Which Cataract Implant Should You Get?


If you’ve been told your cataracts are “ripe” or “ready,” you’re probably starting to think about cataract surgery and what it will entail. The Mayo Clinic defines cataract surgery as, “Cataract surgery is a procedure to remove the lens of your eye and, in most cases, replace it with an artificial lens. Normally, the lens of your eye is clear.


A cataract causes the lens to become cloudy, which eventually affects your vision.” and they say that, “During cataract surgery, the clouded lens is removed, and a clear artificial lens is usually implanted. In some cases, however, a cataract may be removed without implanting an artificial lens.” When you see your surgeon, you may hear about 3 different types of implants that you may pick from. Today I’ll tell you about them and go over pros and cons to help you make an informed decision.


Welcome back to the eye school blog, with me Dr. D, where I teach you about products and treatments related to dry eye syndrome and eye beauty so you can have healthy, beautiful, comfortable eyes. Cataract surgery is very common. About 4 million Americans undergo cataract surgery every year. I like to say some things are inevitable like death, taxes, and cataracts.


An Eye Doctor Explains Intraocular Lenses


Briefly, the surgery involves removing your cloudy lens and replacing it with a new implant (intraocular lens or intraocular lens(IOL)). What you may not realize is that there's a variety of intraocular lens(IOL) types to choose from — all with different benefits. Let’s get into the different types of implants:


Monofocal - are designed to provide the best possible vision at one distance. Most people who choose monofocals have their intraocular lenses(IOL) set for distance vision. They use reading glasses for near-vision tasks.


Toric - have extra built-in correction for astigmatism. Toric contact lenses correct issues that arise from a different curvature of the cornea or lens in your eye (referred to as regular astigmatism, corneal astigmatism or lenticular astigmatism).


Multifocal - 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 - have only one corrective zone. But this zone is stretched to allow distance and intermediate vision. Extended depth-of-focus (EDOF) is a new intraocular lens (IOL) technology in the treatment of presbyopia. In contrast to multifocal (MF) IOLs, EDOF lenses create a single elongated focal point, rather than several foci, to enhance depth of focus.


Accommodative - can also correct vision at all distances. The lens uses the natural movements of your eye’s muscles to change focus. Accommodative lenses are monofocal and are implanted to correct the refractive error when viewing distant objects. Through the muscular contraction of the ciliary body and thanks to its small hinges, they move slightly inside the capsular sac, simulating the natural accommodation of the eye.


An Eye Doctor Explains Intraocular Lenses


Now, how do you decide? Not all intraocular lens(intraocular lens(IOL)) types are covered by insurance. But Medicare and most insurance companies do cover the cost of the most common intraocular lens(IOL), the monofocal lens. These lenses have been used for decades and are the most popular type.


Multifocal, Extended Depth-of-Field Intraocular Lenses and accommodative intraocular lens(IOL)s 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 intraocular lenses (IOL)s are often called “premium” lenses. They are more expensive than monofocals and are often not fully covered by insurance.


Here are some Questions to ask yourself before deciding on the right intraocular lens(IOL) for you.


Does your lifestyle rely on near vision? If you spend a lot of time working at your computer or looking at digital devices or if you’re nearsighted and love to read without glasses one option is to set the monofocal intraocular lens(IOL) for near vision and use glasses for distance vision like watching TV and driving. Alternatively you might find eyeglasses inconvenient for day-to-day wear and want to avoid them all together.


If so you could opt for a monofocal lens but set one lens for distance vision and the other ones for near vision. This is a technique we call monovision. This choice is not for everyone and I would not recommend doing it unless you have tried it in contact lenses first. For most people the brain adapts and can use the information from both eyes to provide adequate vision at all distances. If this does sound appealing again, contact lenses before surgery are very useful.


Do you drive a lot at night? If night driving in particular is important to you you might want to steer clear of multifocal or extended depths of focus lenses. These lenses carry side effects like glitter or halos around lights or even a loss of contrast. This becomes especially true at night or in dim lighting. Most people do adapt to these effects but if you know already that distance vision at night is very critical to you you might be happier in a monofocal intraocular lens(IOL).


More Important Questions About Intraocular Lenses


Do you have significant astigmatism? I’ll link my astigmatism video here. With astigmatism the cornea is not curved like a basketball because it’s more like a football with two different curves. This will distort vision at distance intermediate and near. If you have moderate to high astigmatism you might be happier with a toric intraocular lens(IOL). Insurance does not typically fully cover toric lenses.


Do you have other eye conditions? If you have vision loss from an eye disease like glaucoma or macular degeneration or another I disease multifocal, extended depth of focus lenses are generally not recommended for people with existing vision loss. Because these intraocular lens(IOL) implants allow less light into the eye they can actually make things worse for people who already have vision loss. If avoiding glasses altogether is important to you, monovision monofocal intraocular lens(IOL)S might be a better option for you.


I hope that helped clear up the differences in intraocular implants possible for use in cataract surgery. Let me know in the comments below what type of implant you received in your cataract surgery and let me know your experience with it so other high school pupils can learn as well.


Reference Links:

Visual Outcome Review in Pediatric Congenital Cataract Patients: https://journals.lww.com/jcrs/Abstract/2022/01000/Comparative_analysis_of_visual_outcomes_of.10.aspx?context=LatestArticles

Changing Multifocal Implants https://eandv.biomedcentral.com/articles/10.1186/s40662-022-00280-8

https://www.aao.org/eye-health/treatments/best-artificial-lens-intraocular lens(IOL)-cataract-surgery