What is the best lens for cataract surgery?

Posted by: Clear Vision Cataract & LASIK Center

Cataract surgery is one of the most common procedures in the world. It involves gentle removal of the eye’s cloudy, natural lens (cataract) and replacement of a permanent, artificial lens called an intraocular lens (IOL). Intraocular lenses have been in routine use since the 1970s, and IOL technology has gradually improved over the past 50 years. But what is the best lens for cataract surgery? Before we discuss this common question, let’s first discuss the various categories of lenses used in cataract surgery and custom lens replacement.

What are the different lens options for cataract surgery?

Believe it or not, in 2023, intraocular lenses now come in seven different categories! Those are: single focus (monofocal), extended single focus (advanced monofocal IOL), astigmatism-correcting (toric IOL), extended depth-of-focus (EDOF IOL), diffractive multi-focus (multifocal/trifocal IOL), light-adjustable IOL (LAL), and accommodating IOLs. Which lens is the best for your eyes? Well, the short answer is that it depends on your unique vision goals and eye health, but first let’s discuss each lens category first in more detail.

Lens #1 – Basic single focus (monofocal) lens

A basic single focus (monofocal) lens restores the basic functioning of the eye after a cataract surgery. It has one area of best focus, which you can be distance, midrange, OR near (not all three). Monofocal IOLs have significant limitations, including only bringing one narrow area of vision into focus, necessitating reading glasses, at minimum. They also do not correct astigmatism, which may result in blurred vision in all areas without glasses. Monofocal lenses work best for patients who desire to wear glasses after surgery, who do not have astigmatism, or whom have other significant eye health issues where a simple IOL is indicated. Many models of basic IOLs are on the market, and your surgeon will typically have a basic lens of choice they use on most patients.

Lens #2 – Advanced single focus (extended monofocal) lens

In recent years, advancing technology in optics has allowed for the manufacture of more advanced single focus IOLs. These categories of lenses do everything that a basic monofocal IOL does, but will also extend the depth of focus of the eye by up to 1.5 D. This lens provides some additional correction of midrange after cataract surgery, such as the car dashboard or medium-large cell phone text, without compromising the distance vision or creating any visual side effects. When combined with astigmatism correction from limbal-relaxing incisions (LRIs) or toric lens technology, an advanced single focus IOL can provide better clarity of vision and increased independence from glasses. However, you will still require reading glasses for small and medium size print. Examples of advanced single focus lenses used in combination with astigmatism management include the J&J Eyhance, B&L Envista, and the Rayner EMV lenses.

Lens #3 – Toric (astigmatism-correcting) lens

Astigmatism is a common refractive vision condition. The common example to describe astigmatism is the basketball vs football analogy. A perfectly spherical eye (like a basketball) does not have astigmatism, whereas an eye that is curved more steeply in one direction compared to the other (like a football) does have astigmatism. Astigmatism is commonly corrected by glasses and contacts, but also can be permanently corrected with laser vision correction (LASIK) or a toric lens with cataract surgery. A toric IOL cancels out the irregular curvature, and allows for clear vision without glasses or contacts. Most IOL types discussed in this article have toric versions, including monofocal, advanced monofocal, extended depth of focus, diffractive, and light-adjustable.

Lens #4 – Extended depth of focus (EDOF) lens

Single focus IOLs may correct either your distance OR near vision. But what if you would like to see not only the far distance, but also things in the midrange such as your computer or car dashboard? With a monofocal lens, you would still need progressive lens glasses or a trifocal to see these areas, but an IOL known as the extended-depth of focus (EDOF) IOL is able to provide both distance and midrange vision without glasses. The most commonly used EDOF lenses are the Alcon Vivity and J&J Symphony lenses. EDOF lenses work best in otherwise healthy eyes, as they may cause some reduction in contrast sensitivity in order to gain the extended range of vision. These lenses typically cause less nighttime driving issues such as glare, halos, and starbursts compared to diffractive multi-focus IOLs. However, they do not provide as much near vision as diffracitve multi-focus lenses.

Lens #5 – Multi-focus lens for cataract surgery

A diffractive multi-focus lens is able to provide the full range of vision without glasses. These lenses use a special pattern of concentric rings in the lens which divide the incoming light into multiple areas of focus. The result is that you to see distance, intermediate, and near objects without glasses after cataract surgery. As the design of the lens includes concentric rings, patients do notice light rings (halos) from headlights or street lights. While these symptoms are common, they usually improve over 6-12 months and don’t typically impair night driving. You may also require reading glasses in dim lighting, but 98% of patients who are candidates for this technology report satisfaction with the results and independence from glasses most or all of the time. The most commonly used multi-focus lenses in use today are the J&J Tecnis Multifocal IOL, and the J&J Synergy Lens, and the Alcon PanOptix IOL. These IOLs are also available in toric (astigmatism-correcting) versions.

Lens #6 – Light-adjustable lens for cataract surgery

The light-adjustable lens technology was developed to allow for vision adjustments after surgery for the first time. We implant the LAL lens at the time of cataract surgery just like any other lens. After a few weeks of healing, we will perform precise light treatments to the lens designed to correct any residual prescription in the vision. This allows for HD-like distance vision or custom monovision solutions to reduce or eliminate the need for glasses. The only FDA-approved LAL technology available today is the RxSight LAL, which is available at the Clear Vision Center. Patients who have the LAL lens with cataract surgery report no additional side effects compared to a monofocal lens. However, special UV-protective glasses during the adjustment period of 2-3 months after surgery are required. The special glasses are no longer needed after the LAL “prescription” has been locked in.

Lens #7 – Accommodating lens

Most lenses available today are static, non-moving IOLs. Some use diffractive optics to alter the path of th light with what we call “pseudo-accommodation”. The natural human lens changes shape (accommodation) to allow most of us to read withouth glasses from age 0 – 45. Accommodating IOLs attempt to mimic the natural len’s accommodation and change shape to allow for distance and reading vision. While this sounds like the ideal lens after cataract surgery, we feel that the technology has not fully arrived. While the Crystalens is FDA-approved, we do not currently offer this technology as the results are inferior to other options.

What is the best lens for me?

If you’ve read this far, you can see that may be several lens options to consider for your cataract surgery. Our goal at the Clear Vision Center in Rochester Hills is to help you through the decision-making process. To do this, we will provide a custom lens recommendation at your cataract consultation. Every person is unique and a rubber stamp solution for everyone doesn’t work! We utilize a detailed evaluation process including several modern scans not normally performed in other centers. This comprehensive approach ensures you receive the best recommendation, and the highest possible chance for a successful outcome. If you desire to live your life after cataract surgery without the burden of glasses, we are here to help! And if you wish to continue to wear glasses, well, we are still happy to help as well!