As part of your cataract surgery, your doctor will place a new lens inside of your eye.
A monofocal lens might be right for you if you don't mind continuing to wear glasses for some tasks. A multifocal lens might be better for you if you want to avoid wearing glasses of any sort, but some people do still need glasses after surgery with this lens.
An accommodative lens is another option you can use to obtain good vision without glasses. If you have astigmatism, your doctor is likely to recommend a toric lens. An extended depth-of-focus (EDOF) lens can result in better vision at all distances, also resulting in less dependence on glasses for any distance.
Innovations in lens design are still happening, meaning the lenses of the future might look very different from those we use now. Your doctor can be your guide, both now and in the future, to help you make an informed lens choice.
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What Is a Lens?
Your eye is designed to both accept and bend light. Those little particles of light are pushed to the back of the eye, where they are translated by receptors and transformed into images by the brain. With age and some kinds of diseases, the lens can transform from clear to cloudy, and that can lead to images that are blurred and indistinct even if you wear glasses.
During a cataract surgery, your doctor places a clear lens inside the eye to sharpen light particles as they move through your eye.
According to the American Academy of Ophthalmology (AAO), most lenses are made of silicone or acrylic. Those lenses are also coated with a material that protects you from damage caused by the sun's rays.
While you are discussing surgery with your doctor, you might talk about what kind of lens would be best for your eyes and your vision. You have several different types of lenses to choose from, and the decision is personal. The lens that is just right for you might not be right for another person.
Is a Monofocal Lens Right for You?
A monofocal lens is the most common type of lens used in cataract surgery, according to AAO. This type of lens is designed to give you crisp, clear vision at one particular distance. If you attempt to look at items that are closer or farther away than this set distance, those items may appear blurred. But items at your set distance should be sharp.
As the Daily Journal points out, some people choose a monofocal lens that focuses well on items 18 to 36 inches away from the face. That is the distance at which most computers are placed, and this lens choice allows these people to do their work each day without glasses. Others who enjoy reading, knitting, or close work choose a monofocal lens that offers crisp close images, and they plan to wear glasses when looking at things that are far away.
Is a Multifocal Lens Right for You?
While some people do not mind wearing glasses, and they can live in a world that is blurred from time to time, there are others who are deeply resistant to the idea of using any kind of technology to help them see clearly. For people like this, a multifocal lens might have appeal. This lens has zones of focus, and in time, the brain learns to select the right focus automatically.
In a study in the Journal of Cataract and Refractive Surgery, researchers found that people given lenses like this had what would be considered "good" visual acuity at distances both near and far. But it is important to note that the researchers were assessing "corrected" distance acuity, which could mean that some of these people could have worn glasses after surgery.
In addition, some people who have this kind of surgery deal with side effects that can make vision troublesome. In a study published by Cochrane, researchers found that people with multifocal lenses were more likely to deal with glare and halos than people who had monofocal lenses.
These issues can make driving at night difficult, as the lights from ongoing cars can leave such a big impact that it can be hard to see other items. This can cause intense dissatisfaction after surgery.
Thankfully, people who do have issues with vision after cataract surgery can benefit from talking with their doctors. In research published in the Journal of Cataract and Refractive Surgery, 32 patients had trouble with vision after multifocal lenses were implanted, and 81 percent got better with conservative treatment, such as eye drops. This could mean that the challenges are not permanent, as long as you get the help you need when these symptoms appear.
Is an Accommodative Lens Right for You?
If you do not want to wear glasses but you are not sure a multifocal lens seems like the right choice, an accommodative lens might be a good option for you. This lens is designed to move or shift in shape, just as your natural lens might do. This movement allows you to see things near and far, always in focus.
This type of lens is new, and research is ongoing about how effective this lens type is when compared to traditional lenses. For example, in a study published by Cochrane, researchers examined how well these newer lenses worked when compared to standard monofocal lenses. They found that people with accommodative lenses had close vision that improved in the six months after surgery, but their distance vision may deteriorate during that same time. The researchers weren't quite sure why this was happening, and they proposed doing more studies to examine the cause.
Meanwhile, researchers for Harvard Health Publishing report that eye exercises can be helpful with these lenses, as stronger muscles will be able to move the lens more effectively. However, about half of people with this kind of lens still need reading glasses.
Is a Toric Lens Right for You?
If you have been diagnosed with astigmatism, you may have blurred points in your visual field that do not clear unless you use special eyeglasses. In an article published in Review of Ophthalmology, writers interviewed ophthalmological experts and asked them what kind of lens they would recommend for patients with astigmatism. Among respondents, 48 percent chose a toric lens, making this the most popular type of lens for those with astigmatism.
A toric lens is designed to change shape, just like an accommodative lens, but it is designed to correct your specific refractive error that causes your astigmatism.
In a study published in the journal Ophthalmology, researchers compared performance of a toric lens with the performance of a standard accommodative lens. While 40.7 percent of those with a toric lens had an uncorrected distance visual acuity of 20/20 or better, only 19.4 percent of those with the other lens reached that acuity.
