OBJECTIVE To compare contrast sensitivity and glare disability provided by diffractive and refractive multifocal intraocular lenses (IOLs). METHODS University Eye Clinic Vienna, Austria. METHODS This study evaluated the contrast sensitivity and glare disability in 29 eyes with a diffractive multifocal IOL (3M815LE) and 12 with a three-piece, five-zone refractive multifocal IOL (AMO Array SSM 26 NB). The Brightness Acuity Tester (Mentor, Inc.) was used with stationary sinusoidal gratings at spatial frequencies of 0.5, 1, 3, 6, 11.4, and 22.8 cycles per degree (cpd) generated on a television monitor (Nicolet CS 2000). RESULTS The contrast sensitivity functions of both multifocal IOL groups were within the reference range and were identical at 0.5, 1, and 22.8 cpd spatial frequencies. At 3, 6, and 11.4 cpd, the contrast sensitivity function in the diffractive IOL group was 6, 9, and 10% lower than in the refractive IOL group, and the difference between groups was statistically significant at 6 cpd. When glare was present, contrast sensitivity in the diffractive IOL group was generally in the lower limit of the reference range and remained below at 3 and 6 cpd. Contrast sensitivity in the refractive IOL group remained below the reference range at 3 cpd. At 0.5 and 1 cpd, there were no differences between the groups. At the middle and high spatial frequencies (3, 6, 11.4, 22.8 cpd), contrast sensitivity in the diffractive group was 8, 16, 11, and 12% lower than in the refractive group. At 6 cpd, the between-group difference was statistically significant. CONCLUSIONS Diffractive multifocal IOLs provided decreased contrast sensitivity and greater glare disability than refractive multifocal IOLs.