Sulcoflex Trifocal IOL – Dr. Alberto Bellone

In August 2018, the first implant in the world of an additional trifocal cataract lens, Sulcoflex, was performed. What is that?

When cataract is operated, the crystalline is removed and an artificial crystalline is implanted that remains in the eye in one’s whole lifetime; if there is a refractive calculation error, that is, we wanted the patient to be able to see well from afar without glasses but in reality the patient has a vision defect of 1,2,3,4 diopters of myopia, astigmatism or hypermetropia, these visual defects can be corrected with an almost risk-free and very minimally invasive surgery: How?

By inserting a special non-cataract lens inside the eye but which is added to the lens that was implanted during the cataract surgery; clear lens, well-positioned, well-housed inside the eye but not correct from the refractive point of view.

The new lens that is added can correct the defect of sight to our liking, therefore there are lenses that are called piggy-back that are to be added in the eye, in the case of the Sulcoflex series, which are well suited to the position in which they must be implanted, i.e. in the sulcus: the area of the eye that is exactly behind the iris and immediately in front of the implanted artificial lens; these lenses adapt well, are very stable and allow a near-perfect residual vision correction.

Surgery can also be performed under topical anesthesia (i.e. only with drops), it lasts 2-3 minutes and the patient returns to see how he wanted and should have seen after the first cataract surgery.
These lenses are a great chance for all those patients who have underwent cataract operation but have a residual vision defect.

This is what happened from August 2018, because these Sulcoflex lenses started being available to us and we used them to correct sight defects.

The company has thought of combining trifocal technology, that is intraocular lens technology that allows seeing at all distances (far, half-distance and close), to Sulcoflex technology, that is to make a piggy-back lens.

This was a revolution. The patients who did a cataract surgery 5, 10, 15 years ago and has a certain degree of satisfaction, they do see well and are satisfied with their amount of vision but not the quality because in order to see well, they still need to use a pair of glasses, in these cases, they can do an upgrade and become like cataract patients who are supervised by trifocals. Therefore, the trifocal Sulcoflex piggy-back lens is the means, that is at our disposal today, to have an upgrade of what is a well-conducted but is now an old cataract surgery. It will certainly have a very important impact and it is our duty to make it known, to let people know that it can create this possibility.

It may happen to a couple. The husband has already been operated on ten years ago and is happy with how he sees but he still wears glasses. On the other hand, his wife is operated on with cataract surgery of today, a trifocal is implanted in her, she no longer uses her glasses to ski, play golf, go boating, go underwater. Then, her husband would like to experience the same things without apprehension and comes to ask if he can do the upgrade and have the product of today. Yesterday, this could not be realized. Thankfully, from August 2018, it can already be done with all the cataracts that, I repeat, went very well, the patient was operated on perfectly by the previous surgeon, from the point of view of transparency the lens is perfect but has a residual defect of sight so we want to have a multifocal lens inside the eye.

What Is Sulcoflex Trifocal?


Sulcoflex Trifocal can offer you the FREEDOM to see CLEARLY at all distances without glasses.

You may have better distance vision after cataract surgery, but do you still need glasses for close-up activities like using your mobile phone or reading?

sulcoflex trifocal innovation

A highly advanced supplementary intraocular lens (IOL), Sulcoflex Trifocal is placed in front of the original lens that was implanted during your cataract surgery. With industry-leading optical technologies designed to enhance your near and intermediate vision, Sulcoflex Trifocal can rid the need to wear glasses for most everyday activities at any distance.

Sulcoflex Trifocal features a patented optic that can focus light from any distance. The innovative design splits the light as it enters your eye, giving you separate points of focus for near, intermediate and distance vision. Think of it like having 3 IOLs in one lens.

Sulcoflex Trifocal’s innovative design encourages stable positioning in the eye, for reliable and dependable outcomes. Fewer rings on the optic surface than many trifocal IOLs results in reduced potential visual disturbances and improved night vision.

A trusted British manufacturer of IOLs for over 70 years, Rayner is the only company to offer this advanced optical technology. Designed in partnership with a leading European technology institute, the optical technology in Sulcoflex Trifocal is the most advanced in Rayner’s history.

