---
title: "Diffractive vs Non-Diffractive Lenses in Glaucoma Eyes"
description: "Premium IOL is not a single risk category. Enhanced monofocals, non-diffractive extended depth-of-focus optics and diffractive multifocal designs each handle light differently, and that difference matters in an eye where contrast sensitivity is already a clinical concern. ## How the…"
url: "https://bluefinvision.com/knowledge-base/topics/treatments-procedures/diffractive-vs-non-diffractive-lenses-in-glaucoma-eyes/"
updated: "2026-05-11"
category: "Treatments & Procedures"
---

# Diffractive vs Non-Diffractive Lenses in Glaucoma Eyes

Premium IOL is not a single risk category. Enhanced monofocals, non-diffractive extended depth-of-focus optics and diffractive multifocal designs each handle light differently, and that difference matters in an eye where contrast sensitivity is already a clinical concern.

## How the optics differ

Diffractive multifocal IOLs split incoming light across two or three focal points. The trade-off is a measurable reduction in contrast sensitivity on objective testing. Non-diffractive EDOF designs use wavefront-shaping optics to extend the focal range without splitting light, producing a contrast sensitivity profile much closer to a monofocal lens. Enhanced monofocals modestly extend depth of focus while preserving monofocal-grade contrast.

## What the glaucoma evidence shows

The conventional position has been that diffractive optics should be avoided in glaucoma. The published evidence does not entirely support that. In primary angle-closure and primary angle-closure glaucoma, postoperative contrast sensitivity at all five tested spatial frequencies is statistically equivalent between multifocal and monofocal IOL recipients, both groups gain contrast sensitivity from cataract removal itself.¹ What objective testing measures does not always reflect real-world function.

For non-diffractive EDOF in mild open-angle glaucoma, the evidence is more direct. Prospective data on 52 eyes show preserved contrast sensitivity, strong visual acuity outcomes and high satisfaction.² In early glaucoma compared with monofocals, non-diffractive EDOF delivers better intermediate and near vision, significantly higher spectacle independence and significantly higher satisfaction, with rare bothersome photic phenomena.³

The honest answer is that diffractive optics are not categorically wrong in glaucoma, but they raise the threshold of selection and counselling. Non-diffractive EDOF is the easier case to make.

**References**

1. Kitnarong N, Dagvadorj D, Anothaisintawee T. Effect of multifocal intraocular lens on contrast sensitivity in primary angle-closure patients. *Siriraj Med J*. 2023;75(7):497-504.
2. Ferguson TJ, Wilson CW, Shafer BM, Berdahl JP, Terveen DC. Clinical outcomes of a non-diffractive extended depth-of-focus IOL in eyes with mild glaucoma. *Clin Ophthalmol*. 2023;17:861-868.
3. Kerr NM, Moshegov S, Lim S, Simos M. Visual outcomes, spectacle independence, and patient-reported satisfaction of the Vivity extended range of vision intraocular lens in patients with early glaucoma: an observational comparative study. *Clin Ophthalmol*. 2023;17:1515-1523.

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