Studies like this seem to suggest that a toric lens might be a good way to correct an astigmatism problem. This is not an isolated study.
In a second study published in the Journal of Cataract and Refractive Surgery, researchers found that 95 percent of people with a toric lens did not need to wear glasses in order to see things at a distance, and 79 percent did not need reading glasses.
Extended Depth-of-Focus (EDOF) Lens Right for You?
An extended depth-of-focus lens can result in better near, intermediate, and far vision. Whereas traditional IOLs correct for either near or far vision, EDOFs can give improved vision at all distances.
Most people choose IOLs that result in better distance vision, so they still need to wear glasses for up-close tasks, like reading. With EDOFs, patients are less likely to need glasses for near tasks.
As with some other lens choices, there is the potential for glares and halos with extended depth-of-focus lenses. As a result, people who frequently drive at night may want to avoid these lenses.
Factors to Consider When Choosing a Lens
With so many different types of lenses to choose from, how can you pick just one? Your doctor can help you make an informed choice. In fact, your doctor is in the best position to help you find a lens that is right for your eyes, your vision, and your goals.
In an article published in the Review of Ophthalmology, experts describe the questions they ask their patients before choosing a lens. These questions include:
- What do you do for a living?
- What are your hobbies?
- Do you mind wearing glasses?
- Do you have eye health conditions we should talk about?
Your doctor can assess how healthy your eyes are now, and your doctor can help you understand how each lens might work to help you meet your goals. For example, if you spend all day reading on a computer and you don’t often drive, you may not want a lens that offers sharp distance vision. For you, close work is vital. Your doctor can help you understand the risks and benefits of each lens you are considering.
As NHS points out, some types of lenses are so specialized that they must be ordered in advance. You will want to settle on the right type of lens before your surgery and make sure you have made a decision you can stick with before your surgery day arrives.
Factors to consider include:
Some lenses, like monofocal lenses, make it more likely that you’ll still need to wear reading glasses after surgery. If you live an active lifestyle, in which wearing glasses is inconvenient, a premium lens might be a better choice.
Certain vision conditions will limit your lens choices. Certain vision conditions will limit your lens choices. For example, people with astigmatism generally need toric lenses.
Premium lenses can cost significantly more than standard lenses. Monofocal lenses are the most basic type of lens and the most inexpensive. Premium lenses can add $1,500 to $3,000+ to the cost of your surgery. While the average cost of surgery with a monofocal lens is $3,000 to $5,000 per eye, this price can rise to $7,000 or more with a premium lens. While insurance, including Medicare, will cover standard cataract surgery, premium lenses are generally not included in this coverage. As a result, you must consider the average cost of various lenses before making a decision.
Innovations in Lenses Are Still Happening
At one point, doctors had only one or two different types of lenses to choose from when amending a cataract issue. Now, there are a wide variety of solutions doctors can work with to help you see clearly. Innovations continue, which means doctors may have many more solutions available in the future.
For example, in an article published in the journal Rejuvenation Research, the authors discuss pain felt by some people after cataract surgery. They are accustomed to light that is muted and shaded by the blur of a cataract, and after surgery, lights seem too bright and they can cause headaches. Here, researchers experimented with using lenses tinted yellow, which researchers theorized might reduce pain as well as help patients sleep a little better. In the future, if you have severe headaches caused by light, this could be a lens your doctor recommends for you.
Writers for Medscape describe a lens made of silicon that is sensitive to specific types of light. The authors describe using a light shined through the eyes to change the shape of the lens and correct vision problems that take hold after surgery, all without another incision.
As more people need care for cataracts, technology will continue to improve. When it does, the surgeries of the future may look little like the surgeries of the past.
The Patient Experience
IOL Implants: Lens Replacement After Cataracts. (May 2018). American Academy of Ophthalmology.
Review Your Lens Options for Cataract Surgery. (March 2014). Daily Journal.
Visual Acuity Comparison of 2 Models of Bifocal Aspheric Intraocular Lenses. (April 2009). Journal of Cataract and Refractive Surgery.
Multifocal Versus Monofocal Intraocular Lenses for People Having Cataract Surgery. (December 2016). Cochrane.
Dissatisfaction After Multifocal Intraocular Lens Implantation. (June 2009). Journal of Cataract and Refractive Surgery.
Considering Cataract Surgery? What You Should Know. (July 2018). Harvard Health Publishing.
Cataract Surgeons Wait on New Technology. (March 2016). Review of Ophthalmology.
Visual Outcomes and Patient Satisfaction After Cataract Surgery with Toric Multifocal Intraocular Lens Implantation. (November 2011). Journal of Cataract and Refractive Surgery.
Color of Intra-Ocular Lens and Cataract Type Are Prognostic Determinants of Health Indices After Visual and Photoreceptive Restoration by Surgery. (April 2015). Rejuvenation Research.
Advances in Cataract Surgery: Accommodating Lenses. (2013). Medscape.
Premium Lenses, Cataract Surgery and Glaucoma. (August 2017). Review of Ophthalmology.
Choice of Lens and Glasses After Your Cataract Surgery. (March 2008). NHS.