Sulcoflex Trifocal is a small supplementary IOL that is implanted in front of your existing monofocal IOL. It is made of Rayner’s clinically-proven Rayacryl hydrophilic acrylic material for superb optical clarity. Rayacryl is also biocompatible with eye tissue, which helps to avoid inflammation and irritation.

12 Years Clinically-Proven Platform

41 Thousand Sulcoflex Lenses Around the World

97% Don’t Need Glasses With Rayner Trifocal Technology*

* Data available upon request

Vision After Cataract Surgery
vision after cataract surgery

When referring to our vision, activities are typically defined as being one of the following:

near distanceNear Distance – reading, writing, using your mobile phone

intermediate distanceIntermediate Distance – using your computer, swinging a golf club, or doing anything at arm’s length

far distanceFar Distance – driving, cycling, watching TV

Our eye contains a natural lens that focuses light as it enters our eye. This natural lens flexes its shape depending on whether the light is coming from something close or far away, so that it usually appears sharp and with clarity.

When the cataract inside the natural lens is removed, our ability to naturally focus light is lost and so a small artificial lens (called an intraocular lens, or IOL) is put in its place.

Because the old intraocular lens can’t flex its shape, it can only focus light coming from one distance – usually ‘far distance’. For light coming from near distance and intermediate distances, we rely on glasses to focus the light and give these objects clarity.

What Are the Potential Benefits of Sulcoflex Trifocal?

Sulcoflex Trifocal is the world’s first trifocal supplementary IOL for people who have already had cataract surgery.

Sulcoflex Trifocal can be implanted at any time after your cataract surgery.

Unlike other procedures, if you don’t adapt to Sulcoflex Trifocal lenses then your eye surgeon can remove them. Our eyes are forever changing, and not everyone is able to adapt to trifocal vision. Unlike other procedures which are permanent with no option of adjustability, Sulcoflex Trifocal can be removed, replaced or even upgraded at any time – providing you with flexibility and peace of mind.

Reduce your reliance on glasses for activities at any distance.

Similar to your cataract surgery, Sulcoflex Trifocal implantation is fast, safe and clinically proven. The procedure is performed by an eye surgeon and usually only takes a few minutes. Your eye surgeon may perform the procedure on both eyes in the same session or may arrange a separate visit for your second eye.

Visual Adjustment
If your distance vision after cataract surgery is not as good as it should be, then Sulcoflex Trifocal can correct this at the same time.

8 Million IOLs With Rayner’s Biocompatible Material

100% Patients Don’t Need Glasses for Computer Work*

100% Patients Would Repeat the Rayner Trifocal Surgery*

* Data available upon request

How Does Sulcoflex Trifocal Work?

Whether it’s because of constantly putting them on and taking them off throughout the day, or accidentally leaving them behind when you need them, using reading glasses can be annoying.

Even simple ‘transition’ situations such as watching TV and then reading a message on your mobile phone, teeing off on the golf course and then watching the ball fly down the fairway, or reading a menu and then looking up to say your choice can be slowed down by the use of glasses.

It is likely that the lens that was implanted during your cataract surgery has a single point of focus. This type of lens is known as a ‘monofocal’ intraocular lens (IOL) and typically means that only objects in the distance (more than 6.5ft in front of you) can be seen in detail.

For everything else, you usually need glasses to focus the light as it enters your eye. Approximately 92% of people have this type of lens implanted during cataract surgery.

Unlike a monofocal IOL, Sulcoflex Trifocal has 3 points of focus that cover near, intermediate and distance vision. When paired with the monofocal IOL in your eye, Sulcoflex Trifocal is a flexible solution that can reduce your need to wear glasses for more close-up activities, like reading or gardening.

Sulcoflex Trifocal is one of the most advanced intraocular lenses (IOLs) available today, giving you the opportunity to increase your independence from wearing glasses for the majority of everyday activities, at any distance.

