Trifocal IOLs:
Clear vision at all distances

Multifocal IOLs are intraocular lenses with more than one focal range, providing clear vision at different distances. They include various IOL types, such as trifocal IOLs. Trifocal IOLs incorporate three focal ranges, covering all relevant viewing distances – near, intermediate and distance – and can therefore enable spectacle independence. Older multifocal IOLs, for example, have only two focal ranges and are referred to as bifocal IOLs.
Trifocal IOLs are therefore an advanced, modern form of multifocal intraocular lens.

Thanks to Elevated Phase Shift (EPS) technology, presbyopic patients undergoing CLE or cataract surgery receive trifocal correction that delivers excellent image quality with minimised optical disturbances.^[4] This gives them the opportunity to see clearly at near, intermediate and distance ranges and achieve the greatest possible spectacle independence.^[1]
Our extensive multifocal portfolio includes trifocal and trifocal toric capsular bag and sulcus lenses, as well as various AddOn combinations. This allows you to find the best individual IOL solution to provide your patients with a high degree of spectacle independence and quality of life. The 1stQ multifocal portfolio therefore enables you to treat phakic patients and offer pseudophakic patients an upgrade to excellent trifocal performance.

Our multifocal IOLs for the capsular bag and sulcus use Elevated Phase Shift (EPS) technology to generate trifocality with fewer visual disturbances and excellent image quality at all three viewing ranges: distance, intermediate and near.^[1,4]

The optics of 1stQ trifocal intraocular lenses are designed so that the elevated phase shift (EPS) causes light waves associated with the distance zone and the diffractive near zone to reinforce one another.^[4] This creates constructive interference, generating a third focal range for intermediate vision.^[4] The distinctive feature of this approach is that no additional diffractive steps are required for the intermediate range.^[4]
As a result, multifocal capsular bag IOLs require just eight diffractive steps to generate trifocality (+3.5 D addition), while multifocal sulcus IOLs require only six diffractive steps.^[4] Other multifocal intraocular lenses, by comparison, have 14 or more diffractive steps.^[6] As visual disturbances, light scattering and light loss increase with the number of diffractive steps, 1stQ multifocal IOLs with EPS technology achieve excellent trifocal performance with optimised image quality and minimised visual disturbances.[1,2,4] ^(1,2,4)

Our multifocal Basis IOLs for the capsular bag offer the following features:

• EPS technology for excellent trifocal performance with fewer optical disturbances
• Biocompatible hydrophilic acrylic material
• High Abbe number of 58, reducing chromatic aberration
• Refractive index of 1.46, close to that of the crystalline lens
• Extended PCO prevention thanks to 360° sharp edge design as cell barrier
• Optimised A-constants for reliable achievement of the target refraction
• Integrated UV filter as standard
• Natural Yellow blue light filter for natural colour perception and enhanced retinal protection
• Choice of multi-loop haptics or Z-haptics
• Also available with trifocal toric optics (Basis Z, AddOn)

In addition to the features of trifocal Basis and AddOn^® IOLs, the toric trifocal IOLs offer a cylinder range of +1 to +6 dioptres (Basis) or +1 to +4.5 dioptres (AddOn) for precise astigmatism correction.
The toric trifocal Basis IOL features Z-haptics, while the toric trifocal AddOn has four flexible haptics, as do the other AddOn lenses. Both haptic designs ensure stable positioning in the capsular bag or sulcus, respectively.^[7,8]

Our multifocal AddOn IOL allows you to offer patients with monofocal IOLs who desire spectacle independence an upgrade to excellent trifocal performance.[1,4]^(1,4) The trifocal AddOn is implanted in the pseudophakic eye and can be removed or exchanged atraumatically at any time.[2,3]^(2,3) It is compatible with all commonly used capsular bag lenses and is also available in a trifocal toric version.
Like all 1stQ AddOn IOLs, the trifocal and trifocal toric AddOn lenses also offer the following features:

• Suitable for almost any sulcus shape thanks to four flexible haptics
• High rotational stability through their non-torque design [7,8]
• No iris capture thanks to their square design ^[9]
• Rounded edges to prevent iris chafing and pigment dispersion [9]
• No contact with the capsular bag IOL thanks to their convex–concave optical design ^[9]

The dual lens procedure Liberty² with a multifocal AddOn offers a flexible way to correct presbyopia in a single surgical session.^[5,6] A monofocal or monofocal toric Basis IOL is implanted in the capsular bag, with a free choice of all available variants. Trifocality is provided by the multifocal AddOn (+3.0 D addition), which is implanted in the sulcus.
The AddOn remains atraumatically reversible even after many years, providing a high degree of flexibility.[2,3] ^(2,3) The dual lens procedure Liberty² also offers economic advantages, with uniform pricing regardless of the optical combination or lens powers – including toric versions.

Multifocal IOLs with trifocal optics are particularly suitable for patients who want clear vision at all distances without relying on glasses. As people maintain active lifestyles into later life, more and more patients have high expectations of their vision and come to the practice with a clear desire for spectacle independence. Aesthetic considerations are also becoming increasingly important. For these patients, trifocal IOLs can offer a substantial improvement in quality of life.
Trifocal IOLs may also be a useful solution for patients who find glasses inconvenient in everyday life or when pursuing their hobbies.

Liberty² is particularly relevant to younger patients aged 45 and over with advanced presbyopia who are considering clear lens extraction (CLE), are still working and lead active lifestyles. Their eyes need to keep up with both everyday and digital demands, so these patients often have very high expectations of their vision and regard glasses as an obstacle. Liberty² may also be a good option for cataract patients with a strong desire for spectacle independence.
If visual preferences or the physiological condition of the eye change over the years, the flexible multifocality offered by Liberty² can be particularly advantageous. As the AddOn can be removed atraumatically, it offers a flexible safety option.^[2,3] This also applies to patients whose ocular status makes multifocal outcomes difficult to predict preoperatively, such as patients with retinal conditions or those who have undergone LASIK.^[3]

Yes. The multifocal AddOn enables pseudophakic patients to receive a subsequent upgrade to trifocality at any time.^[1] The AddOn is implanted in the sulcus in addition to the existing monofocal capsular bag lens. The AddOn remains atraumatically reversible at any time should explantation or exchange of the sulcus lens become necessary.[2,3] ^(2,3)

The new ‘Match & Mix’ lens concept with RALV^® may be particularly beneficial for these patients. The combination of a trifocal IOL in one eye and an EDOF or Mono+ IOL in the other eye can enable patients to be free from spectacles whilst experiencing even fewer dysphotopsias. ^(1-4) With the innovative RALV device, your patients can also test IOL combinations pre-operatively and find out in advance whether the multifocal option is suitable for them.^(1,5)

⁽¹⁾ 1stQ data collection DOC 2026; data on file

⁽²⁾Naujokaitis T, Łabuz G, Khoramnia R, Auffarth GU. Review of Mix-and-Match Approach and Binocular Intraocular Lens Systems. J. Clin. Med. 2025;14:4263. https://doi.org/10.3390/jcm14124263

⁽³⁾Rakhimova M, Aldasheva N, Auyezova A, Orazbekov L, Utelbayeva Z, Svetlanova S, Karibayeva I. Visual Outcomes After Mix-and-Match Implantation of Trifocal and Extended Depth-of-Focus Intraocular Lenses: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2026;62(6):1112. https://doi.org/10.3390/medicina62061112

⁽⁴⁾Niknahad A, Łabuz G, Muzyka-Woźniak M, Yildrim TM, Son HS, Auffarth GU. An Update on Intraocular Lens Technology for Presbyopia Correction and Visual Outcomes. Med Sci (Basel). 2026;14(2):299. https://doi.org/10.3390/medsci14020299

⁽⁵⁾La Schiazza O, Kornfeld M, Brezna W, Dragostinoff N, Plank N, Socías R. Leistungsbewertung eines Sehsimulators für Intraokularlinsen. Ophthalmologie 2026. https://doi.org/10.1007/s00347-026-02451-7