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How to Choose an Intraocular Lens Implant by Justin Wilkin, M.D.

March 5, 2020

Dr. Wilkin is an ophthalmologist and cataract surgeon at the Marietta Eye Clinic.

An intraocular lens, commonly referred to as an IOL, is an artificial lens implanted during cataract surgery. Because cataract is irreversible, IOLs are 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 even better. They are made of silicone, acrylic, or other plastic compositions. Because of the material, IOLs also protect your eyes from ultraviolet (UV) rays.

Types of IOLs

IOLs come in an array of focusing powers, like prescription glasses or contacts. The length and curvature  of your eye will be measured before surgery and used to calculate the focusing power of your IOL. Because some IOLs can correct for presbyopia, your dependency on reading glasses may be reduced or even eliminated after surgery. You can have the same type of IOL implanted in each eye or combine two different types of IOLs to achieve custom vision.

There are 6 categories of IOLs currently on the market. They are:

  • Monofocal
  • Monofocal toric
  • Multifocal
  • Accommodative
  • Extended depth of focus
  • Multifocal toric

In the sections below, we’ll look at the different kinds of IOLs and the benefits and disadvantages of each. There is no one-size-fits-all option. The best IOL for you will depend on your lifestyle, your hobbies, and your vision preferences. For this reason, it is critical to discuss these topics with your surgeon beforehand.

Monofocal IOLs

Monofocal IOLs are the most common lens replacements. Like monofocal eyeglasses, they have one focal point. A monofocal IOL can be set to focus for up close, medium range, or far vision.

The most common way to correct with a monofocal IOL is to set both eyes for distance vision. The drawback is that you will need to wear glasses for near vision. However, this can usually be accomplished with over-the-counter reading glasses. You can also have one IOL set for near vision and the other set for distance vision to achieve what is referred to as monovision, although your vision may not be as crisp as it could be with this option. Many people love this option, but not everyone can tolerate having their eyes focus differently.

Medicare and most insurance providers cover the cost of monofocal IOLs, making them the most affordable option.

Monofocal Toric

Monofocal toric IOLs are monofocal lenses that correct for astigmatism. Astigmatism is a condition in which the shape of the eye is more like a football rather than a round basketball which, when uncorrected, causes the vision to be blurred. Patients with astigmatism typically see better after surgery 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 surgery if your astigmatism cannot be completely corrected.

During the cataract surgery, you may also have arcuate keratotomy or limbal relaxing incisions made to correct for some types of astigmatism. Your insurance may or may not cover this portion of the procedure.

Multifocal IOLs

Multifocal IOLs allow you to see at multiple distances with one lens. They have multiple focal zones, just like bifocal or trifocal eyeglasses. If you choose to have multifocal IOLs implanted, your brain will handle switching between focal points. This adaptation is often very quick. Multifocal IOLs generally allow better and more functional vision for activities requiring both distance and near focus. Most people who choose multifocal IOLs become less dependent on glasses after surgery and only require them for a few specific activities.

One drawback to multifocal IOLs is that they can cause  glare or halo from lights and could reduce contrast in your vision, making it harder to see at night or in dim light, so these lenses are not always ideal for patients who intend to do a lot of night driving.

Multifocal IOLs are typically only partially covered by insurance.

Accommodative IOLs

An accommodative IOL  closely imitates a natural lens. Accommodative IOLs have flexible hinges that allow the lens to move inside your eye to focus at different distances,  similarly to the way a natural lens would.

Accommodative IOLs, like multifocal IOLs, can cause halos around lights and may not provide the clearest near vision compared to alternatives. These lenses typically have a limitation on the range of focus. You may still require reading glasses for small print or in dim lighting.

Accommodative IOLs are typically only partially covered by insurance.

Extended Depth of Focus IOLs

Extended depth of focus IOLs are the newest type of lens implants. They create a single elongated focal point and offer a more consistent extended range of vision compared to multifocal or accommodative IOLs.

Similar to the multifocal IOL, the extended depth of focus IOLs have been shown to cause glare and halo, especially at night. Although most people can function well without glasses for distance and mid-range vision, reading glasses may still be required for close vision and small print.

Extended depth of focus IOLs are typically only partially covered by insurance.

Multifocal Toric IOLs

A multifocal toric lens is simply the combination of a toric IOL and a multifocal IOL. Previously, patients with astigmatism were poor candidates for a multifocal lens. With the advancing technology, we can now offer a lens implant to correct the distance vision and near vision in people who have astigmatism.

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, aberrations on your eyes, or your level of astigmatism. It is important that you have a comprehensive examination and consultation so your ophthalmologist can help you find the best fitting IOL for you.

More About Cataract Specialist Justin Wilkin, M.D.

Dr. Wilkin is an ophthalmologist with the Marietta Eye Clinic. He specializes in cataracts and dry eye, in addition to offering comprehensive care. He serves the Kennestone, Canton, and Towne Lake offices. Dr. Wilkin graduated magna cum laude from the Georgia Institute of Technology with his undergraduate degree in applied biology and microbiology. He received his medical degree from the Medical College of Georgia. He is a member of both the American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgeons. He is board-certified by 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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