Recovery and Follow Uprecovery and follow up

After Sulcoflex Trifocal surgery, your brain will have to get used to the way your new trifocal IOL processes light. All trifocal IOLs split light at different points across their surface to give you multiple points of focus at any one time. You may need a little more time to adjust, reinterpret and resolve these images so you see one clear image. This process of adjustment is called ‘neuroadaptation’ and varies from person to person, but usually you will have adjusted within a few weeks.
If you struggle with the neuroadaptation then you may choose to discuss removing Sulcoflex Trifocal with your eye surgeon, reverting back to your previous vision and the use of glasses for near and intermediate activities.

Am I Suitable? UNDERSTAND if This Is Right for You

Sulcoflex Trifocal is suitable if you…

  • Are keen to get rid of your glasses for activities at near and intermediate distances
  • Spend a lot of time doing near distance activities, like reading or using a mobile phone/computer

Sulcoflex Trifocal may not be suitable if you have co-existing eye conditions or do a lot of night driving.

What Are the Risks?

Side effects and complications with Sulcoflex Trifocal are rare. Some of the adverse reactions that have been associated with the implantation of trifocal intraocular lenses like Sulcoflex Trifocal are:

  • Decrease in contrast sensitivity – the ability to distinguish between light, dark and colours
  • Halos when driving at night – a halo shaped light appearing around headlights and traffic lights, which usually decrease with time (neuroadaptation)

Unlike other procedures, Sulcoflex Trifocal is reversible and can be removed by your eye surgeon if you do experience any side effects or are unable to adapt to them.

As with all surgical procedures, the outcomes for a trifocal intraocular lens cannot be guaranteed. It is important to be aware of possible effects on vision after surgery. Please discuss possible risks and side effects with your eye surgeon. Not all patients are suitable for this type of intraocular lens. Your eye surgeon at the time of consultation will indicate whether this type of lens is suitable for you.


What is Sulcoflex Trifocal?
Sulcoflex Trifocal is a high precision optical device that is surgically placed behind the iris and in front of the primary intraocular lens (IOL) that was implanted in your eye during cataract surgery. Sulcoflex Trifocal can help to remove the need for glasses for the majority of everyday activities.

How does Sulcoflex Trifocal work?
Sulcoflex Trifocal uses advanced diffractive optic technology that splits the incoming light to create simultaneous multiple images on the retina of distant, intermediate and near objects. The optics transmit 89% of available light to the retina.

Who is Sulcoflex Trifocal intended for?
Sulcoflex Trifocal is primarily intended for people who have already had the natural lens in their eye replaced with an artificial lens during cataract surgery (known as pseudophakia). These people consequently need to wear glasses for near and intermediate activities, which they find frustrating.

Who should not have the Sulcoflex Trifocal procedure?
Sulcoflex Trifocal may not be suitable if you have co-existing eye conditions or do a lot of night driving. You should always discuss your suitability for Sulcoflex Trifocal with a suitable refractive eye surgeon.

What are the key potential benefits of Sulcoflex Trifocal?
The key potential benefit of Sulcoflex Trifocal is the ability to see clearly and perform activities at any distance (near, intermediate, far) without the need for glasses. If your vision after cataract surgery is not as good as it should be then Sulcoflex Trifocal can correct this at the same time. Unlike other procedures, if you do not adapt to your new vision then your surgeon has the option to remove Sulcoflex Trifocal.

What is Sulcoflex Trifocal made of?
Sulcoflex Trifocal is made of Rayacryl, Rayner’s proprietary hydrophilic acrylic material. Rayacryl has been safely used in cataract surgery around the world for over 20 years. The material is clinically-proven to have excellent biocompatibility (it does not cause a reaction inside the eye) and offers superb optical clarity.

Can Sulcoflex Trifocal be removed from my eye?
Unlike many other corrective procedures, Sulcoflex Trifocal can be removed, exchanged or upgraded at any time. If Sulcoflex Trifocal is removed then you will revert to needing glasses for near and intermediate vision.

Will anyone be able to see my Sulcoflex Trifocal IOLs?
No, Sulcoflex Trifocal is implanted behind your iris (the coloured part of the eye). Only eye care professionals will be able to tell that you have had the advanced lens implanted.

