Cataract Surgery Lens Implant Options

Posted by: Philadelphia Eye Associates in Eye Health on January 8, 2023

Written by John Kim and edited by Michael Abendroth, MD, MBA

A cataract is an age-related clouding of the lens in the eye. This cloudy lens blocks light from entering the eye, resulting in blurry vision, glare, and haloes. The only treatment is cataract surgery, where the cataract is replaced with a clear, plastic lens called an intraocular lens implant (IOL). The IOL also corrects some or all of the glasses prescription, thereby decreasing the need for glasses after surgery.

There are several options for the IOL. The standard IOL is covered by insurance but does not correct astigmatism or vision at every distance, so people still need glasses after surgery. Advanced-technology IOLs can correct astigmatism and vision at every distance, so most people do not need glasses after surgery. However, these IOLs are not covered by insurance and are not a great match for every eye and lifestyle. Therefore, this decision often requires careful consideration and discussion with your surgeon.

Below are the IOL options and factors to consider when choosing the best IOL for you:

Monofocal (Single-Focus) IOL

• Covered by insurance
• Does not correct astigmatism
• Improves distance OR near vision, but not both, therefore will need glasses after surgery
  • Distance option: improves distance vision (e.g. for TV, driving, and sports). Will need glasses for reading and other near activities
  • Near option: improves near vision (e.g. for reading, makeup, and phone). Will need glasses for distance activities

Monofocal (Single-Focus) Toric IOL

• Not covered by insurance
• Does correct astigmatism
• Gives the best distance OR near vision, but not both, therefore will need glasses after surgery

Multifocal (Multiple-Focus) IOL

• Not covered by insurance
• Does correct astigmatism if needed
• Gives the best distance AND near vision, therefore may not need glasses after surgery

There are two categories of multifocal IOLs:

• Trifocal (e.g. Alcon PanOptix or J&J Synergy): great near vision but small risk of glare and halos. Best for people that prioritize reading and do not drive at night
• Extended Depth of Focus (e.g. Alcon Vivity): good near vision and low risk of glare and halos. Best for people that frequently drive at night and don’t mind wearing glasses for the smallest print

Multifocal lenses offer the best vision in healthy eyes, but they might not work well if there are conditions such as macular degeneration, macular pucker, glaucoma, or sometimes prior LASIK. Therefore monofocal IOLs often are a better option for people with these conditions.

Importantly, there currently is no perfect IOL that will restore your childhood vision. Each option has advantages and drawbacks. Our goal is help you understand the options and choose the best IOL for your budget and lifestyle. We look forward to discussing with you!

Sources:

• https://www.nature.com/articles/nrdp201514
• https://www.aao.org/eye-health/diseases/cataracts-iol-implants
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8785133/pdf/opth-16-145.pdf
• https://link.springer.com/content/pdf/10.1007/s00417-021-05245-6.pdf?pdf=button