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  • Factors to Consider in Choosing an IOL for Cataract Surgery

    Reviewed By J. Kevin McKinney, MD
    Published Dec. 12, 2022

    Cataract surgery is very common. Nearly 4 million Americans undergo cataract surgery each year to restore their vision.

    During cataract surgery, the natural clouded lens is replaced with an artificial lens called an intraocular lens (IOL). An IOL can not only restore vision lost to cataracts, but may also correct refractive errors such as nearsightedness (myopia), farsightedness (hyperopia), astigmatism or presbyopia.

    There are a variety of IOL types — all suited to different visual needs and lifestyles.

    We'll help guide you to an informed decision that best fits your budget and your lifestyle. A thorough discussion with your ophthalmologist is the critical final step.

    What Are the Different Types of Lenses for Cataract Surgery?

    First, let's review the options:

    • Monofocal lenses are designed to provide the best possible vision at one distance. Most people who choose monofocals have their IOLs set for distance vision. They use reading glasses for near-vision tasks.
    • Multifocal IOLs have corrective zones built into the lens, much like bifocal or trifocal eyeglasses. This allows you to see both near and far objects. Some multifocals may also correct intermediate vision.
    • Extended depth-of-focus (EDOF) IOLs have only one corrective zone. But this zone is stretched to allow distance and intermediate vision.
    • Accommodative lenses can also correct vision at all distances. The lens uses the natural movements of your eye’s muscles to change focus.
    • Toric lenses have extra built-in correction for astigmatism. These are available in monofocal and some presbyopia-correcting IOLs.
    • Light-adjustable lens (LAL). This newer type of monofocal IOL is the only type of IOL that can be customized after surgery. With an LAL, your ophthalmologist will be able to adjust the lens for any leftover refractive error after your eye heals so that you don’t need glasses for distance vision. This adjustment can include astigmatism. Monovision can also be set to allow both near and distance vision without glasses. Adjustments are done through a series of office-based light treatment procedures.

    Here are some budget and lifestyle factors that might go into the decision-making process. Your ophthalmologist is the best person to help you choose the right lens based on your individual situation. 

    Which IOL Can You Afford?

    Not all IOL types are covered by insurance, and some can cost more than a thousand dollars out of pocket. But Medicare and most insurance companies do cover the cost of the most common IOL, the monofocal lens. These lenses have been used for decades and are the most popular type.

    Multifocal, EDOF, toric, light-adjustable lenses and accommodative IOLs are considered premium lenses and can reduce the need for glasses or contact lenses. But the ability to read and perform other tasks without glasses varies from person to person. They are more expensive than monofocals and are usually paid out of pocket.

    Does Your Lifestyle Rely on Near Vision?

    Maybe you spend a lot of time working at your computer or looking at digital devices. Or maybe you're nearsighted and love to read without glasses. One option is to set the monofocal IOL for near vision and use glasses for distance vision tasks, like watching TV and driving.

    Alternatively, you may find eyeglasses inconvenient and want to avoid them altogether. If so, you could opt for monofocal lenses but set one lens for distance vision and the other lens for near vision. This is a technique called "monovision." This choice is not for everyone. For many people, the brain adapts and can synthesize the information from both eyes to provide adequate vision at all distances. If this sounds appealing, try wearing monovision contacts before cataract surgery. This will help you figure out if monovision works for you.

    Do You Frequently Drive at Night?

    If night driving is important, you might want to steer clear of multifocal or EDOF lenses. Side effects such as glare, halos around lights or loss of contrast can happen. This is especially true at night or in dimly lit places. Most people adapt to these effects, but those who drive at night a lot may be happier with monofocal IOLs.

    Do You Have Moderate to High Astigmatism?

    With astigmatism, the cornea is not uniformly curved like a basketball, but is shaped more like a football. One curve is longer than the other. This distorts both near and distant objects. People with moderate to high astigmatism are usually happier with toric IOLs.

    Another procedure called limbal relaxing incisions may also be recommended to reduce astigmatism. This can be done at the time of cataract surgery or separately.

    Do You Have Other Eye Conditions?

    Multifocal and EDOF lenses are generally not recommended for people with vision loss from glaucoma, macular degeneration or other eye diseases. These IOLs allow less light into the eye so they can actually make things worse for people with vision loss. If avoiding glasses is important and you have eye damage, monovision may be a better option.

    It’s important to learn about these lens choices so that you can ask relevant questions and have a more productive conversation with your surgeon so that the selected IOL suits your budget and your visual needs.  Each patient has their own individual circumstances and preferences, and your cataract surgeon can select an appropriate IOL among the available options.