This study compares the optical quality of zonal refractive multifocal and diffractive bifocal intraocular lenses (IOLs) and visual outcomes after implantation in 93 patients(93 eyes) with cataracts and high myopia. A retrospective analysis was conducted to measure visual acuity at far, intermediate, and near distances, defocus curves, wavefront aberrations, modulation transfer function (MTF), a Quality of Vision questionnaire (QoV) and visual quality self-evaluation were examined at 3 months. The results demonstrated the ZMB group showed better uncorrected near visual acuity (
P
< 0.01), and the MF15 group showed better uncorrected intermediate visual acuity (
P
< 0.001). The ZMB group provided better MTF than the MF15 group (
P
< 0.01) but demonstrated a worse QoV score, especially for the severity of glare, halo, and starburst (
P
< 0.05). The satisfaction score and spectacle independence rate in the ZMB group were higher than in the MF15 group (
P
< 0.01). LS-313MF15 and TecnisZMB00 offered excellent visual restoration, stable distance visual acuity, and good subjective visual function.