193–208.Google Scholar
  15. 15.
    Holladay JT, Hoffer KJ. Intraocular lens power calculations for multifocal intraocular lenses. Am J Ophthalmol. 1992;114:405–8.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Stein Eye Institute, University of CaliforniaLos AngelesUSA
  2. 2.St. Mary’s Eye CenterSanta MonicaUSA
  3. 3.Studio Oculistico d’AzeglioBolognaItaly

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