Lens Options for Cataract Surgery

Cataract surgery involves removing your clouded lens and replacing it with an artificial intraocular lens (also called an IOL) to improve your vision. However, not all IOLs are the same. Choosing the lens for you can be confusing. The information below helps explain your options.

In choosing the right lens for you, consider your goals for after cataract surgery. Is glasses independence important to you? Where is the most important range for you to have focused and clear vision after surgery? Do you have specific hobbies or a job that may influence your choice for you preferred range of clear vision? Do you have a history or previous eye surgery including Lasik or refractive surgery?

 

Intraocular Lens Options (IOL)

Monofocal (standard) lenses are designed to provide the best possible vision at one distance. You decide which is most important to you. It is called monofocal because it has one focusing distance. It is set to focus for close work, medium range, or distance vision depending on your visual needs. Most people who choose a monofocal IOL have their lens set for distance vision. They use reading glasses for near vison tasks. A monofocal lens is covered by your insurance.

Toric lenses have extra built-in correction for astigmatism. Astigmatism is when the eye’s focusing power differs in different directions. For example, when the focusing power of the eye is greater horizontally, and less vertically, astigmatism is present. Another way to put it is that an eye with astigmatism is shaped more like a football than a basketball. Toric lenses reduce your astigmatism to help improve the quality of your vison. Toric lenses are not covered by insurance plans.

Monovision is where one eye is implanted with a monfocal lens aiming for distance vision, and the other (non-dominant) eye has a monofocal lens aiming for near vision. It is used frequently with cataract surgery to decrease a person’s dependency on reading glasses and computer glasses after surgery. However, reading glasses may still occasionally be required for some near work and reading fine print.

Monovision does not work for everyone and some people are unable to adapt to using one eye for distance viewing and one for near/intermediate viewing. Monovision works well in people who have experienced mono vision with contact lenses prior to cataract surgery. Limitation can include loss of depth perception and still needing to wear glasses for driving and other distance activities.

Presbyopia- correcting lenses (also called multifocal/trifocal or extended depth-of-focus lenses) correct both near, intermediate, and far vision. Astigmatism can also be corrected with these lenses. For many people, this means depending less on distance glasses and reading glasses after cataract surgery. Presbyopia correcting lenses are not covered by insurance plans. 

  • Multifocal IOLs have corrective zones or focusing powers built into the lens, much like bifocal or trifocal eyeglasses, which allow good vision at most ranges at all times. It may allow you to see clearly in the distance without glasses as well as read or use a computer, also without using glasses. You still may need glasses for some circumstances such as reading small newspaper print. The different zones of the IOL focus light differently, splitting the light between seeing near, intermediate, and far.

 

  • Extended depth-of-focus (EDOF) IOLs have only one corrective zone, but this one is stretched to allow for good distance and intermediate vision and also focus functional near vision. You may still need to wear reading glasses for very small print and low light conditions. There also tends to be less concern for glare and halos with night driving after surgery.

In general, presbyopia correcting lenses should be avoided if you have other eye disease (such as glaucoma, macular degeneration, diabetic retinopathy) or are at risk of developing such eye diseases. Also, if you are a very detail oriented person, you may not enjoy these lenses due to the optical side effects that are often noted by people who have presbyopia correcting lenses implanted. The special optics of the presbyopia correcting lens may cause you to see halos or sparkles around lights, particularly when driving at night after cataract surgery. These may not bother you, but some people are so bothered by these optical effects they may need further surgery to exchange the lens, which can have an increased risk of complications.