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Choosing an Intraocular Lens (IOL) for Cataract Surgery

Choosing an intraocular lens (IOL) is one of the most important decisions to discuss with your cataract surgeon. The best lens depends on your vision goals, lifestyle, eye health, astigmatism, tolerance for visual phenomena such as glare and halos, and willingness to use glasses.

Monofocal Lens Implants

Monofocal lens implants are designed to provide good vision at one primary distance, most commonly distance vision. When there is no significant uncorrected astigmatism or other eye disease, patients can often obtain excellent distance vision but generally need glasses for reading and some intermediate tasks.

Enhanced Monofocal Lens Implants

Enhanced monofocal lenses broaden the range of useful focus compared with traditional monofocal lenses. They may provide improved intermediate vision for activities such as computer work, viewing a dashboard, or eating a meal. Mini-monovision, in which the non-dominant eye is targeted somewhat more toward near vision, can further extend functional vision for selected patients.¹

Bottom line: These lenses may provide more useful intermediate vision while still leaving many patients dependent on reading glasses for small print and close-up tasks.

Extended Depth of Focus (EDOF) Lenses

Extended depth of focus lenses are designed to extend the range of functional vision beyond a traditional monofocal lens. Their primary potential advantage is improved intermediate vision, such as computer use and dashboard viewing. Some patients can achieve useful near vision as well, although reading glasses may still be needed for fine print, books, or smartphones.

Compared with some multifocal designs, EDOF lenses may offer a lower likelihood of bothersome glare and halos for some patients, while maintaining good optical quality and contrast sensitivity. Individual outcomes vary.

Multifocal Intraocular Lenses

Multifocal IOLs use an optical design that creates multiple focal points to provide vision at distance, intermediate, and near. Their goal is to reduce dependence on glasses across a wider range of activities.

Patient Satisfaction and Glasses Independence

• One study following 27 patients reported 88% were fairly satisfied to very satisfied with bilateral implantation of one multifocal lens model.²
• Another study reported 85% of patients were very satisfied and 12% somewhat satisfied with a particular multifocal IOL.³
• Studies have reported high rates of glasses independence, although results vary by lens design, patient selection, and study methodology.^3,4

Potential Downsides of Multifocal IOLs

• Halos, glare and starbursts: These optical effects can occur and may be more noticeable in certain lighting conditions.
• Contrast sensitivity: Some patients may notice reduced ability to distinguish subtle differences in contrast or fine outlines.
• Possible lens exchange: In a small percentage of dissatisfied patients, exchanging the IOL may be considered. Published rates vary substantially by study and patient population.^6,7

Toric Lens Implants for Astigmatism

Many monofocal, enhanced monofocal, EDOF, and multifocal IOL categories are available in toric versions. Toric IOLs are designed to reduce corneal astigmatism and can improve the likelihood of achieving a clear image without glasses when astigmatism is a significant part of the patient’s prescription.

In many insurance plans, a toric IOL is considered an elective upgrade and may involve an out-of-pocket charge. Coverage and pricing vary, so patients should discuss this with their surgeon and insurance provider.

See How Different Lens Types Can Affect Vision

Visual simulators can be useful when discussing premium IOLs. The examples below illustrate the general concept of differences in distance, intermediate, and near focus. They are educational illustrations, not predictions of an individual patient’s surgical result.

Even with a monofocal lens implant, prescription or over-the-counter reading glasses can provide clearer near vision when needed.

How Should You Choose a Cataract Lens?

There is no single “best” IOL for every patient. Your cataract surgeon should consider your eye health, corneal shape, astigmatism, prior LASIK or other refractive surgery, visual demands, tolerance for glare and halos, and how important glasses independence is to you.

Disclosure: No individual intraocular lens type or manufacturer is promoted over another on this website. These descriptions are intended to provide general background about commonly used categories of lens implants. Lens technology continues to evolve, and this website does not include every individual lens model. Final IOL selection should be made with your personal cataract surgeon.

References

1. Auffarth GU, Gerl M, Tsai L, et al. Clinical evaluation of a new monofocal IOL with enhanced intermediate function in patients with cataract. Journal of Cataract & Refractive Surgery. 2021;47(2):184-191. doi:10.1097/j.jcrs.0000000000000399.
2. Ribeiro FJ, Ferreira TB, Silva D, Matos AC, Gaspar S. Visual outcomes and patient satisfaction after implantation of a presbyopia-correcting intraocular lens that combines extended depth-of-focus and multifocal profiles. J Cataract Refract Surg. 2021;47(11):1448-1453.
3. Hovanesian JA, Jones M, Allen Q. The PanOptix Trifocal IOL vs the ReSTOR 2.5 Active Focus and ReSTOR 3.0-Add Multifocal Lenses. Clin Ophthalmol. 2021;15:983-990.
4. Torky MA, Nokrashy AE, Metwally H, et al. Visual performance following implantation of presbyopia correcting intraocular lenses. Eye. 2022.
5. Schallhorn JM, Pantaneli SM, Lin CC, et al. Multifocal and accommodating intraocular lenses for the treatment of presbyopia. Ophthalmology. 2021;128(10):1469-1482.
6. Venter JA, Pelouskova M, Collins BM, et al. Visual outcomes and patient satisfaction in 9366 eyes using a refractive segmented multifocal intraocular lens. J Cataract Refract Surg. 2013;39(10):1477-1484.
7. Woodward MA, Randleman JB, Stulting RD. Dissatisfaction after multifocal intraocular lens implantation. J Cataract Refract Surg. 2009;35(6):992-997.