The most important thing to understand is that this decision is one that you only get to make once in a lifetime. Careful thought about your lens choices is important during this step of the process. 

An IOL is an artificial lens (usually made of clear plastic, silicone, or acrylic) that replaces the eye's natural lens, which has become the cataract and is removed during surgery. These new, artificial lenses help restore clear vision but can also help reduce or even completely eliminate the need for glasses or contacts after surgery. Now, let’s break down the lens options and technology.

• Standard, Monofocal IOL: These lenses provide a single point of focus, either up close or far away, but not both. It does not correct astigmatism. Patients will still require glasses or readers after surgery. The standard lens is the only lens covered by insurance (after applicable copays, deductibles and coinsurance as described in your insurance plan benefits).

• Toric Monofocal IOL: Toric IOLs are similar to the standard monofocal IOL but provide the benefit of correcting astigmatism so patients who have astigmatism correction in their glasses may be able to function without glasses for distance vision, but will require glasses for intermediate and/or near tasks. There is an out-of-pocket expense for this lens in addition to the out-of-pocket payment required by your insurance.

• Multifocal IOL: A multifocal IOL is essentially a trifocal lens that creates three distinct focal points; distance, intermediate, and near ranges. This technology corrects several things at once; cataracts, near or farsightedness and presbyopia thereby helping to reduce or eliminate the need for glasses after cataract surgery. If you have astigmatism, these Multifocal IOLs can correct this condition as well. This technology, while beneficial for correcting the aforementioned visual issues, also has its drawbacks. Due to the technology used to provide three points of focus, multifocal IOLs can cause glares and halos as well as slightly decreased contrast which become noticeable after surgery. For many, these issues slowly decrease over time as the brain becomes used to this new visual input by a process called neuroadaptation. This lens technology is considered out-of-pocket and is not covered by insurance.

• Extended Depth of Focus (EDOF) IOL: Much like the multifocal IOL, the extended depth of focus IOL corrects nearsightedness (myopia), farsightedness (hyperopia) and astigmatism. The technology creates an elongated field of focus which allows for three points of focus, distance, intermediate and functional near vision. The difference between the multifocal and EDOF is that the reading range is slightly more limited, but the EDOF IOLs have reduced risk for nighttime side effects like glares and halo as well as have slightly improved contrast compared to the multifocal IOL. This lens also has out of pocket expense.

Not Everyone is a Candidate for Advanced IOLs

While it can certainly be exciting to consider the possibility of reduced or no dependence on glasses after cataract surgery, it’s important to understand that there are some individuals who may not qualify for specialty IOLs. The overall health of the eye needs to be good, with no ocular disease or retinal conditions. Having a pre-existing ocular condition prevents the IOL’s technology from working to its full potential, if at all. Essentially, this would be a waste of money for the patient, and they would likely still need glasses to see their best. Your surgeon will have these discussions with you during your evaluation so that you know which lens you qualify for. 

Let’s talk range

When your surgeon discusses your IOL options, you’ll hear the terms distance, intermediate, and near. While lens technology can never guarantee you’ll see everything perfectly with an upgraded lens, generally, the common tasks patients ask about apply here:

• Distance: television (small tickers may be problematic), dashboard and beyond (driving)
• Intermediate: computer, menu, alarm clock
• Near: reading, cell phone, or close-up detail work (pill bottles, threading a needle)

It’s worth mentioning again that no surgeon can guarantee a specialty IOL will give you perfect vision at all ranges and for all tasks. It’s reasonable to expect you may need to grab a pair of readers for very fine, detailed work.