What happens during the Sulcoflex Trifocal procedure?
The procedure is very similar to your original cataract surgery, except that it is less invasive because your natural lens has already been replaced. Local anaesthetic is administered and there is very little discomfort during the procedure which only takes a few minutes. You can leave the clinic the same day but will need someone to drive you home. Some eye drops or medication will be prescribed, and you will typically visit your eye surgeon the next day to see how your vision is adapting to the new lens.

How quickly will my eyes adapt to Sulcoflex Trifocal?
Everyone is different but most people experience the benefits of Sulcoflex Trifocal within a couple of days, with many seeing vast improvements the very next day.

When I had cataract surgery, my eye surgeon advised that I wasn’t suitable for multifocal/trifocal IOLs. Will it be the same with Sulcoflex Trifocal?
Because Sulcoflex Trifocal can be removed by your eye surgeon if you do not adapt to trifocal vision, they may re-evaluate your suitability.

Can my monofocal IOL be swapped for a trifocal IOL?
An eye surgeon will only remove a monofocal IOL under special circumstances because it can cause damage to the eye. Sulcoflex Trifocal can help you to achieve glasses-free vision without the need to remove your monofocal IOL.

Is Sulcoflex Trifocal permanent?
Sulcoflex Trifocal lenses can be removed, replaced or upgraded by your eye surgeon at any time.

Does it matter which monofocal IOL I have implanted in my eye?
No, Sulcoflex Trifocal can be placed in front of any monofocal IOL that was implanted at any time.

What is the price of the Sulcoflex Trifocal procedure?
The price of the Sulcoflex Trifocal procedure varies by surgeon and clinic. Your surgeon will be able to advise pricing and payment plans during your initial consultation.

In 2014, I had a cataract operation and they put a normal lens in my eye. I still had to wear a progressive lens so I can see far and near. Then, the another cataract was growing on the other eye and I met Dr. Bellone just in time. He advised me that we could put, instead of a normal lens, a trifocal lens after I removed my cataract. That’s what we did. So, I can see very well now without glasses. However, he said that there is something to make my eyes more perfect. In my left eye, where I had a cataract operation in 2014, we could put a piggyback lens so that I can now see perfectly far and near without glasses. That’s what we did. So now, with my eyes, I can see far and near, no more glasses. That’s it.

What is new of this surgery is not the trifocal of the right one [eye]. For me, for other doctors, it is a normal surgery to implant a trifocal lens but the problem is when you have a patient that had implanted a normal lens, monofocal lens, in the other eye. How can we manage this situation? We can manage this situation by implanting a piggyback IOL. That is a lens that we put under the old one. From August 2018, we have the new lens, Sulcoflex piggyback trifocal, that is an additional lens that we can implant into the eye. We can upgrade all the patients that had all the normal surgeries. She decided to implant both trifocal lens. Primary, we can call it primary lens in the right one with the normal femto cataract surgery with the trifocal primary lens and then, a piggyback IOL in the left one. The best thing is she feels better with the left one because it is the dominant one. So, she didn’t have any problem during the surgery. She didn’t have any kind of issue after the surgery.

There is no side effect. They took out the patch and then, I can see normally as if there’s no problem, no side effect.

Do you feel any difference between the left and the right one?

Yes, the left one actually is even better than the right one. The left one that had this cataract surgery, with the piggyback, is even better. And I feel that my balance is now better. Because before this operation, my balance, I was leaning towards one side more but with both operations, the trifocal and the piggyback, when I walk, my balance has improved a lot. So, it has got something to do with the eyes.

Okay. So you are happy with your operation.

Yes, I am very happy with the upgrade. I’m glad I met you because it is just the right timing.

Yes. What about your night vision? Do you see any kind of halos?

No, I don’t see any. You know before the operation there was something flying over my eye. Right now, there is nothing. You know, it’s just clear. Clear vision.

Useful vision.

Yes, useful vision. It’s like before I had the cataract when I was younger. I recommend it to everybody. It’s a new thing but no side effects. It’s the most important thing. It’s non invasive. It’s very short. Very quick you don’t even know you had it. It’s like they’re just going to start but it’s already finished.