How to Choose an Intraocular Lens Implant by Shunai Jiang, M.D., Ph.D.

April 27, 2020

Dr. Jiang is an ophthalmologist, cataract surgeon, and glaucoma specialist at the Marietta Eye Clinic.

An intraocular lens, or IOL, is an artificial lens implanted during cataract surgery. Because cataract is irreversible, the implant is used to replace a clouded lens that has been affected by cataract. In addition, IOLs correct refractive errors, so IOLs can restore a patient’s vision to the state it was before the development of cataracts or better. They are made of silicone, acrylic, or other plastic compositions. IOLs also typically have a coating that protects your eyes from ultraviolet (UV) rays.

Types of IOLs

Like eyeglasses or contacts, IOLs come in an array of focus powers. The length and curve of your eye will be measured before surgery and used to set the focus power of your IOL. Your dependency on reading glasses may be reduced or even eliminated. 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 many IOLs currently on the market. Some of the most common types include:

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

In the sections below, we’ll look at the different kinds of IOLs as well as their benefits and disadvantages. There is no single option that is best for everyone.

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 near, medium range, or distance vision.

You can have your IOLs set to either near- or far-sighted vision and wear glasses or contacts to complement them if you experience myopia or presbyopia. To reduce your need of glasses or contact lens after cataract surgery, you can also have one IOL adjusted for near vision and the other adjusted for distance vision to achieve what is known as monovision. The downsides to monovision are that your vision may not be as crisp as it could be and you may lose some depth perception. However, many people find they adapt well to monovision and use glasses or contact lenses only occasionally.

Monofocal IOLs are completely covered by Medicare and most insurance providers.

Toric

Toric IOLs are lenses that correct for moderate or high astigmatism in addition to myopia or hyperopia. Astigmatism is an imperfection in the curvature of the eye. Instead of curving like a basketball, the surface of an eye with astigmatism is shaped more like a football. This causes blurred vision at all distances. Toric IOLs have different powers in different meridians of the lens and thus reduce astigmatism. Patients with astigmatism typically see much better with toric IOLs than with regular monofocal IOLs. You may still need to wear glasses or contacts after surgery if your astigmatism cannot be completely corrected. During or after cataract surgery, you may also have limbal relaxing incisions made to further correct mild or residual astigmatism.

Neither insurance nor Medicare cover the cost of toric IOLs or limbal relaxing incisions.

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. If you choose to have multifocal IOLs implanted, your brain will handle switching between focal zones. Multifocal IOLs generally allow better and more sustained near-distance vision, so many people who choose multifocal IOLs become less dependent on reading glasses after surgery.

One drawback to multifocal IOLs is that some patients may see halos and glare and experience reduced night vision. Therefore, these lenses may not be the best option for patients who intend to do a lot of night driving. Multifocal IOls can also reduce contrast in your vision. However, many patients with those complaints are still satisfied because they are willing to trade the complaints for not wearing glasses.

Previously, patients with high astigmatism were poor candidates for multifocal IOLs. With advancing technology, a toric multifocal IOL that is a combination of toric IOL and multifocal IOL is now available to offer people with both astigmatism and presbyopia the clear vision at all distances they desire.

Medicare and insurance do not cover the cost of multifocal IOLs.

Accommodative IOLs

Accommodative IOLs move and change shape inside your eye to focus at different distances the same way a natural lens would.

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

Medicare and insurance providers do not cover the cost of accommodative IOLs.

Extended Depth of Focus IOLs

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

Similar as multifocal or accommodative IOLs, extended depth of focus IOLs have been shown to increase glare, especially at night. Reading glasses may still be required for fine print.

Medicare and insurance providers do not cover the cost of extended depth of focus IOLs.

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

Several factors beyond just your vision preferences affect which type of IOL will work best for you. Some of these include power ranges required, aberrations on 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 IOLs for your eyes.

More About Cataract Specialist Shunai Jiang, M.D., Ph.D.

Dr. Jiang is an ophthalmologist at the Marietta Eye Clinic who specializes in cataracts and glaucoma. She serves the Kennestone, Canton, and East Cobb locations. Dr. Jiang studied at Jilin University in China and the Karolinska Institute in Sweden, the home of the Nobel Prize in Physiology or Medicine. She received her residency training in ophthalmology from University of Louisville and fellowship training in glaucoma from Emory University. She is a member of the American Academy of Ophthalmology and the American Glaucoma Society. 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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