Modern cataract surgery has developed tremendously during the past 10-15 years. Improved surgical techniques, as well as improved implant materials and designs, have enlarged patient profiles and indications for cataract surgery. This also created much higher expectations from the patients' site. The loss of accommodation is loss of quality of life for presbyopic and especially young pseudophakic patients. Therefore cataract surgery with multifocal IOL implantation is not only of academic interest, but reflects demands and expectations of our patients. Multifocal IOLs have been implanted since 1986, starting with 2-3 zone refractive and diffractive designs. Due to surgical techniques of that time MIOL decentration and surgically induced astigmatism were possible complications. In addition reduced contrast sensitivity and increased glare were common problems of MIOL because of their optical principles. New developments in this field in recent years such as the multizonal, progressive refractive MIOL in combination with improved surgical techniques have overcome those initial problems. Therefore, modern multifocal IOLs can be considered not only for correction of aphakia but also for refractive purposes.