Intraocular Lens Implant (IOL)

During cataract surgery we replace the cloudy lens of the eye with an artificial lens implant, restoring your eye’s inherent potential for vision.

This technology, called an intraocular lens implant (IOL) has been successfully used for over thirty years. Although this eliminates the cloudiness caused by the cataract, you may still need glasses to correct for other vision problems not related to the cataract.

However, advances in technology now make it possible to choose premium lens implants that may further reduce, or even eliminate, the need for reading glasses by simultaneously correcting for other vision-related problems such as astigmatism and nearsightedness.

The lens types available include:

  1. Alcon AcrySof® IQ ReSTOR®
  2. Alcon AcrySof® IQ PanOptix®
  3. Alcon AcrySof® IQ PanOptix® Toric
  4. Johnson + Johnson TECNIS® Multifocal
  5. Johnson + Johnson TECNIS® Symfony®
  6. Johnson + Johnson TECNIS® Symfony® Toric

These newer lenses have additional costs associated with them that are not typically covered by insurance. Prior to surgery, we’ll review all of your options in detail and help you select the lenses that best meet your needs.

Vision Correction Options

There are essentially four options for correcting vision during cataract surgery:

#1 Use monofocal lens to restore distance vision in both eyes

Monofocal lens implants are highly successful at restoring excellent vision and have been considered the standard for many decades. A monofocal lens implant is designed to provide sharp focus and vision at a distance. Glasses are usually needed for clear vision at distances, such as reading or using a computer. Monofocal lens implants are covered by Medicare and private insurance.

 Advantages

  • Industry standard with millions in use
  • Usually provide excellent vision at a single working distance
  • Routinely covered by most insurances for treatment of cataracts

 Limitations

  • Inability to change focus
  • Still likely to need glasses for near vision
  • Do not correct astigmatism

#2 Use monofocal lenses to achieve monovision

Monovision is another way to reduce the need for glasses. During childhood, people with normal vision focus on distant and near objects seamlessly and without effort. When we reach our forties the eye generally loses the ability to focus on both distant objects and near objects (presbyopia), resulting in diminished vision for focusing up close.

With monovision, we can improve vision by correcting the vision in your one eye for distance and the other eye for intermediate (computer) or near distance (reading). The visual cortex in the brain selects the image of interest and suppresses the fellow eye. It is relatively common for contact lens patients to use monovision to achieve relative glasses independence.

We can now use monofocal lens implants to create monovision at the time of cataract surgery, with the goal of reducing dependence on glasses. By choosing the appropriate intraocular lens powers at the time of lens implantation, we create a distance focus eye and a near or intermediate focus eye. It is possible to perform a monovision trial with contact lenses prior to cataract surgery to help you decide if monovision is right for your needs. The trial employs contact lenses to simulate the result of surgery with near and distant images.

Monofocal lens implants are covered by Medicare and private insurance.

 Advantages

  • Usually reduces reliance on glasses for near and intermediate distances
  • Routinely covered by most insurances for treatment of cataracts
 Limitations
  • Not tolerated by all people
  • Do not correct astigmatism

#3 Use multifocal and accommodating lenses to achieve both near and distance vision in both eyes (Presbyopia-correcting lenses)

Newer multifocal lens implants specifically designed to correct presbyopia and provide enhanced vision at multiple distances. These lenses, when combined with highly accurate advances in eye measurements, sophisticated calculations and surgical expertise, provide precise results. Multifocal lenses work by providing simultaneous near and distance vision in each eye, allowing both eyes to work together when focusing at near, intermediate and far distances. We have extensive experience with multifocal lenses and will work with you to determine whether or not this option might be the best for you. Excellent options for multifocal lenses include AcrySofReStor (by Alcon) and Tecnis Multifocal (by AMO). Crystalensand Trulign (by Bausch and Lomb) achieves an extended range of focus through accommodation. They are also more expensive than standard implants and the additional costs are usually not covered by insurance. However, we do offer financing to qualified patients.

 Advantages
  • Reduced need for glasses
  • Reading usually possible without glasses
  • Increased satisfaction with overall vision reported by most patients
 Limitations
  • Do not function as well if significant astigmatism is present
  • Glasses may still be needed for some tasks
  • More pre- and post- surgical examination required
  • May require subsequent surgical enhancement to refine results
  • Additional cost not usually covered by insurance
  • There may be an increase in glare or halos noted though these are rarely very limiting

#4 Lens implants to correct astigmatism

Astigmatism is an optical abnormality usually occurring when the cornea is not spherical, but is somewhat more elliptical or football-shaped. This is conventionally treated by glasses or contact lenses but can now be corrected by monofocal lenses such as Acrysof IQ Toric lens implants, or an accommodating Trulign lens. Other astigmatism correcting lens options will be available in the near future. The astigmatism is corrected by precisely rotating the lens within the eye to align with the direction of the corneal curvature, reducing the need for glasses after surgery. These lenses are more expensive than standard lenses and require additional measurements and follow-up appointments that are typically not covered by insurance.

 Advantages
  • Reduced need for glasses for some activities
 Limitations
  • Only astigmatism of limited degree can be treated. Very high amounts may require additional procedures
  • Glasses will still be required for some activities
  • Additional measurements and examination is required
  • Additional cost not typically covered by insurance