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How do I know what intraocular lens (IOL) to choose?

There are multiple types of lenses that can be used during cataract surgery. Below is a brief description of options. Choosing the right lens can be complex; the choice of what lens is best for you should be made after a thorough understanding of your options and a careful discussion with your ophthalmologist.

There are five main options to choose from:

  1. Standard
  2. Astigmatism Correcting
  3. Multifocal
  4. Extended Depth of Focus
  5. Accommodating

Multifocal, extended depth of focus, and accomodating IOLs are considered presbyopia correcting IOLs. These provide you with less dependence on glasses for distance and near, but there are no guarantees that choosing a multifocal, extended depth of focus or accommodating lens will eliminate your need for glasses. Some degree of glasses may still be needed, because there is no perfect lens technology available.

Besides standard IOLs, the lens options below are not covered by insurance—your surgery scheduler can provide you with the current cost analysis.

Click through the different options below to learn more!

 

Standard IOL

A standard IOL, also referred to as “monofocal” or “single focus,” gives very good clarity of vision and is the most common IOL chosen. Insurance companies often cover the cost of a standard IOL. With a monofocal lens patients often choose one of three options:

  • Correcting for distance vision in both eyes
  • Correcting for near vision in both eyes
  • Monovision (one eye distance, one eye near)

Read more about these three options:

Monofocal option 1: Correcting for distance vision both eyes

Most patients who have a standard IOL choose to have the lens correct their distance vision as best as possible. A small glasses correction for distance may still be needed, especially if you have astigmatism (see below). In this option you will still need glasses for near (e.g. reading) and intermediate (e.g. computer) work.

Monofocal option 2: Correcting for near vision both eyes

Some patients who have a standard IOL choose to have the lens correct their near vision as best as possible. In this situation a patient may not need to wear glasses for near, however may need them to drive (or other tasks to see at distance or even intermediate distance); glasses will be needed for optimum clarity.  Would also mention may need glasses for near if they have astigmatism (see below).

Monofocal option 3: Monovision (one eye distance, one eye near)

Monovision is when one eye is corrected for distance vision and the other eye is corrected for near vision in an attempt to decrease your dependence on wearing glasses. It’s often recommended to first try monovision with contact lenses to see if you can adapt to this type of vision. Some find it too difficult to adjust to each eye working differently; while many enjoy the benefits of this option.

Astigmatism Correcting IOL

Astigmatism simply means that the front part of your eye, the cornea, is not perfectly spherical. It is very common, and for most people is not a sign of anything serious. Contact lenses or glasses usually correct astigmatism. A “toric” or “astigmatism correcting” IOL is an option for patients with moderate amounts of astigmatism. Choosing this option, if you have astigmatism, can reduce your need for glasses after your surgery. If you choose a standard lens implant (i.e. no astigmatism correction) and you have astigmatism, you could wear glasses to correct the astigmatism.

However, if it is desirable to have better vision when you are NOT wearing glasses, you may want to consider a toric lens implant. Your surgery scheduler can provide you with a guide to the costs. A different option (not related to IOLs) for correcting astigmatism involves creating Limbal Relaxing Incisions (or LRIs). Your surgeon may perform this at the time of cataract surgery. These are extra incisions in the cornea to help reshape the cornea and can reduce the amount of astigmatism. LRIs are also NOT covered by insurance.

Multifocal IOL

These lens options can help reduce your dependence on glasses. A multifocal lens offers two focus points, distance and near vision (different models have different near points). There are many pros and cons for the options in this category and these lens choices should be considered only if the eye has no other health problems.

Adjusting to these type of lenses can take time (sometimes months), and glare (star-bursting) and halos, decreased contrast and color vision can be a side effect.  Unfortunately, there are no guarantees that choosing a multifocal or accommodating lens will eliminate your need for glasses. Some degree of glasses will often still be needed, because there is no perfect lens technology available.

Extended Depth of Focus IOL

The Tecnis Symfony lens was released in 2016 and is the latest innovation in lens technology. It is also available as a toric lens that can also correct for astigmatism. The extended depth of focus in this lens can provide a continuous range of high-quality vision from distance to intermediate and can allow patients to be more independent of glasses after cataract surgery, though some patients may still need glasses for near vision.  Some star bursting of lights has been reported with the use of this lens, though for most patients this is not severe. This lens may not be appropriate for everyone and it is important to have a thorough exam and discussion with your doctor about pre-existing conditions that may limit the use of this lens implant.

Accomodating IOL

The Crystalens is an artificial lens implant designed to treat presbyopia (the loss of intermediate and near vision) by modeling it after the natural lens in the human eye.  This lens is designed to flex and accommodate in order to improve visual focus across all distances.  The Crystalens can reduce a person’s need for prescription glasses and reading glasses after cataract surgery.  Many patients have greater freedom from glasses after surgery, compared to a standard or monofocal IOL.  Patients still may require reading glasses for small print or other near vision tasks.

Trulign Toric is an artificial lens implant designed to treat presbyopia and to correct astigmatism when implanted during cataract surgery.  It is similar in design to the Crystalens, but has been modified to include correction for astigmatism.  This allows more precise correction of distance vision for patients with astigmatism, and also improves the vision for intermediate and near tasks.  With Trulign Toric, many patients experience a broader range of vision and enjoy increased independence from glasses, compared to a standard or monofocal IOL.

 

Make an appointment today to learn more about IOL options!

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