Purpose: To evaluate the visual performance of different multifocal intraocular lens (MIOL) designs in pseudophakic eyes with and without retinal pathologies. Methods: Seventeen pseudophakic eyes with normal retinal function and thirteen pseudophakic eyes with various retinal diseases were examined using the VirtIOL intraocular lens simulator. Each eye was tested with a monofocal, an extended depth of focus (EDOF), a trifocal, and a high-addition (+8 D) MIOL. Visual acuity, defocus capacity, and contrast sensitivity were compared between groups. Results: Eyes with retinal pathologies showed lower overall visual acuity and contrast sensitivity; however, all MIOLs demonstrated improved near visual acuity and defocus performance compared to the monofocal lens. Conclusions: MIOLs, including high-addition designs, are a viable option for patients with macular diseases. Despite reduced retinal function, patients benefit from the multifocal optical concept without further compromise in contrast sensitivity.