• Choosing an Artificial Lens for Cataract Surgery

    Reviewed By J Kevin McKinney MD
    Edited By David Turbert
    Mar. 01, 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). 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. These basic questions may help narrow down your options, though.

    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.

    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.

    Multifocal, EDOF and accommodative IOLs 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. These IOLs are often called “premium” lenses. 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. 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 (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.