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How to Choose an Intraocular Lens by Charles Ho, M.D.

February 25, 2020

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

An intraocular lens (IOL) is an artificial lens implant inserted during cataract surgery. Because cataract is irreversible, the implant is used to replace a clouded lens that has been affected by cataract. IOLs can restore a patient’s vision to the state it was before the development of cataracts — or better. Traditional silicone IOLs have been largely replaced by acrylic IOLs. IOLs also typically have a coating that protects your eyes from ultraviolet (UV) rays.

Types of IOLs

IOLs come in a selection of focus powers, like prescription glasses or contacts. The length and curve of your eye will be measured before surgery and used to calculate the focus power of your IOL. In the past, patients were happy just to see. However, current IOL technology allows a patient to have a significant reduction of dependence on glasses. Myopia, hyperopia, astigmatism, and presbyopia can all be addressed, often helping a patient to see better than they ever did, even before the cataracts developed. This has made the average age of cataract surgery patients even younger, simply because many patients look forward to the refractive correction of modern cataract surgery.

There are 4 categories of IOLs currently on the market:

  • Monofocal
  • Toric monofocal
  • Multifocal
  • Toric multifocal

In the sections below, we’ll look at the different kinds of IOLs as well as the benefits and disadvantages of each. There is no one best lens for every patient.

Monofocal IOLs

Monofocal IOLs are the most common lenses implanted during cataract surgery. Like monofocal eyeglasses, they have only one focal distance. A monofocal IOL can be adjusted to focus for up close, medium range, or far 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 contacts to complement what you will see. You can also have one IOL adjusted for near vision and the other adjusted for distance vision to achieve what is known as monovision, although your surgeon may advise against it if there is no prior experience with monovision contact lenses.

Toric Monofocal IOLs

Toric IOLs are monofocal lenses that correct for astigmatism in addition to myopia. Patients with astigmatism typically see better with toric IOLs than with regular monofocal IOLs, though a toric IOL may not completely correct your vision. You may still need to wear glasses or contacts after having a toric IOL implanted if your astigmatism cannot be completely corrected. During or after cataract surgery, you may also have limbal relaxing incisions made to further correct astigmatism. Your insurance may or may not cover this procedure.

Multifocal IOLs

Multifocal IOLs allow you to see at multiple distances with a single lens. They have multiple focal zones like bifocal or trifocal eyeglasses. Multifocal IOLs are available in bifocal, trifocal, and progressive forms. If you choose to have multifocal IOLs implanted, your brain will handle switching between focal points. Multifocal IOLs generally allow better and more sustained near-distance vision. Many people who choose multifocal IOLs become less dependent on reading glasses after surgery. The newest generation of multifocal IOLs have greatly improved upon what the first-generation lenses lacked: mid-range vision, such as the distance of your car’s dashboard or piano sheet music.

Multifocal IOLs may cause halos around lights at night while driving. They are limited in that you may need reading glasses for small print, may have difficulty reading in dim light, or may need to hold reading material at least 12 inches from your eyes. Ask your surgeon about these minor limitations. Carefully choosing the best option for each individual patient helps patients feel satisfied with their results. Multifocal IOLs are generally not covered by insurance.

Toric Multifocal IOLs

In the first generations of multifocal IOLs, only patients without astigmatism could enjoy refractive benefits. However, technology has evolved and allowed for correction of astigmatism with IOLs. All but the most extremely high astigmatism patients can enjoy the benefits multifocal IOLs offer. Before ruling out multifocal IOLs due to astigmatism, ask your surgeon to evaluate whether your astigmatism qualifies for multifocal IOLs. Toric multifocal IOLs are not covered by insurance.

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

A variety of factors beyond your vision preferences can affect which type of IOL will work best for you, including power ranges required, co-existing conditions of your eyes, or your level of astigmatism. It is important to have a comprehensive examination and consultation so your ophthalmologist can help you find the best-fitting IOL for you.

More About Cataract Specialist Charles Ho, M.D.

Dr. Ho is an ophthalmologist with the Marietta Eye Clinic. He specializes in cataract and adult strabismus surgery. During his practice, he has performed thousands of surgeries, developed microsurgery instruments and testing, and taught countless students. He performs surgery at Marietta Eye Surgery, the Northside Hospital, and several WellStar Hospitals. He sees patients at the Kennestone and East Cobb offices. Dr. Ho received his undergraduate degree in computer and electrical engineering from Drexel University and his medical degree at the Hahnemann University School of Medicine. He is a member of the American Academy of Ophthalmology, the American Association of Pediatric Ophthalmology and Strabismus, and the Georgia Society of Ophthalmology. His board certification is from the American Board of Ophthalmology. Read his 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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