Objective:To analyze the cause of poor distance visual acuity after refractive rotationally asymmetric multifocal intraocular lens (IOL) implantation in cataract patients.Methods:The data were collected from patients who underwent cataract phacoemulsification combined with intraocular lens (refractive rotationally asymmetric multifocal intraocular lens, SBL-3) implantation at Beijing Aier Intech Eye Hospital from December 2016 to December 2018, and followed up for six months after operation. Standard logarithmic visual acuity chart was used to record uncorrected distance visual acuity, best corrected distance visual acuity, intermediate visual acuity, and near visual acuity. Defocus curve was drawn. The corneal topography, postoperative visual quality and intraocular lens centered or not were checked by Itrace.Results:Total 95 eyes of 70 patients were implemented by cataract phacoemulsification combined with regional refractive intraocular lens operation. Among them, uncorrected distance visual acuity of 16 eyes of 16 patients, were less than or equal to 0.6. The distance power zone of the intraocular lens of 7 patients were placed in the area of high corneal refractive power. Because of measurement error, reserved error, etc, the power of IOL in 7 patients had deviations. Farsightedness and dizziness occurred in 2 patients. The visual discomfort symptoms disappeared and vision improved through intraocular lens positioning.Conclusions:The poor quality of distance visual acuity is mainly caused by the coincidence of the distance power zone with the corneal high-refractive region, the deviation of the power of the intraocular lens, and the intraocular lens center shift. If the cornea has a high refractive area, the distance power zone should avoid to be placed in the same area. The intraocular lens should be reserved between 0-+ 0.25 D. Two-step surgery is recommended. It′s also recommended to make sure the lens is centered during the operation by lens reflection method.