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Choosing an Intraocular Lens in Cataract Surgery by Denise Johnson, M.D.

March 3, 2020

Dr. Johnson is an ophthalmologist and cataract specialist at the Marietta Eye Clinic.

An intraocular lens (IOL) is an artificial lens implanted during cataract surgery to replace a clouded lens that has been affected by cataract. Having the natural lens replaced with an IOL can restore a patient’s vision to its state before the development of cataracts or better. Most IOLs today are made of acrylic or silicone. IOLs usually also have a coating that protects your eyes from ultraviolet (UV) rays.

Types of IOLs

Like prescription glasses or contacts, IOLs come in a variety of focus powers. Therefore, in addition to eliminating a cataract, cataract surgery can also correct for myopia, hyperopia, presbyopia, and astigmatism. The length and curve of your eye will be measured before surgery and used to set the focusing power of your IOL, which could reduce or even eliminate your dependency on glasses or contacts post-surgery. 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 4 categories of IOLs currently on the market. They are:

  • Monofocal
  • Multifocal
  • Accommodative
  • 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 individual lifestyle and vision needs.

Monofocal IOLs

Monofocal IOLs are the most common lenses implanted during cataract surgery. They have only one focal distance, similar to monofocal eyeglasses. A monofocal IOL can be set to focus for near-sighted, medium range, or far-sighted vision.

Medicare and most insurance providers cover the complete cost of monofocal IOLs. If you need help seeing both near and far, you can have your IOLs set to either near- or far-sighted vision and wear glasses or contact lenses to complement. You can also have one IOL set to near vision and the other set for distance vision to achieve what is known as monovision. The drawback to monovision is that your vision may not be as crisp as it could be with other types of IOLs.

Toric monofocal IOLs are monofocal lenses that also correct for astigmatism. 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 is not covered by insurance, called limbal relaxing incisions may be performed during cataract surgery to fully correct the astigmatism.

Toric IOLs are not covered by insurance.

Multifocal IOLs

Multifocal IOLs will allow you to see at multiple distances with one lens. Similar to multifocal eyeglasses, they have multiple focal zones. If you have multifocal IOLs implanted, your brain will switch between the focal points. Multifocal IOLs generally allow better and more sustained near-distance vision, leaving you less dependent on reading glasses. Additionally, modern multifocal IOLs allow for mid-range vision.

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

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

Accommodative IOLs

An accommodative IOL most closely imitates your eye’s natural lens. Accommodative IOLs can move and change shape inside your eye to focus at different distances.

Similar to multifocal IOLs, accommodative IOLs can cause halos around lights and may not provide the clearest near vision compared to their alternatives. You may still require reading glasses for fine print or in dim lighting.

Accommodative IOLs are not covered by insurance.

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 or accommodative IOLs, extended depth of focus IOLs offer a more consistent extended range of vision.

One downside to extended depth of focus IOLs is that they have been shown to increase glare. Reading glasses may still be required for fine print.

Extended depth of focus IOLs are not covered by insurance.

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 Denise Johnson, M.D.

Dr. Johnson is an ophthalmologist at the Marietta Eye Clinic who offers comprehensive care and specializes in cataracts, dry eye, and cosmetic treatments. She serves the Acworth and Towne Lake locations. She is board-certified by both the American Board of Ophthalmology and the American College of Lifestyle Medicine. She received her undergraduate degree from Cornell University and her medical degree from the Temple University School of Medicine. She is professionally associated with the American Academy of Ophthalmology, the American Society of Cataracts and Refractive Surgeons, the American College of Lifestyle Medicine, and the Physician’s Committee for Responsible Medicine. 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, 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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