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Choosing an Intraocular Lens by Kristen Peterson, M.D.

March 12, 2020

Dr. Peterson is a comprehensive ophthalmologist, cataract specialist, and dry eye specialist with the Marietta Eye Clinic.

Cataracts, which are clouded lenses due to natural aging, are irreversible, but modern surgical practices offer patients who undergo cataract surgery more benefits than ever. When clouded lenses impede on an individual’s day to day life, cataract surgery may be recommended to restore clear vision. During surgery, an eye surgeon will remove the cloudy natural lens within the eye and replace it with an artificial lens implant, referred to as an intraocular lens (IOL). Most IOLs today are acrylic, although some are made of other plastic compositions. IOLs usually also have a coating that protects your eyes from ultraviolet (UV) rays.

Types of IOLs

IOLs come in a variety of focus powers, just like prescription glasses or contacts. This means that in addition to eliminating your cataract, cataract surgery can also correct for myopia, hyperopia, presbyopia, and astigmatism. Depending on your vision before surgery and the lenses you choose, your dependency on glasses or contacts post-surgery can be greatly reduced or even eliminated. The length and curve of your eye will be measured before surgery and used to set the focusing power of your IOL. You can have the same kind of IOL implanted in each eye or combine two different types of IOLs to achieve custom vision.

There are multiple categories of IOLs currently on the market. They include:

  • Monofocal
  • Toric
  • Multifocal
  • Extended depth of focus

In the sections below, we’ll explore the different kinds of IOLs and look at their benefits and disadvantages. There is no one best option. The IOL that works best for you will depend on your eye, your individual lifestyle, and your personal vision needs.

Monofocal IOLs

Monofocal IOLs are the most common lenses implanted during cataract surgery. Like monofocal glasses, they have only one focal distance. A monofocal IOL can be set to focus for near-sighted, medium range, or far-sighted vision. Having one IOL set to near vision and the other set for distance vision is referred to as monovision.

Medicare and most insurance providers completely cover the cost of monofocal IOLs.

Monofocal IOLs are also available in toric form, meaning they can correct for astigmatism, as well. Patients with astigmatism usually see better with toric monofocal IOLs than with regular monofocal IOLs. A toric IOL may not completely correct astigmatism, so you may still need to wear glasses or contacts after surgery. An additional procedure, which may or may not be covered by insurance, called limbal relaxing incisions, may be performed during cataract surgery to further correct astigmatism.

Multifocal IOLs

Multifocal IOLs allow you to see at multiple distances with a single lens. Like multifocal eyeglasses, they have multiple focal zones. Multifocal IOLs are available in bifocal, trifocal, and progressive forms. When multifocal IOLs are implanted, a patient’s brain can automatically switch between the focal points. Multifocal IOLs generally allow for better and more sustained near-distance vision compared to monofocal IOLs, leaving you less dependent on reading glasses.

One drawback to multifocal IOLs is that they can cause more glare from lights and may reduce contrast in your vision, making it harder to see at night. You may also need to wear reading glasses for fine print.

Multifocal IOLs are not covered by most insurance providers. They are also available in toric form for patients with astigmatism.

Extended Depth of Focus IOLs

Extended depth of focus IOLs are the latest advancement in lens implants and are used to create a single elongated focal point. Compared to multifocal IOLs, extended depth of focus IOLs offer a larger range of vision.

One downside to extended depth of focus IOLs is that they have been shown to cause glare or starbursts. Additionally, reading glasses may still be required for fine print.

Extended depth of focus IOLs are not covered by most insurance providers.

Speak with an Ophthalmologist About Which IOL is Best for Your Needs

In addition to your vision preferences, a variety of other factors can affect which type of IOL will work best for you, including power ranges required, aberrations on your eyes, and your level of astigmatism. It is important to have a comprehensive examination and consultation so your ophthalmologist can explain the options available to you and the benefits and disadvantages of each IOL option relative to your eyes.

More About Cataract Specialist Kristen Peterson, M.D.

Dr. Peterson is an ophthalmologist with the Marietta Eye Clinic who specializes in cataracts and dry eye. She serves the Kennestone, East Cobb, and Towne Lake offices. She received an undergraduate degree in biology from Emory University and a medical degree from the Emory University School of Medicine. She is a member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Association for Research in Vision and Ophthalmology. Read her full bio here.

References and Additional Resources

The American Academy of Ophthalmology (AAO) is the world’s largest association of eye physicians and surgeons. It describes itself as a “global community of 32,000 medical doctors who protect sight and empower lives by setting the standards for ophthalmic education and advocating for our patients and the public.” Its website is a great resource to learn more about how to care for your eyes.

The American Optometric Association (AOA) describes itself as the leading authority on quality care and an advocate for our nation’s health, representing more than 44,000 doctors of optometry (O.D.), optometric professionals, and optometry students. 

Presbyopia-correcting IOLs

https://eyewiki.org/Presbyopia-correcting_IOLs

IOL Implants: Lens Replacement After Cataracts

https://www.aao.org/eye-health/diseases/cataracts-iol-implants

Bye, Cataracts. Hello, Intraocular Lenses: How to Decide What Type of IOL is Best for You

https://www.aao.org/eye-health/diseases/intraocular-lenses-iols-how-to-decide-what-type

Multifocal vs Extended Depth of Focus IOLs

https://www.aao.org/interview/multifocal-vs-extended-depth-of-focus-iols

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