• Choosing an Artificial Lens for Cataract Surgery

    Written By: Cheryl terHorst
    Reviewed By: J Kevin McKinney MD
    May. 14, 2020

    More than 25 million Americans have cataracts — clouding of the eye’s lens with age—and 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). What you may not realize is that there's a variety of IOL types to choose from — all with different benefits.

    Choosing the right IOL can be difficult. 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, but these basic questions may help narrow down your options.

    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 and use reading glasses for near-vision tasks.
    • Multifocal IOLs have multiple corrective zones built into the lens (much like bifocal or trifocal eyeglasses). This allows you to see both near and far objects. In addition, 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, but the lens uses the natural movements of your eye’s muscles to change focus.
    • Toric lenses have extra built-in correction for astigmatism.

    Now we're ready to figure out the best lens for your budget and lifestyle.

    Which artificial lens can you afford?

    Not all IOL types are covered by insurance. 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.

    Other options — such as multifocal, EDOF and accommodative IOLs — can also reduce the need for glasses or contact lenses. However, the ability to read and perform other tasks without glasses varies from person to person. These IOLs are often called “premium” lenses because they are more expensive than monofocals and are often not fully covered by insurance.

    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 — but 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, you should “test drive” monovision before cataract surgery by wearing monovision contact lenses for a period of time. 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 (resulting in dull vision) may occur with these lenses, especially 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 (the clear, front window of the eye) 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 (LRIs) may also be recommended to reduce astigmatism. This can be done at the time of cataract surgery or separately. Insurance may not fully cover toric lenses or LRIs.

    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.