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Purpose: To compare visual acuity outcomes and ocular and intraocular optical quality in patients with a monofocal intraocular lens (IOL) or a multifocal IOL with rotational asymmetry. Setting: Vissum Corporation, Alicante, Spain. Design: Comparative case series. Methods: Consecutive eyes of cataract patients were divided into 2 groups. One group received a Lentis Mplus LS-312 multifocal IOL and the other, an Acri.Smart 48S monofocal IOL. Distance and near visual acuities, contrast sensitivity, intraocular aberrations (global minus corneal aberrations), and defocus curves were evaluated preoperatively and postoperatively during a 3-month follow-up. Results: The study evaluated 52 eyes of 29 patients (age range 36 to 87 years); 24 eyes were in multifocal IOL group and 28 eyes, in the monofocal IOL group. Both groups had a significant improvement in uncorrected and corrected distance visual acuities and in distance-corrected near visual acuity (DCNVA) postoperatively (P≤.04). The multifocal IOL group had significantly better uncorrected near acuity and DCNVA (Jaeger [J] 5 versus J2) (both P<.01). The defocus curves showed significantly better visual acuities in the multifocal group at several levels of defocus. The multifocal group had significantly higher amounts of postoperative intraocular primary coma (P<.01), especially in eyes with significant IOL tilt, although there were no significant differences in contrast sensitivity between the 2 IOL groups (P≥.25). Conclusions: The new-generation multifocal IOL restored distance, intermediate, and near visual function after cataract surgery. The optical quality with this type of IOL was particularly affected by IOL tilt and decentration. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosure is found in the footnotes. [ABSTRACT FROM AUTHOR]