Halos After Multifocal Lens Surgery: How Long Do They Last, and When Should You Get Checked?

Hello. I’m Dr. Jinhag Baik, an ophthalmologist and head director of nuneHIM Eye Center on Siheung-daero in Guro-gu, Seoul.

By November in Seoul, it’s dark by the time most people leave work. That’s when patients who’ve had a multifocal lens implant tend to notice it most: a ring of light around oncoming headlights, street lamps and traffic signals. The questions are usually the same. Is this permanent? When will it go away? Did something go wrong?

The short answer: halos are an expected side effect of multifocal and extended depth-of-focus (EDOF) lenses, and in studies they usually get smaller and fainter over the first six months. They don’t always disappear completely. If they’re still bothersome after that, the next step is to look for treatable causes, not to assume the lens has to come out.

Why multifocal lenses cause halos

In lens-replacement surgery for presbyopia (the same procedure as cataract surgery), the eye’s natural lens is replaced with an artificial one, called an intraocular lens or IOL. A monofocal IOL focuses light at one distance. A multifocal IOL (bifocal or trifocal) splits light between distance, intermediate and near. An EDOF lens stretches a single focus over a longer range.

Because a multifocal lens splits light, every bright point at night also forms an out-of-focus image from the other focal points. You see that as a ring, or halo, around the light. Glare and starbursts can come with it, and all of them are most noticeable in the dark.

Monofocal lenses aren’t halo-free either. They just cause halos less often.

How common are halos?

• A 2016 Cochrane review (20 randomized trials, 2,230 people) found that multifocal lenses gave similar distance vision to monofocal lenses, better near vision and less dependence on glasses. People with multifocal lenses were also about 3.6 times as likely to report halos (risk ratio 3.58, moderate-certainty evidence). The authors concluded that whether the benefit outweighs the halos varies from person to person, and that motivation to be free of glasses is probably the deciding factor.
• In the FDA approval study of one trifocal lens (129 trifocal vs. 114 monofocal patients, non-randomized), 63.8% of trifocal patients reported halos at 6 months, compared with 22.7% of monofocal patients. Severe halos were reported by 12.6% vs. 0.9%. But only 2.4% of trifocal patients said halos bothered them “very much.”

In other words, many people notice halos, but far fewer are seriously bothered by them.

Do halos fade over time?

Usually, yes. In a 2021 Japanese study of 160 patients with trifocal or EDOF lenses, patients rated their own halo size on a 0–10 simulator scale:

Halo size and brightness dropped significantly between each visit, with the largest drop between months 3 and 6. Note, though, that scores at 6 months were still not zero.

Why they fade: your brain adapts

The lens doesn’t change, but your brain does. This is called neuroadaptation.

A 2017 Portuguese study scanned 30 multifocal-lens patients with functional MRI at 3 weeks and 6 months after surgery. Early on, glare reduced the brain’s visual response, and attention and learning areas were working harder than usual. By 6 months that pattern had normalized, and patients’ symptom scores and reading performance had improved. Meanwhile, optical measurements of the eye were unchanged. A smaller 2021 study from China (22 patients) found a similar recovery in visual-cortex activity by 3 to 6 months.

Both studies were small, and neither can predict who will adapt well.

Still bothered after six months? Look for treatable causes

Two studies of dissatisfied multifocal patients (Woodward 2009, 43 eyes; de Vries 2011, 76 eyes) found that most complaints had a fixable cause:

• Posterior capsule opacification (PCO), a clouding behind the implant. It caused 66% of light-related complaints in one study.
• Residual refractive error or astigmatism, which can be corrected with glasses or laser.
• Dry eye, which blurs vision and scatters light.
• Lens decentration or a large pupil, less often.

Conservative treatment helped 81% and 84% of eyes, and only 7% and 4% needed a lens exchange. A 2026 study of 390 eyes reached a similar conclusion and added one more common cause: expectations that didn’t match the outcome.

One important detail: the YAG laser used to clear PCO opens the lens capsule, and that can make a later lens exchange harder. Woodward and colleagues advised delaying the laser until it’s clear an exchange won’t be needed.

What about replacing the lens?

