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How to Choose an Intraocular Lens by Amy Cherof, M.D.

June 22, 2020

Dr. Amy Cherof is a comprehensive ophthalmologist and cataract surgeon at the Marietta Eye Clinic.

An intraocular lens (IOL) is an artificial lens implanted during cataract surgery. The IOL replaces the natural lens that has become clouded, yellow, and hazy due to the development of cataract. Replacing the natural lens 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 typically also have a coating that protects your eyes from ultraviolet (UV) rays.

Types of IOLs

IOLs come in a variety of powers, just like prescription glasses or contact lenses. Because of this, in addition to eliminating cataracts, cataract surgery can also correct for refractive error such as myopia, hyperopia, and astigmatism. The length and curvature of your eye will be measured before surgery and used to determine the appropriate power of your IOL. Customizing your IOL selection could reduce or even eliminate your dependency on glasses or contacts after surgery.

There are 4 categories of IOLs currently on the market. They are:

  • Monofocal, including standard IOLs and toric IOLs
  • Multifocal or trifocal
  • Extended depth of focus
  • Accommodative

In the sections below, we’ll explore the different kinds of IOLs. There is no one best option for all patients. The IOL that works best for you will depend on your lifestyle and vision needs, and it should be discussed with your surgeon.

Monofocal IOL

Monofocal IOLs are the most common artificial lenses used in cataract surgery. They are designed to provide the best possible vision at one distance or focal point, like monofocal eyeglasses. A monofocal IOL can focus your vision at either near, mid-range, or distance. Commonly, patients choose to have both eyes set for distance vision, and they wear glasses for mid-range and near visual tasks. Another option is to have one IOL set for mid-range or near vision and the other set for distance vision to achieve what is known as monovision. Monovision minimizes the dependence on reading glasses, but it may affect depth perception and requires each eye to work independently. An advantage of monofocal IOLs is that Medicare and insurance providers cover the cost of the lens.

Toric monofocal IOLs are monofocal lenses that also correct for astigmatism, or irregular curvature of the surface of the eye. Patients with significant astigmatism will see better with toric monofocal IOLs than with regular monofocal IOLs. If a patient has significant (moderate or severe) astigmatism that is not corrected at the time of surgery, glasses or contact lenses will be required to see clearly at all distances after surgery. Toric IOLs are not covered by insurance.

Multifocal or Trifocal IOL

Multifocal IOLs allow you to see at multiple distances by having multiple corrective zones built into the lens, similar to bifocal or trifocal eyeglasses. Multifocal IOLs generally provide better and more sustained near vision, leaving you less dependent on reading glasses. However, you may still need to wear reading glasses for very small print or in dim lighting. A drawback to multifocal IOLs is that they may cause glare or halos from lights and may reduce your contrast sensitivity, which can make it harder to see at night. These IOLs are also available in toric form for patients with significant astigmatism. They are not covered by insurance.

Extended Depth of Focus IOL

Extended depth of focus IOLs are a newer advancement in lens implants and are used to create an elongated focal point to improve mid-range vision when compared to monofocal IOLs. Extended depth of focus IOLs may also result in some glare or halos as well as decreased contrast, though it may be less significant than with multifocal lenses. Reading glasses may still be required for fine print or dim lighting. Extended depth of focus IOLs are also available in toric for patients with astigmatism. These premium IOLs are not covered by insurance.

Accommodative IOL

Accommodative IOLs are designed to slightly change shape inside the eye in response to the eye’s movements to focus at different distances. This IOL may provide improved distance vision over multifocal IOLs, but its ability to provide intermediate and near vision can be limited, so reading glasses are likely to still be required. Similar to multifocal IOLs, accommodative IOLs can cause halos around lights. Accommodative 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 or in 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 Amy Cherof, M.D.

Dr. Cherof is an ophthalmologist with the Marietta Eye Clinic who specializes in cataracts in addition to offering comprehensive care. She serves the Kennestone, West Cobb, and Windy Hill locations. Dr. Cherof graduated summa cum laude with highest honors with her undergraduate degree from the University of Georgia. She received her medical degree from the Augusta University Medical College of Georgia. She is a member of the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and the Georgia Society of 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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