Cataract Surgery: Lens Implant Options

Cataract Surgery

A cataract is a progressive clouding of the natural lens inside the eye. If this clouding impairs your ability to do tasks and new glasses won’t improve symptoms, surgery may be your best option. Cataract surgery involves removing the cloudy cataract lens and replacing it with a clear intraocular lens (IOL) to restore vision and depth perception. Since IOLs can incorporate varying amounts of your glasses prescription into them, depending on the type of IOL selected, it may also reduce dependence on glasses for seeing near, far, or both. (Please go to the Cataracts page under the "Eye Disorders" tab for more detailed information.)


The following was written to help prepare you for a discussion with your eye care specialist as to which type of lens implant is best for your lifestyle and budget.

Cataract--implant%20%26%20chart_edited.j

Lens Implant
(replaces cataract)         
Clear Image

Types of Lens Implants (IOLs)

There are three main types of IOLs—monofocal, toric and multifocal. All IOLs improve how well you can see with glasses after surgery; the specific type determines how well you will see without glasses. Monofocal IOLs are the only IOLs covered and paid for by Medicare and insurance. Advanced technology toric and multifocal IOLs that can further reduce dependence on glasses after surgery are not considered a medical necessity and, therefore, are not covered by medical, vision, or other insurances. If you select an advanced technology IOL, your insurance will still provide coverage for the surgery, however, you are responsible for the cost of the IOL itself and additional testing. Which type of implant is best for you depends on your vision, lifestyle, eye anatomy, surgeon’s recommendations, expectations and budget. 

Monofocal Lens: Fixed Focus Capability          


The monofocal IOL is a fixed-focus implant. This means that: 

 

  • IF you DO NOT have a visually significant amount of astigmatism (an oval-shaped eye that distorts vision), the monofocal IOL provides clear vision without glasses at one fixed distance—either far away OR near, but NOT BOTH.

    • If your lens prescription is set for far (driving, watching TV, etc.), you will need glasses to see near.

    • If your lens prescription is set for near (reading, close tasks, etc.) or intermediate (computer work, etc.), you will need glasses to see far

    • If you have successfully used contact lenses for “monovision” (one lens prescription for near and the other for distance), cataract surgery can be done to achieve similar results.

    • No matter what the IOL prescription, there may still be a need to wear glasses to fine­-tune vision even at the targeted distance. 

  • If you DO have significant astigmatism, you will need glasses/bifocals to see clearly at ALL distances.

  • Monofocal lenses are covered by Medicare and insurance—subject to deductibles and co-insurance. 
     

Advanced Technology IOL Options
Toric Lens:  Astigmatism-Correction Capability      


In addition to providing for clear vision near or far, the toric IOL includes a correction for astigmatism. Astigmatism is a condition in which the cornea is more oval­-shaped, like an egg, rather than round, like a normal eye. This causes images to appear blurry at all distances and is typically corrected with glasses or contact lenses. After cataract surgery, however, a toric IOL can help to achieve best vision either at near or far without glasses or contact lenses by correcting the astigmatism. 


The monofocal toric IOL works at one fixed distance only. This means that:

 

  • If your lens prescription is set for far (driving, watching TV, etc.), you will need glasses to see near.

  • If your lens prescription is set for near (reading, close tasks, etc.) or intermediate (computer work, etc.), you will need glasses to see far

  • If you have successfully used contact lenses for “monovision” (one lens prescription for near and the other for distance), cataract surgery can be done to achieve similar results.

  • No matter what the IOL prescription, there may still be a need to wear glasses to fine­-tune vision even at the targeted distance. 

  • Toric IOLs have a small risk of rotating out of alignment within the first week after surgery. If this occurs, another surgical procedure may be required to reposition the lens.

  • Toric lenses are NOT covered by Medicare and insurance—there is an additional cost for each eye/lens over and above the normal cataract surgery fee. 


Multifocal Lens:  Multiple Focus Capability


Unlike monofocal IOLs that provide your best vision at one fixed distance, multifocal IOLs can allow you to function across multiple distances.  

 
Multifocal IOLs reduce the need for glasses for near, intermediate and distance vision after cataract surgery. In addition:

 

  • There may still be a need to wear glasses to fine-­tune vision at various distances and in certain situations like low-light reading and/or driving at night.

  • Multifocal IOLs can cause more halos and glare around light sources at night. This is mild and tolerable for most patients, but, rarely, some people require removal of their lens due to severe symptoms. 

  • Multifocal IOLs can also come with a built-in correction for astigmatism for patients who have that condition as well (which is explained above).

  • If your multifocal IOL also corrects for astigmatism, there is a small risk of it rotating out of alignment within the first week after surgery. If this occurs, another surgical procedure may be required to reposition the lens.

  • Multifocal lenses are NOT covered by Medicare and insurance—there is an additional cost for each eye/lens over and above the normal cataract surgery fee. 

Basic or Advanced Technology IOLs?  

Both = Positive Results

   

At least 3.8 million Americans undergo cataract surgery each year to successfully restore their vision. The vast majority of patients experience enhanced quality of life. So, no matter which type of implant you end up choosing, you will most likely improve your vision to a level you haven’t seen in years. 

When Was Your Last Eye Exam?

Remember, the best way to protect your vision is to schedule regular, thorough, dilated eye exams to check for hidden signs of sight-threatening conditions. Ask yourself and your family members—"When was your last eye exam?" If it was more than two years ago, it's time to pick up the phone.

For more information or a comprehensive examination . . .

Since 1985, Eye Care Specialists has provided comprehensive medical, surgical and laser care for virtually every eye condition to more than 185,000 people. If you would like one of our free educational booklets on any of the eye concerns reviewed on this website, please complete this form or call our Communications & Education Department at 414-321-7035. To schedule a comprehensive eye examination or a second opinion evaluation, call any of our three convenient Milwaukee-area locations directly.