OBJECTIVE: To model the lifetime costs and consequences of wearing spectacles versus implantation of ReSTOR® (a multifocal IOL), or other multifocal IOLs (MFIOLs), in the treatment of presbyopia. METHODS: A Markov model followed subjects from age 45 (presbyopia onset) to death. The prevalence rates of patients without spectacles after ReSTOR® surgery and other MFIOLs were taken from clinical trials. The number of cataract operations avoided by presbyopia surgery (PS) and mortality prevalence rates were estimated from national statistics. Resource utilization included surgical procedures, implants, spectacles, visits to ophthalmologists and eye-centers, transportation, and time lost by patients. Discount rates and sensitivity analyses were performed. Two perspectives were considered: Sickness Fund (SF) and Societal. RESULTS: Spectacle-free rates were >80% for ReSTOR® and 40% for MFIOLs. Mean lifetime numbers of spectacles purchased were 4.2 with ReSTOR®, 12.7 with MFIOLs, and 21.3 without PS. Early PS avoided 0.80 late cataract surgeries per subjects. Surgical procedure costs were €3292 for ReSTOR® and €2292 for other MFIOLs, respectively. From the societal perspective, total undiscounted costs for ReSTOR® were €5268, €7170 for other MFIOLs, and €8492 without PS. With a 3% discount rate, these costs were €4569, €5071 and €4244, respectively. From the SF perspective, total undiscounted costs were €146 with ReSTOR®, €437 with MFIOLs, and €1.688 without PS. With a 3% discount rate, these costs were €76, €227 and €747, respectively. CONCLUSION: PS should decrease the undiscounted costs of vision care from both perspectives. For SF it is highly beneficial while PS remains unlisted for reimbursement. For Society, the discounted incremental cost of avoiding spectacles at age 45 was less than €9/year. ReSTOR® improves patients' lifestyle and is a cost-effective alternative versus spectacles in presbyopic patients.