Cataract surgery is normally performed with ultrasound (phacoemulsification) and more recently has been aided by the use of a femtosecond laser in some cases. When you decide you are ready for cataract surgery, you will have options to consider. Just as in trying to answer the question “What is the best car?”, the answer to “What is the best intraocular lens for cataract surgery?”, is highly variable depending on the person and circumstance. Below, I have listed the major considerations with my typical recommendations highlighted and you can see videos on these lens options and laser cataract surgery here: Laser Cataract Surgery & Lens Options
The natural lens that we are born with has the ability to change shape very quickly when looking at distance, intermediate, and near objects. As we gain experience (get older), the lens gets stiffer and loses some of its ability to change shape. This is called presbyopia and leads to the need for reading glasses or bifocals. When cataract surgery is performed we have to consider this issue with the new, artificial intraocular lens (IOL).
With a monofocal lens, we decide on one focal distance that is fixed. The options are: distance (10 feet and beyond), intermediate (computer distance), or near (reading distance). The benefit of monofocal lenses lies in the sharpness of vision that they provide and high predictability with minimal or no issues with glare, halos, or fuzzy outlines. However, you can expect to still need glasses at least for near and intermediate tasks.
Multifocal lenses use concentric rings of light bending power to simultaneously provide vision for two of the three focal distances above. The benefit is that there is less dependence on reading glasses for near or intermediate objects. The drawback is that it is more likely that you may experience glare, halos, and fuzzy outlines (particularly at night) due to the superimposed rings of power.
This lens tries to most closely mimic the actual function of the natural lens. These lenses change shape to allow for focus at more than one distance. They tend to give sharper vision than multifocal lenses but sometimes don’t perform for multiple distances as well as advertised. Sometimes, these lenses move into distorted positions causing blurred vision that may require further surgery.
Monovision is intentionally setting the focus of one eye (the dominant eye) for distance while setting the focus of the other eye for intermediate or distance. This can be a very successful strategy for patients that are used to doing this in contact lenses. Not everyone who tries monovision ends up liking it, so it is best to have a trial of monovision prior to choosing this option.
Corneal astigmatism correction
Corneal astigmatism is an uneven curvature of the cornea that blurs vision. Some astigmatism can also be caused by the lens, but since the lens is being removed in cataract surgery, it is not of significance.
Toric lenses can be used to reduce or fully neutralize corneal astigmatism and allow for better vision without glasses.
Laser correction of corneal astigmatism
This involves one of the many variations of laser refractive surgery such as limbal relaxing incisions (LRIs), LASIK, or PRK.
Most intraocular lenses are made of either acrylic or silicone.
This is the most common intraocular lens material.
This material is less common due to its interaction with silicone oil that is sometimes necessary for patients with retinal detachments.
Extra measurements during cataract surgery
Intraoperative wavefront measurement using the ORA system allows for a verification of the intraocular lens power and position at the time of surgery. It can be particularly useful for patients undergoing cataract surgery that have previously had refractive surgery. It is sometimes used for verification of the proper placement of toric lenses.
Keep in mind that despite all of these choices and interventions, it is not uncommon for patients to still be able to sharpen their vision further after cataract surgery with glasses and/or contact lenses even if they choose to go without them. Additionally, several of these choices (multifocal lenses, accommodating lenses, topic lenses, laser correction, and intraoperative wavefront measurement) involve extra costs beyond what Medicare or your private insurance will pay.
I look forward to discussing cataract surgery options that are specific to you.