Lens exchange is a last resort. It can reduce halos, but there’s a trade-off. In a 2022 Spanish series, 13 patients swapped their multifocal lenses for monofocal ones at an average of 15 months. Their halos and distance vision improved, but uncorrected near vision got worse, and 77% said they would not repeat the exchange.

Who notices halos more?

Larger pupils and leftover nearsightedness were linked to bigger halos in the 160-patient study. Correcting the residual refraction made halos smaller. These factors help guide counseling, but they can’t predict exactly how one person will experience halos.

Choosing a lens if you drive at night a lot

In a 2013 UK randomized trial of 212 patients, 71.3% of multifocal patients and 25.8% of monovision patients said they never wore glasses at 4 months. But 6 multifocal patients (5.7%) had a lens exchange in the first year, compared with none in the monovision group.

A 2025 review on night driving concluded that night driving can remain challenging for some multifocal patients whose neuroadaptation isn’t complete. If you drive at night often for work, or you’re very sensitive to glare, it’s worth comparing monofocal and monovision options too. The FDA trial above also excluded people with conditions such as macular disease, glaucoma, prior LASIK/PRK or an irregular corneal surface, so results may not apply to those eyes.

Practical tips for the first few months

• Ease into night driving. Start on familiar routes and avoid long, unfamiliar night drives early on.
• Take care of dry eye. Long screen sessions reduce blinking, so use your prescribed drops and take regular breaks.
• Keep notes on when and where symptoms bother you. They make it much easier to pin down the cause.
• If your vision gets better and then turns hazy again months later, mention it at your check-up, because it could be PCO.

The bottom line

“The right presbyopia lens isn’t the one that does the most. It’s the one that fits the distances you use every day and how you live after dark.”

Halos after multifocal surgery are common and usually fade as your brain adapts. If they don’t, the cause is often something treatable. Talk with your ophthalmologist about your night-time habits before choosing a lens, and about any lingering symptoms afterward.

nuneHIM Eye Center (눈에힘안과의원), 5F Gwanghui Building, 551 Siheung-daero, Guro-gu, Seoul. Website: http://www.nunehim.com

This article is for general education, based on published research and FDA device documents as of November 2026. It is not a substitute for an individual eye examination. Whether surgery is appropriate, and which lens to choose, should be decided with an ophthalmologist after testing.

References

1. de Silva SR, et al. Multifocal versus monofocal intraocular lenses after cataract extraction. Cochrane Database Syst Rev. 2016;12:CD003169. https://pubmed.ncbi.nlm.nih.gov/27943250/
2. U.S. FDA. Summary of Safety and Effectiveness Data, PMA P040020/S087 (trifocal IOL), 2019. https://www.accessdata.fda.gov/cdrh_docs/pdf4/P040020S087B.pdf
3. Teshigawara T, et al. Effect of age, postoperative refraction, and pupil size on halo size and intensity with a trifocal or EDOF lens. Clin Ophthalmol. 2021;15:4141–4152. https://pubmed.ncbi.nlm.nih.gov/34703200/
4. Rosa AM, et al. Functional magnetic resonance imaging to assess neuroadaptation to multifocal intraocular lenses. J Cataract Refract Surg. 2017;43(10):1287–1296. https://pubmed.ncbi.nlm.nih.gov/29120714/
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8. Wang K, et al. Reasons for dissatisfaction after implantation of EDOF and trifocal intraocular lenses. BMC Ophthalmol. 2026;26:116. https://pubmed.ncbi.nlm.nih.gov/41792642/
9. Al-Shymali O, et al. Multifocal intraocular lens exchange to monofocal for the management of neuroadaptation failure. Eye Vis (Lond). 2022;9:40. https://pubmed.ncbi.nlm.nih.gov/36316701/
10. Wilkins MR, et al. Randomized trial of multifocal intraocular lenses versus monovision after bilateral cataract surgery. Ophthalmology. 2013;120(12):2449–2455. https://pubmed.ncbi.nlm.nih.gov/24070808/
11. Liu J, et al. Efficacy and safety of extended depth of focus intraocular lenses: a systematic review and meta-analysis. BMC Ophthalmol. 2019;19:198. https://pubmed.ncbi.nlm.nih.gov/31477053/
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