PurposePresbyopic patients over the age of 50 often present decreased lens transparency and increased lens volume. This, however, may reduce anterior chamber as well as angle depth and lead to angle closure and IOP increase. A possible solution for these problems is clear lens exchange with multifocal IOL implantation.MethodsAccurate preoperative evaluation and patient selection are mandatory. Anterior chamber OCT provides accurate and objective evaluation of lens size and angle opening. Cataract surgery can be performed with the well-accepted technique of topical anesthesia, lateral incision, capsulorhexis, hydrodissection, phacoemulsification. Multifocal IOL is implanted according to refractive situation, patient life style, eye dominance, and established distance and near vision.ResultsOcular dominance with good distance vision must be preserved, patient expectations must be realistic and care has to be dedicated in identifying the best possible IOL for the case. All the opportune steps must be taken to prevent posterior capsule opacification.ConclusionsIdentification of dominant eye is mandatory, since 35% of the population has one clearly dominant eye, usually in charge of providing good distance vision. Following a meticulous approach, clear lens exchange with multifocal IOL implantation may prove to be a safe and reliable technique for the treatm.